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ARMY MEDICAL LIBRARY

        WASHINGTON

          Founded 1836
Section.
Number
L£?2££L
i t o 3—10543
Form 113e, W.D., S. G. O.
 (Revised June 13, 1936) 
 uUE TWO WEEKS FROM LAST  DATE

IfOCT 15 1951"
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<3PO  B87422 
 
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THE            '    r~
COMPLETE WORKS
JOHN  HUNTER,  F.R.S.
                  EDITED BY

         JAMES F.  PALMER,
SENIOR SURGEON TO THE ST. GEORGE'S AND ST. JAMEs's'DISPENSARY, FELLOW
    OF THE HOTAL MEDICAL AND CHIRURGICAL SOCIETY OF LONDON,
                   ETC., ETC.
           VOL. I.
ILLUSTRATED WITH NUMEROUS ENGRAVINGS.
          THE LIFE OF HUNTER
                   BY
              DREWRY OTTLEY.

LECTURES  ON THE PRINCIPLES OF SURGERY;
                WITH NOTES
           BY JAMES F.  PALMER.
                 JiMu latf cIjjU fa :
HASWELL, BARRINGTON,  AND HASWELL.
           NEW YORK: J. & H. G. LANGLEY.
                     1841. 
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THE  LIFE
JOHN  HUNTER,  F.R.S.
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DREWRY  OTTLEY.
         ."""'LIBRARY  1
         SURGEON GENERAL'S OFFICE


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HASWELL, BARRINGTON, AND HASWELL,
      393 MARKET  STREET.
1841.  / 
 
PREFATORY ADVERTISEMENT.
    Those who have traced the progress of modern surgery to its true source will
  not fail to have discerned, in the principles which Hunter established, the germs
  of almost all the improvements which have been since introduced.  Like a wise '
  master-builder, he laid the foundation of the profession upon so broad a basis
  that it has withstood the attacks of adversaries and the versatility of public opin«-
  ion not only uninjured,  but with fresh accession of fame to himself, and (with
  few exceptions,)  the  most complete verification of his opinions.  The strict
T inductive method  of reasoning Avhich he pursued, upon physiological  subjects,
I led the way to juster modes of investigation; the zeal which he evinced stimu-
  lated many ardent followers in the path which he had opened, and the principles
  which he inculcated became the fruitful  source of an infinity of practical appli-
  cations, which were capable of being worked out by inferior minds.  Thus the
  fame of Hunter, after a lapse of nearly half a century, is rather augmented than
  diminished by each succeeding year:  the country which gave him birth is justly
  proud of his name; and those who have shown the deepest insight into the prin-
  ciples of their profession, and made the greatest improvements in the practice of
  it, have ever been most forward in celebrating his merits.
    But it is unnecessary to enlarge further on the celebrity of this distinguished
  philosopher, of whom it has been truly said, that "he  was  the greatest man in
  the  combined character of physiologist and  surgeon  that  the whole annals of*
  medicine can furnish."*  For a more full account of the character of Hunter's
  genius, and the peculiarities of his  works, the  Editor begs  leave to refer the
  reader to the ensuing memoir,  in which the language  of indiscriminate pane-
  gyric, so freely employed by his preceding biographers, has given place to the
  voice  of truth.  His  merits have been weighed in  a just balance, and  the less
  favourable  parts of his character, as a man and as a philosopher, pointed  out
  without disguise.
    The reconstruction and enlargement of the Hunterian Museum, together with
  the publication of well-digested catalogues of its contents, seem well calculated
  to extend the fame of its founder, as well as to fix it on a more rational founda-
  tipn.   To the  Editor these circumstances have appeared to afford a favourable
  occasion for the re-publication of Mr. Hunter's writings, considering that as all
  his labours were directed to the elucidation of the laws of life, they can only be
  advantageously studied in their totality.  Those, therefore, who have familiar-
  ized themselves with his style and mode of thought, as displayed in his writings,
  possess the best clue  to  his museum; as, on the other hand, those who have
  made themselves well acquainted with the contents  of his museum, possess  the
  best guide in the  perusal  of his works.  The two may be regarded as forming
  necessary parts of that  general undertaking in which the author was engaged;
  his writings forming the text to his museum,—his museum the appropriate illus-
 tration of his writings.
    It cannot but be a subject of deep regret to all those who have the interest of
  science or of their profession at heart, that no one  should have undertaken to
  collect  these,  writings before.   Dispersed through scattered volumes  of  the
  Transactions of the Royal and  other learned Societies, many of his most valua-
  ble papers have been  unknown or neglected, or at least have been inaccessible
  to the great bulk of the profession ;  while of those which have been published
  separately, some are nearly out of print and scarcely to be  obtained, others are
 extremely incorrect, and the greater number are excluded from general  circula-
* Lawrence. 
4
ADVERTISEMENT.
tion in consequence of their expensive  form or inconvenient bulk.  To remove
these disadvantages, by presenting to the profession a cheap and correct edition
of the author's whole works, has been one of the principal objects of the present
edition.
  It was considered that the utility of the work would be greatly promoted by
an incorporation of the most important results of modern discoveries, in the form
of foot notes ; and  in the prosecution of this part of his scheme the Editor has
to acknowledge the able assistance of several distinguished friends, whose par-
ticular acquaintance with the subjects which they have respectively undertaken
is well known to the public.  As far as possible brevity has been consulted, and
it is scarcely necessary to add, that each gentleman is alone responsible for the
opinions contained in his own notes.
  The superiority of  the  present  edition  above all the preceding will appear
from the following particulars :—
  1.  It embraces the whole of Mr.  Hunter's published works.
  2.  It contains a full  and collated copy of his Surgical and Croonian Lectures.
  3.  It is preceded by a new life of the author, containing original  anecdotes, a
       critical  disquisition concerning the character and writings of the author,
       and  a summary exposition of his  Museum;  to  which  has  also been
       added Mr.  Hunter's  correspondence  with Dr. ,Jenner  and Sir Joseph
       Banks.
  4.  It is illustrated by numerous  engravings.
  5.  The whole work  is accompanied by illustrative notes, with  the purpose of
       supplying such deficiencies as the progress of science has rendered  neces-
       sary.
  6.  The text  has been  corrected, the punctuation rectified,  and the modern
       synonyms  introduced.  Obscurities (so far  as they have  appeared to
       depend   on  improprieties   of  expression,) have  been  obviated,  and a
       copious index has been added to the whoje.
  7.  The work has been  printed in a clear and legible type, at the same time
       that the  size and price of the Edition, and the manner of its publication,
       have been accommodated to the convenience of purchasers.
  Having thus stated the design and object of the undertaking, it is hoped that
the reader  will not be disappointed in his  expectations.   The  writer is well
aware that the works of so great a master deserve a much more  learned and
critical Editor  than he can pretend  to be.   He  begs, however, that it may be
borne in mind,  that so far as he is concerned,  the work is not designed for those
who have completed,  but for those who are commencing their profession, and if
he has failed in the execution of his task, he at least will have  the satisfaction
of having attempted a good work, which ought, in his opinion, to have been loner
since finished  by a more able hand.
J. F. PALMER. 
LIFE  OF  JOHN  HUNTER,  F.R.S.
                          CONTENTS.
Introduction to the Life     ........      9
                           CHAPTER   I.

Mr. Hunter's birth and family;—his  early habits.—Dr. Wm. Hunter's rise to
  fame;—his difficulties at the outset of life.—Mr. Hunter's arrival in London;
  —his rapid acquisition of anatomical knowledge;—becomes a,pupil ofChesel-
  den.—Cheselden's mode of operating for stone;—his character and death.—
  Mr. Hunter's employments at this period ;—the advantages which he derives
  from his brother's society      ........     11
                           CHAPTER  II.

Hunter becomes a pupil of Pott.—Pott's character as a Surgeon.—Hunter enters
  at St. Mary's Hall, Oxford;—enters as a pupil at St. George's  Hospital;—
  discovers the mode of connexion between the placenta and uterus;—his con-
  duct as a lecturer  and  demonstrator of anatomy.—Disputes of the  Hunters
  with  contemporaneous anatomists respecting the  anatomy of the testes,  the
  office of the lymphatics, and the hernia congenita.—Hunter traces the nerves
  of the nose;—his  experiments on the subject of venous absorption;—com-
  mences the pursuit of  comparative anatomy;—embarks for Belleisle;—is still
  ardent in the  pursuit of science.—Jesse Foot and his Life  of Hunter .    18
                          CHAPTER III.

Hunter settles in London.—Alienation between the brothers.—His straitened
  circumstances ;—his favourable position in other respects.—Patience and for-
  titude required  of young surgeons.—Obstacles  to Hunter's success;—his
  contempt of humbug;—his thirst for fame and knowledge greater than his
                                    o 
6
THE  LIFE  OF JOHN HUNTER.
 love of wealth ;—delivers lectures on anatomy ;—his persevering industry.—
 The state of surgery at this period.—The  plan of his vast future labours con-
 ceived  and  entered upon.—The  Baconian philosophy—Earl's  Court.—His
 encounter with a bull and two leopards ;—is made F.R.S.—His description of
 the Proteus  ;—ruptures his  tendo-Achillis ;—is elected surgeon to St. George's
 Hospital;—removes to Jermyn-street.—Dr. Hunter's liberal offer to the Go-
 vernment rejected.—Mr. Hunter's house-pupils.—The pupils of distinguished
 surgeons themselves become distinguished.—Dr. Jenner;—his immortal dis-
covery of vaccination.—Mr. Hunter's treatise on the teeth;—his marriage.
Mrs. Hunter...........95
                           CHAPTER IV.

Mr. Hunter's paper on the digestion of the stomach ;—his museum ;—his private
  practice;—his illness,  attended with a cessation  of the heart's action;—his
  correspondence with Dr. Jenner;—his paper on the torpedo ;—his lectures on
  surgery ;—his character as a lecturer.—Hunter effects a revolution in surgery ;
  —his  paper  on  the receptacles for air in birds, and  on  the  stomach of the
  gillaroo trout.—The general  character of his monographs.—Mr.  Bell,—Mr.
  Hunter's warmth of temper;—his method of employing his time ;—his punc-
  tuality.—Anecdote  of Mr. Cline.—Dictates his various  compositions ;—his
  domestic habits;—contemplates the  establishment of a school of natural his-
  tory ;—his paper on the heat of animals and vegetables;—is appointed surgeon
  extraordinary to  the King;—his paper on  the recovery  of drowned persons ;—
  Croonian lectures;—correspondence;—is attacked with an alarming illness,
  attended  with peculiar symptoms;—his  visit to Bath;—his  character as an
  experimentalist;—his  second part on the teeth;—his expenses and difficul-
  ties      ............37
                            CHAPTER  V.

Mr. Hunter's paper  on the hermaphrodite black cattle;—his anxiety for rare
  specimens to enrich his museum;—renewal  of the disagreement between him
  and his brother.—Mr. Hunter's paper  on small-pox during  pregnancy;—his
  paper on the hen pheasant.—Trial of Sir T. Boughton.—Croonian lectures.__
  His paper on the organ of hearing in fishes;—removes to Leicester square ;__
  assists in forming the Society for the Improvement of Medical and Chirurgical
  Knowledge.—Charlatanism.—Correspondence.—Mr.  Hunter's notion  of the
  immateriality of matter from the theory of colours;—his paper on the inflam-
  mation of veins;—his fame and practice at this time;—his merits as an opera-
  ting surgeon;—his illness returns ;—his second visit to Bath;—Mr. Home acts
  as  his assistant.—Mr. Hunter's paper on the double-coned  Terebella;__his
  operation for popliteal aneurism;—is appointed Deputy Surgeon-general to the
  Army;—his Treatise on  the  Venereal Disease;—his  work on the Animal
  QSconomy;—prints his own works at his own house ;—his paper on the Wolf 
CONTENTS.
7
Jackal, and Dog ;—his paper on Whales—The giant O'Brien__Obtains the
Copley medal;—opens his museum to the public—Mr. Home and Mr. Keate
appointed assistant surgeons at St. George's Hospital.—Sits for his  portrait
to Sir Joshua Reynolds.—Sharpe's engraving.—Death  of Pott;—comparison
between him and Hunter__Pott's character    .                   .57
                           CHAPTER VI.

Mr. Hunter's high station in the profession at this period ;—anecdote of his early
  rising—Mr. Thomas.—Sir A. Carlisle—Mr. Lynn.—Instance of Mr. Hunter's
  generosity ;—stands godfather to Dr. Jenner's first child ;—his paper on intus-
  susception ;—his paper on paralysis of the oesophagus.—Mr. Home's paper on
  the formation of loose cartilages—White's New South Wales__Mr. Hunter's
  illness ;—his violence of temper ;—his style of living;—his fondness for bees ;
  —his Tory politics—Funeral of Sir Joshua Reynolds.  Mr. Hunter's paper on
  bees ;—his letter to Sir Joseph Banks on this subject;—his surgical lectures ;
  —his work on the Blood and Inflammation.—Veterinary College established.—
  Mr. Hunter's disagreement with his colleagues at St. George's Hospital;—his
  death, and character as a private man and as a philosopher;—his will and effects
  —the purchase of his museum.—Correspondence between Lord Auckland and
  Sir Joseph Banks on this  subject.—The  terms on which this purchase was
  finally made.—Rebuilding of the College of Surgeons    ...     82
CHAPTER  VII.
The Hunterian Museum.........102
Appendix
130 
 
INTRODUCTION  TO THE LIFE.
  Besides several brief memoirs of John  Hunter which  have ap-
peared in various works of general biography, his life has already
been written at considerable lensrth  bv three different authors.
Neither of these publications, however, furnishes us with more than
a very imperfect account of his character, either as a private in-
dividual or as a Natural Philosopher.
  The memoir  by Sir Everard Home, prefixed to the work on In-
flammation,  is  a scanty outline, almost wholly devoid  of those
characteristic anecdotes which form so essential a part of biography,
and which his near connexion with Mr. Hunter would have enabled
him to introduce; whilst nearly a third part of the whole is occu-
pied with a detailed account of his various illnesses.   The memoirs
by  Dr. Adams, and Mr. Jesse Foot, stand in  singular contrast to
each other, the former displaying everywhere marks of indiscrimi-
nate and  unbounded  partiality towards Mr. Hunter, the latter of
bitter hostility, leading to the most flagrant misrepresentations of
facts.
   It appeared, therefore, if not necessary, at least  appropiate  and
desirable, to prefix  to this new and revised  edition of his writings,
a full and impartial account of this eminent man.
   It is known to most of those who have kindly furnished informa-
tion for this work, that  Mr. Palmer  did  at first intend  himself to
have^ undertaken the office of Mr. Hunter's biographer;  and he feels
that some  apology is  due to those from whom  he received commu-
nications under this supposition, for transferring the task to another.
   A want of sufficient time  to execute the task was the chief, if not
 the only reason, for his declining to fulfil his intention; and it was
only when satisfied that such was the fact, that I consented to engage
 in  an  undertaking which I  should gladly have seen continued in
 more able hands.
    In fulfilling the charge with which J have been entrusted, 1 have
 endeavoured to avail myself of all the information  respecting Mr.
 Hunter to be found in preceding  publications ; nor have I scrupled
 to  adopt the opinions of others regarding him where I thought them
 correct.
                                3 
10
INTRODUCTION.
  In addition to the materials gathered from these sources, I have
been enabled to enrich this  memoir with the whole of the letters
written by Mr. Hunter to Dr. Jenner, during a friendship of more
than twenty years' duration.  The originals of these,  many of
which have already appeared in Dr. Baron's Life of Jenner, were
liberally communicated  to  Mr. Palmer by Robert Fitzhardinge
Jenner, Esq., of Berkeley.
  The letters of Hunter to Sir Joseph Banks, as well as  the inter-
esting correspondence between  the latter and Lord  Auckland,  res-
pecting the Museum, were obtained through the  kind intervention
of Dawson Turner, Esq., of Yarmouth, to whom  were  entrusted
the  whole  of Sir Joseph Bank's papers, by his executor, Sir Edward
Knatchbull.
  During the time that Mr. Palmer contemplated writing this life
himself, he was at the  pains to  gather as much general information,
and as many authentic anecdotes as possible, respecting the subject
of this memoir, from his  surviving friends and  pupils.   Of these
anecdotes, many of which are highly  characteristic, I have intro-
duced by far the greater number; some which I have inserted
may be thought so trivial as  scarcely to have merited notice, but
I have preferred rather to risk  having this laid to my charge than
to omit anything that  might serve to  illustrate Hunter's  real
character.
  It will be  seen from what I have  said that my duty has  been
greatly lightened by having the  already accumulated  materials
placed at my disposal; in addition to this I have to acknowledge
the  receipt of many valuable suggestions from my friend Mr.  Pal-
mer, respecting the various  parts of the  work,—suggestions from
which I have rarelydissented, but which have often madexne regret
that circumstances prevented his being able  himself to carry them
into execution.   How far I  may have  satisfactorily accomplished
what I have undertaken, is  not for me to judge,   I will not  pre-
tend to indifference respecting the judgment that others may come
to on the point;  on the contrary, it would afford me much satis-
faction to feel that my time had not  been uselessly employed, but
that I had succeeded in furnishing, what has been hitherto a deside-
ratum in medical literature, a full  and faithful account of the life of
John Hunter.
                                   DREWRY  OTTLEY.
Exeter, March 3d, 1835. 
THE   LIFE
OF
JOHN   HUNTER,   F.R.S.
                      CHAPTER  I.

                          1728 to 1751.

Mr. Hunter's birth and family;—his early habits.—Dr. Wm. Hunter's  rise to
  fame;—his difficulties at the outset of life.—Mr. Hunter's arrival in London ;
  —his rapid acquisition of anatomical knowledge ;—becomes a pupil of Chesel-
  den.—Cheselden's mode of operating for stone;—his character and death.—
  Mr. Hunter's employments at this period ;—the advantages  which he derives
  from his brother's society.
%_
Johx Hunter  was  born  at Long Calderwood,  a small  estate
belonging to his family, situated  about eight  miles from Glasgow,
in the parish  of Kilbride East,  Lanarkshire.  His  father, who
appears to have been a small farmer living on his own estate,^was
descended from the ancient family of Hunter  of Hunterston,  a part
of which property  they  had received from  Robert  the  Second.
His mother, whose maiden name  was Paul, was the daughter of a
respectable citizen of Glasgow, who  held the office of Treasurer of
that  place.  John, the youngest  of ten  children, was born in the
year 1728, but on what  day is  not exactly known :  the  parish
register states the 13th of February to have been his birthday, but
he himself used to date it on the day following, and it is on the 14th,
consequently,  that his  anniversary is celebrated  at  the College of
Surgeons.   We have no means of knowing whether either  of his
parents displayed any remarkable degree of talent, but it is certain
that  their offspring, both in the first and second generation, included
an unusual number of persons eminent  for their intellectual superi-
ority.*  Besides William, of whom mention will  often  be made in

  * Mr. Wardrop, in his interesting life of Dr. Baillie, observes, that " the extent
of talent united in his family and connexions was remarkable.  He was not only
the son of an able Professor, and nephew of the two Hunters, but his sister, Miss
Joanna Baillie, has attained the most elevated rank in literature.  Mrs. Baillie's 
12
THE LIFE OF JOHN HUNTER.
the course of these memoirs, another brother, James, the eldest of
the family, possessed considerable abilities.  He was intended lor
the Law,'and completed his studies  with a view to practising as a
writer to the Signet in Edinburgh;  but on visiting London in his
twenty-seventh year, he became  so enamoured of the  pursuits in
which he found "his brother William engaged,  that he  determined
on  devoting himself thenceforward to Physic.  He immediately
began the study of anatomy, and pursued it with such  zeal  and
dilligence, as speedily to attain considerable proficiency; added to
this he was possessed of peculiarly engaging manners, and displayed
talents which,  in Dr. Hunter's opinion, could  not have failed to
place him in the highest rank as a professional man in London.  He
was, however, attacked with a spitting of blood, which obliged him
to relinquish his pursuits and return  to his native place; but the
change proved  of no avail, his complaint increased, and in no long
time proved fatal.
  One of the daughters,  Dorothea,  was  married  to  Dr. James
Baillie, Professor of  Divinity in the University of  Glasgow,  and
gave  birth to the late Dr. Baillie, author of the ' Morbid Anatomy,'
and  for  many years the  first physician  in London;  and to Mrs.
Joanna Baillie, the highly gifted authoress of the Dramas on the
Passions.
  Agnes, another daughter, married Mr. Buchanan, a cabinet-maker
of Glasgow.  The other children all died young.   Hunter's  father
died in 1738, at the age of 78, and  John was thus left, at ten years
of age, to the care of a fond, and apparently over-indulgent mother:
the consequence was, that being  in  a great measure master  of hft
own actions, and having little taste for books, he preferred engaging
in country sports, to studying those elementary branches of  know-
ledge which are best acquired in youth, and the want of which, as
in the case before us, is sure to be severely felt in after-life.
   When Hunter was about seventeen, he went to stay for a time at
the house of his brother-in-law, Mr. Buchanan, under the hope of
being able to assist in freeing  him  from  the  pecuniary difficulties
into which his  convivial habits and inattention to  business had led
him.   It is probable that whilst here, Hunter,  who  prided himself
on his manual  dexterity, assisted  his brother-in-law in his workshop,
and that hence originated the statement made by  Foot, that he had
served as a  millwright  or a  carpenter.  His efforts, however,
proved unavailing to  accomplish the object  of his visit, and Mr.
Buchanan soon after resigned  his business, and earned a scantv
livelihood  as  a teacher of music, and clerk to  an Episcopalian
chapel in Glasgow.

sister was married to the late Sir Richard  Croft, a man  whose name is endeared
in the recollection of many, as well for his manly and  upright heart as  for his
professional celebrity : and Mr. Denman, who has distinguished himself so much
at the bar, (now Lord Chief Justice), was  Dr. Baillie's brother-in-law."  Of this
 tendency of genius to display itself in various members of the same family, many
 remarkable examples might be adduced from ancient as well as modern history. 
THE LIFE OF JOHN HUNTER.
13
  During this time.Wm. Hunter was rapidly pursuing his  way to
fame and fortune.  After receiving a classic education at Glasgow
University,  and  studying  medicine  for three years as  a  pupil of
Cullen, who was at that time practising at Hamilton, he resorted to
Edinburgh, where he spent a winter attending the schools of anatomy
and medicine, and finally settled in London in 1741.
  He was immediately engaged by  Dr. Douglas to assist  him in
making preparations for a work on  the bones,  and also  to  take
charge of the education of his son.  With these views, accordingly,
he became an inmate of the family ;  but on the  death of Douglas,
in the following year, he turned his thoughts to lecturing on anatomy,
and immediately set about making preparations on a  large scale
for the purpose.
   In  1745 a fair opening for his exertions offered, on the resignation
of Wm.  Sharpe, who had for several years past given a course of
lectures  on surgery, which he had undertaken at the express request
of a number of naval surgeons.  To this  class Wm. Hunter suc-
ceeded,  and after a time altered the  plan  of the lectures  so as to
render his course much more of an anatomical than of  a  surgical
nature.*
   Previously to this time, Wm.  Hunter's means had  been  very
limited,  for though the  family  property had  fallen to him at  his
 brother  James's death, yet as his mother continued, with his permis-
 sion, to  reside on the estate, the surplus accruing to him could have
 been but small,  In proof of this, Mr. Watson, formerly  surgeon to
 the Westminster Hospital, and one ofWm. Hunter's earliest pupils,
 used to  relate, that as  they  were walking home together  after the
 introductory lecture,  the  latter,  who carried a  bag  containing
 seventy guineas, which he had received for entrance fees, remarked,
 that this was a larger  sum than he had ever before been possessed
 of.   Linnasus gives a similar account, of his own slender beginnings
 where he says,  "Exivi patria,  triginti  sex nummis aureis dives;"
 and it is related by Sir James Earle, that  at Pott's death, a  small
 box was found among his papers, containing a few pieces of money,
 not amounting  to  five pounds,  being the whole which he  ever
 received from the wreck of his father's fortune.  Such anecdotes
 may serve to encourage those  who,  at  the outset of their journey
 through life, chance to have their purses  but slenderly furnished:
 numbers more  might be found  by a reference to the lives of eminent
 men in  all professions, many of whom, though they have afterwards

   * It was customary for the lecturers of that day to treat in one course on a
 number of subjects, sufficient to furnish matter for three or four distinct courses
 according to our present system ; and the meagre amount of information afforded
 to their  hearers may be judged of by the following facts, mentioned by Mr.
 Chevalier in his Hunterian Oration.   Mr.  Bromfield, who was suifeeon to  St.
 George's, and a lecturer of considerable note, comprised anatomy and surgery in
 a course of thirty-six lectures. Dr. Nicholls, at whose school  Wm. Hunter
 studied,  professed to teach anatomy, physiology, and  the general  principles ot
 pathology and midwifery  in thirty-nine, and Mr. Nourse of St. Bartholomew s
 embraced "totam rem anatomicam" in twenty-three lectures. 
14
THE LIFE OF JOHN HUNTER.
  reaped a bountiful share of the favours of Fortune, were doubtless
  obliged, on their first starting in life,  to have  recourse to  shifts
  quite as curious as those of Johnson's Irish friend, who in describing
  how a  man  may live  respectably in  London on thirty pounds a
  year, allots ten for the expenses of clothes,  and provides that all
  visits are to be paid on  clean shirt  days.
    Wm. Hunter had  many difficulties to  overcome in establishing
  his anatomical school;  he  was the first surgeon, unconnected with
  a  hospital,  who  had  lectured  on  anatomy,* and no one had
  attempted it on a scale  at all equal to what he proposed: his prede-
  cessors had been accustomed to employ but one subject for demon-
  strating all parts of  the body, excepting the  bones and  arteries,
  which were described on preparations; and the  nerves, for exhibiting
  which  a foetus was  usually employed.  Practical dissection was
"  unknown to the great bulk of the profession.   Added to all  this, a
\ far greater horror of anatomical pursuits existed in the public mind
'' at that time than at the present.
    William Hunter's address and perseverance at length triumphed
  over all these difficulties, and he  succeeded in  forming an estab-
  lishment,  which,  in  consequence  of  the  superior  advantages it
  afforded, and  the unrivalled talent of its founder as a lecturer, for a
  long time maintained its rank as by far the first anatomical  school
  in London.
    John Hunter was now in his twentieth year,  when the fame of
  his brother's success made him desirous of entering into the same
  profession. He accordingly wrote to his brother, requesting to be
  allowed to join him  in  London, and offering his  services  as an
  assistant in the dissecting-room.   The reply was favourable, and
  contained a kind  invitation to visit London.  He lost  no time in
  complying with this,  but set  out on horseback in  September, in
  company with Mr. Hamilton, a friend of the family, and arrived at
  his brother's house about a fortnight  before the  commencement of
  the  autumnal  course of lectures.   No long  time elapsed  before

   * It was not until 1745 that the alliance between  barbers and surgeons was
  happily dissolved : before this time, any  surgeon dissecting a body out  of their
  Hall was liable to a fine of  ten pounds.   Amongst other privileges, they
  possessed the right of claiming annually the bodies of four executed felons, which
  probably led Dr. Caius  to choose  the Barber-Surgeons' Hall, to deliver his
  anatomical lectures in, soon after their incorporation in 1540.  From this time to
  the dissolution of the company, their readers of anatomy were, with very few
  exceptions, chosen from the College of Physicians, to whom, with the exception
  of Cowperand Cheselden, is due the merit of supporting the fame of this country
  in anatomical pursuits, from the time of Caius to that of the Hunters.  In the list
  of physicians who successively  taught anatomy in England, we find the names
  of Caius, Harvey, Glisson, Mead, Willis, Lower, Wm. Hunter, and last, though
  not least, qf Matthew Baillie.   With Dr. Baillie ended the race  of Physician-.
  Anatomists, with the exception of Dr. Wilson, who lectures at the present day.
  This resignation  of the professor's chair of anatomy on the part of the physicians!
  arose not however from any lack of able men to fill it, but from a conviction that
  the surgeons were now fully capable of instructing their own pupils, and with
  more practical effect. 
THE LIFE OF JOHN HUNTER.
15
John's skill was put to the trial in preparing for the lecture a dissec-
tion of the muscles of the arm.  It is. probable that Wm. Hunter
had not as yet formed a very high estimate  of the  talents of his
hitherto idle brother, and little foresaw that he was ere long to
eclipse his preceptor: he was, however,  so  well  pleased with his
pupil's first essay, that he soon after entrusted him with the prepa-
ration of a similar part, of which the blood-vessels were  injected.
In this the young student again succeeded so well as to obtain much
praise for his dexterity from his brother, who foretold that he would
soon become a good anatomist, and promised that he should never
want  employment.  From this  time, therefore, we  may consider.
Hunter  as engaged in the dissecting-room, under the instruction of
his brother's assistant, Mr. Symonds, where he pursued his studies
with such zeal and  diligence that by the next season he was able
to take  the charge of directing the pupils in their dissections ;—thus,
by his  rapid progress, showing what  ma}7 be effected  by great
diligence, and adding another to the examples furnished by Chesel-
den, Haller, Albinus, Baillie, Abernethy, and a host of others, that
the surest foundation for future professional eminence  is an early
and extensive knowledge of anatomy.
   The summer after  he arrived  in town, Wm. Hunter  obtained
permission for his brother to attend  at the Chelsea Hospital, under
Cheselden, of whom, as  Hunter's first  master in  surgery, and as
the most celebrated surgeon of his day, no apology  will be neces-
sary  for introducing a short account.   This admirable surgeon
was now more than sixty years of age, and  had  retired  in great
part from the toils of a profession  in which  he had been engaged
during  nearly forty years, and in which he had attained the highest
rank.   As a surgeon, Cheselden may be said to have enjoyed the
same repute, both  in England and on the Continent, which his
contemporary and friend Dr. Mead  had acquired  as a physician.
He was educated  at  St. Thomas's  Hospital, under  Mr.  Feme, a
very  able man, and studied anatomy under the celebrated Cowper.
At twenty-two he  became  a lecturer on  surgery  and anatomy,
and in the following  year was elected  a member  of the Royal
Society, to whose Transactions he  contributed several papers, the
most  remarkable of which contained the description of the opera-
tipn by  which he restored to sight a lad who had been  blind nearly
from  birth.  At Feme's death he was elected first  surgeon to St.
Thomas's, and was appointed consulting  surgeon  to St. George's
and   the Westminster  Hospitals.    He was  eminent  in  every
department  of surgery, but  it was  as a  lithotomist that his name
first became known all over Europe.  The  operation  he at  first
adopted was that called  the high  method,  when the bladder  is
entered above the pubes, which be  performed with considerable
success, saving six out of every seven who were  cut.   About this
period, however, all Europe rang with the name of  Raw, the famous
Dutch lithotomist, who had adopted Frere Jacques's method, with
improvements of his own, but kept his plan so profound  a secret 
16
THE LIFE OF JOHN HUNTER.
as to blind the eyes even of the famous Albinus, his assistant, as to
the exact parts through which he  cut.  Cheselden, with Douglas,
and other surgeons in London, who had met with less success by
the high method, tried the mode described as Raw's by Albinus, in
which  the  whole wound in  the bladder  was made beyond  the
prostate; but they experienced such ill fortune that they felt assured
the operation was not correctly described, and Cheselden, abandon-
ing this, planned the lateral operation as it is at present performed.
He now met with  such signal success, that Morand, then  one of
the first surgeons in Paris, came  over to this  country purposely to
learn the operation, and during his  stay saw Cheselden cut twenty-
seven patients without losing  one.   Cheselden's manners were ex-
ceedingly kind and gentle, and notwithstanding the extensive prac-
tice  he had enjoyed, he always,  before an operation, felt sick at
the thoughts of the pain he was  about to inflict; though  during its
performance his coolness and presence of mind never forsook him.*
In alluding to  this feeling, Morand  relates an anecdote of a  French
surgeon who,  on visiting the  Hospital, expressed great surprise at
witnessing such an  evidence of weakness, as he  considered it, on
the part of so  famous a surgeon: after the  operation was over, the
visitor was invited by Cheselden to accompany him to the  fencing
school, whither  he was going to see a sparring match; but  here
the tables were completely turned, for no  sooner  did the  contest
begin, than  the stranger turned  pale at the sight, and was  obliged
speedily to betake himself to  the open air.
   It was under this great man that Hunter received his first lessons
in surgery,—a worthy master for  so eminent a pupil; and he con-
tinued to attend regularly at  the Chelsea Hospital during the  sum-
mer months of 1749  and 1750.  Here he would have probably
continued for  some time longer, but in the following year  Cheselden
was obliged to resign his situation in consequence of an attack of
paralysis, which entirely unfitted him for business.   He repaired to
Bath in the hope of amendment,  but in  1752  he was seized with
apoplexy, which put an end  to  his life, in  the sixty-fourth year of
his age.   Besides his  talents as  a  surgeon,  Cheselden displayed
considerable taste in the fine arts  ; he was fond of poetry, and an
intimate friend of Pope; he  had also made architecture his study,
and it was  from his plans that Putney Bridge, and the former  Sur-
geons' Hall in the Old Bailey were erected.
   But to return to Hunter.   We may consider him  as  now  fully
entered on  his professional  studies; and as he was not one who
ever loitered  over an undertaking, it is  probable that his time was
pretty fully occupied between the  hospital  and the dissectino--room.
He was, however, fond of company, and as he had not, like Haller,
forsworn the use  of  wine  on  commencing his  medical studies,
 though he found it necessary to  do so in after life, he mixed much
   *Such feelings, in a less marked  degree perhaps, are far  more commonly
 experienced than i9 generally supposed,  by the very best surgeons previously to
 undertaking operations of importance. 
THE LIFE OF JOHN HUNTER.
17
in the society of young men of his own standing, and joined in that
sort of dissipation which men  at his age, and freed from restraint,
are but too  apt  to indulge in.   Here, as  in  graver matters, his
ambition urged him to take the lead of his companions, amongst
whom he went by the familiar title  of " Jack  Hunter."   Nor was
he always  very nice in the choice of his associates, but  sometimes
sought entertainment in the coarse broad humour to be found amid
the lower ranks  of society.  He was employed by his  brother to  -
cater for the dissecting-room ; in the course of which employment
he became a great favourite with that certainly not too respectable
class of persons the resurrection men ;  and one of the amusements
in which he took  especial pleasure,  was to mingle with the gods in
the shilling gallery* for the purpose of assisting to  damn the pro-
ductions of unhappy authors, an office in which  he is said to have
displayed peculiar tact and vigour.
   It must not, however, be supposed that it was to company like
this, or to the society of wild young men, that Hunter was confined.
His brother was a scholar, and possessed of gentlemanly manners,
and though comparatively a stranger in London, he was  already
known as a man  of much talent, and as  likely to rise to eminence;
he was also  fond of society, and his house was consequently fre-
quented by many of the first men, not only in his^own but in other
professions.  It has therefore seldom fallen to the lot of young men
to enjoy equal opportunities of cultivating their minds by association
with men of talent; and though  there can be no question  that by
far the greater part  of his future   eminence  was owing to the  •
original powers of his mind, yet, in recording the history of his life,
it will be proper to trace the means by which those  powers were
improved, and to show, as far as may be, the assistance he received
in bringing them fully into action.  It is the more necessary to do
this, in order to correct an unfounded opinion which generally pre-
vails,  that Hunter should be classed  with those untaught geniuses
who have risen to the highest honours by their own unaided powers.
This was evidently not the case, and the meagreness of his early
history seems sufficiently to prove that it was at his brother's table,
and in his brother's dissecting-room, that his ambition and  his talents
were first  roused to activity: without such a  stimulus  his genius
might  have slumbered,  or have  taken  a wrong direction.  Nor
does this detract from his real merit. There is perhaps nothing
that more  distinguishes  the man of genius than  the manner in
which he turns to account the advantages  which common minds
would let slip without profit.  Hunter was a man of extraordinary
powers; he was  placed in circumstances the best  fitted to excite
these powers, and give  them their  full  effect, and the result was
such as could only have been produced by this fortunate combina-
tion of circumstances.
4 
18               THE LIFE OF JOHN HUNTER.
                        CHAPTER II.

                         1751 to 17C3.

Hunter becomes a pupil of Pott.—Pott's character as a Surgeon.—Hunter enters
  at St. Mary's Hall, Oxford ;—enters as a pupil  at St. George's Hospital ;—
  discovers the mode of connexion between the placenta and uterus;—his con-
  duct as a lecturer and demonstrator of anatomy.—Disputes of the Hunters
  with contemporaneous anatomists respecting the anatomy of the testes, the
  office of the lymphatics, and the hernia congenita.—Hunter traces the nerves
  of the nose;—his experiments on the subject of venous absorption ;—com-
  mences the pursuit of comparative anatomy ;—embarksfor Belleisle;—is still
  ardent in the pursuit of science.—Jesse Foot and his Life of Hunter.

On the retirement  of Cheselden from the Chelsea Hospital, Hunter
entered  as a surgeon's pupil at St. Bartholomew's.   To this  hospi-
tal Pott had been  elected surgeon about  two  years before, after
having served as assistant from 1745.   He was now in his thirty-
eighth year, and was fast rising in reputation as a most able practical
surgeon.  As an author he was not  yet  known, for his  first work
of importance, the '• Treatise  on Ruptures," which was composed
during his confinement with a compound  fracture of the leg,  did
not appear until 1756.  Nor had he at  this time  commenced  the
delivery of his surgical lectures.   At the hospital, however, Hunter
must have acquired many a  useful  lesson, from a comparison of
the lenient practice of leaving tnuch to  the efforts of nature,  which
Pott's sound judgment had led  him to adopt,  with the  rude and
pernicious  interference  with  these efforts, which Nourse and his
other colleagues, according to the custom  of their day, were in the
habit of employing.
   Surgery was at  this time beginning fast  to emerge from the state
of barbarism in which it had long  existed.   To  this change  the
French Academy of Surgery greatly contributed, and  they have
left us, in their Memoirs, a fine example of men laying aside petty
jealousies and uniting their powers  for  one common object,—the
advancement of their common profession.
   It was in the operative parts of surgery, as  might be  expected, *
that the chief improvements were first made, a result almost  neces-
sarily  arising from the knowledge of  anatomy becoming  more
diffused.  Far less had been done towards simplifying the curative
department.   The actual cauteries and  charcoal-pan  were  still
considered an essential part of the dressing apparatus at the hospi-
tal, and a farrago  of applications, going under  the names of  suppu-
ratives,  digestives, and  sarcotics, were   implicitly relied on  for
effecting those changes which Nature was  all the while performing
in spite of her injudicious allies.
   Pott  was  the  first surgeon in this  country who successfully
attacked these abuses, and, as usually falls to the lot of innovators, 
THE LIFE OF JOHN HUNTER.
19
was laughed at by his colleagues for his attempts.  Several of the
improvements suggested by him were, no doubt, introduced after
the time when Hunter was a student;  yet we may fairly suppose
that the latter obtained many useful hints from those he witnessed,
which, confirmed and improved on during his  practice in the army,
may have formed the basis of some of the philosophic views which
we owe to his genius.
   At  this hospital  Hunter attended regularly during the summer
months of 1751, and occasionally in the winter, when any opera-
tion of importance was to be performed.  During the next summer
he was absent from town, on a visit to  Scotland, whither he went,
partly probably to enjoy some relaxation from his labours, but
principally for  the purpose of accompanying to London his sister,
Mrs.  Buchanan, whose husband had died not  long before.
   In 1753 Hunter  entered as Gentleman Commoner at  St. Mary's
Hall, Oxford.  Neither  of his  biographers satisfactorily explains
the motives which led him to take this step, but it seems probable
that he was persuaded to it by his brother.  It was not yet  decided
what line  of practice John should pursue, and if there were thoughts
of his becoming a physician, as it seems there were, it was natural
that William, who was a good classic, and valued literary attain-
ments, should recommend his  brother to devote some time to the
cultivation of those branches of knowledge, which  he had  hitherto
so entirelv neglected.  He was also recommended, it would seem,
to try his"fortune as an accoucheur;  but neither this proposal nor
the former was to  his liking, and he eventually decided on confining
himself to the practice of surgery. In speaking of this period  of
his life  some  years  afterwards  to Sir  Anthony Carlisle, then  a
 student at the hospital, Hunter said:  " They wanted to make  an
old woman of me;  or  that I should stuff' Latin and Greek at the
University; but,"  added he, significantly pressing his thumb-nail  on
the table," these schemes I cracked like so many vermin  as  they
came before  me."   It was fortunate, probably, that he  decided  as
he did, for though  his future  progress was slow, the roughness  of
his manners would have been a still greater impediment to him in
either of  the other branches of the profession.
   Having determined, then, on adhering to the practice of  surgery,
Hunter naturally  felt anxious  to  secure for himself a chance  of
election  at some  future day to one of the London hospitals.  His
prospect  of obtaining the situation of surgeon to the Chelsea was
too uncertain and too remote to be calculated on;  and at St.  Bar-
tholomew's it  would have been  necessary for him to serve  an
apprenticeship of five years to one of the surgeons, which, at  his
 age,  and  with his occupations, was quite out of the question.  For-
tunately,  no such obstacle offered at St. George's, where he accord-
ingly entered as surgeon's pupil in 1754, and attended, as in the
former instances, during the summer months, whilst the winter was
devoted to his  duties and  studies in  the dissecting-room.  Two
years after this he served the office of  house-surgeon to the hospi. 
20
THE LIFE OF JOHN HUNTER.
tal, a most desirable post for a young  man  intending to enter on
surgical  practice, since, in  addition to the  immediate care of all
the patients under the direction of the  surgeons, in their absence, a
a great part of the treatment of fractures, and several of the minor
operations of surgery, usually devolve upon  this officer.
  Hunter's extensive acquaintance with anatomy was now generally
known and appreciated,  and he was not unfrequently applied to by
others  to assist them in clearing up any difficulties  they might en-
counter in their researches.  It was on an occasion ot this  kind,
and  about this time, that the important discovery of the  mode  of
connexion between the placenta and  the  uterus was  made.   The
honour of solving this anatomical  problem  was laid  claim to by
each of the Hunters, and the dispute to which it gave  rise twenty-
five years afterwards caused a breach between them that was never
healed  until William was on his death-bed ;  and scarcely, it would
seem, in his mind, even then.   The following is the account which
John Hunter has given of the transaction in  his work on the " Ani-
mal  CEconomy."
  In May 1754, Dr. Mackenzie, then an assistant with Dr. Smellie,
had  been particularly successful in injecting the arteries and  veins
of the uterus, in a woman who had died  during pregnancy.   The
appearance being new, he applied to Hunter for his  assistance in
making the examination, who, after having  dissected and  made
the  whole into preparations, on his  return home  in  the  evening
communicated what had been done  to  Dr. Hunter.   The  latter
treated his brother's  account at first with  good-natured raillery,
but on  seeing the parts was soon convinced  of the truth of the state-
ment.  Some of  the  portions were given to the Doctor,  who
afterwards exhibited them  at his  lectures: but in what  manner
he mentioned the subject, or what credit he gave to John on  these
occasions, does not appear.  In his work  on the gravid uterus,
published in 1774, he gives  general acknowledgments to his brother
for his assistance, but does  not mention his name in connexion with
this particular subject.  As it will be necessary to  recur briefly to
this  dispute  at a latter period, no  more  need  be  said at  present,
except to remark, that attempts have been recently made to show
that this  discovery, on which so high a value was  set at the time,
is in truth not a discovery,  but an erroneous opinion.
   The most distinguished anatomists and physiologists of the present
day, on the  Continent, take this view of the subject;  still, the doc-
trine of the Hunters is supported by evidence too strong to be easily
overset, and it is said that some recent minute dissections instituted
by Mr. Owen, which have  not yet been  made public, still further
confirm the truth of their opinion.
   In the course  of  this year Hunter became a  partner with  his
brother in the anatomical school, and a portion of the lectures was
regularly allotted to  him;  besides which, he took his brother's  sta-
tion whenever he was unavoidably absent.   The lecture-room was
 not, however, a place in which John Hunter was calculated to shine, 
THE LIFE OF JOHN HUNTER.
21
as he had always great difficulty in delivering himself  extempore,
an  acquirement almost  indispensable  in  anatomical teaching.
Hence, notwithstanding his extensive  and accurate knowledge of
anatomy, he never gained a popular  manner, and  could  not  but
have appeared to great disadvantage when contrasted with  the
Doctor, who was so pre-eminently qualified as a teacher.
  In the dissecting-room he felt himself more at home,  and it was
here that he spent all  his leisure  hours, in  making preparations,
and in pushing his inquiries in anatomy and physiology  beyond the
point which his predecessors had attained.
  Since the time of Vesalius anatomy had been  prosecuted with
great zeal and success by eminent men, both in England  and on
the Continent, and the most important parts of the human body had
been more or less  accurately described.  There still remained,
however, many minor parts, the structure of which had not been
fully made out, and the newly discovered system of the lymphatics
was as yet but imperfectly known.   The invention of various modes
of injecting the vessels had  of late greatly facilitated researches into
the minute structure of parts.   Many able anatomists in the various
schools  of Europe were ardently engaged  in pursuing such re-
searches, and  by none were they carried on with  more zeal than
by  the Hunters.
  A natural consequence of this direction of many minds to one
object was, that a  new discovery was frequently  made nearly at
the same time by different inquirers, and it became difficult to  ap*
portion  the degree of credit due to each.  The eagerness of the
claimants  for honour often led to disputes, in which far  more
warmth was displayed than the point  in  question  merited, so that
on  reading the annals of these paper wars, we  cannot  but feel
surprise at the violence  shown abo«t matters of such little mo-.
ment.  Dr. Hunter himself was   a very Achilles in this sort of
warfare.

                Impiger, iracundus, inexorabilis, acer.

  Jealous of his supposed rights, and unwilling to admit the  possi-
bility of a discovery occurring to two independent inquirers, he was
far  too apt to accuse his antagonists of plunder if they displayed as
their own any of those anatomical trophies to which he could es-
tablish a prior claim.
  In several of his encounters, tlie discoveries which gave rise  to
them were due in great part to  John, who, being far more dexte-
rous with the scalpel than the pen, left the defence of their common
property to William, whose literary attainments better fitted him
for the service, and who  displayed  considerable ability in  its per^
formance.
  Two of these disputes were with the Munros: the one, as to the first
successful injection of the tubuli testis with mercury; the  other, as to
the discovery of the true office of the lymphatics.  In both cases Dr,
                              4* 
22
THE LIFE OF JOHN HUNTER.
Hunter fairly showed that he had taken  the lead  of  the  Munros.
On the former question, indeed, he had been, to a  certain extent,
forestalled by Watson and by Haller; but on the latter, though
other physiologists may have somewhat earlier suggested that  the
lymphatics were probably absorbents, the merit of proving this by
observation and experiment, and of pointing out the great impor-
tance of these vessels in the animal  ceconomy,  is undoubtedly
chiefly due to William and John Hunter.
  The third  encounter was with  Pott, who was no favourite with
the Scotch faction in London, of which William Hunter was a
leading member.  He accused Pott of stealing from himself and his
brother  the  knowledge  of the true nature  of hernia  congenita,
without acknowledging it in the paper  he published on the subject.
Pott, however, denied the accusation,  and we  have no  reason to
doubt his veracity.  Be this as it may, both  had  been anticipated
by Haller, who had a year or two before explained the  nature of
the disease, and given it the name of congenital hernia.
  There was a question, however, connected with this latter subject
which required to be cleared up,  namely as to the cause and mode
of descent of the testis in the foetus.   The explanation of the process
given by Haller  and Pott was fanciful and unsatisfactory; and to
John Hunter alone is due the merit of explaining  the steps of  this
curious physiological problem in so full a manner as to  leave no-
thing to be  added  by others on  the subject.  The details of  this
inquiry, which gained him great credit, were first published in  Dr.
Hunter's Commentaries, and are given more at  length in John
Hunter's valuable work on the Animal (Economy.
   In addition to  the above researches, he about this time traced the
ramifications of  the first  pair of  nerves within the nose;  and from
his preparations  the engravings were executed which he  published
in the Animal (Economy, accompanied by some valuable physio-
logical remarks on the nervous system generally.
   In 1758, and the  following year, he  instituted a set of experi-
ments, which are detailed in Dr. Hunter's Medical Commentaries,
for the purpose of ascertaining whether veins possess the power of
absorbing.   These were ingeniously  contrived, and, to   the  minds
of all present, so satisfactorily decided the question in the negative,
that they  greatly contributed to confirm the opinion that absorption
was carried on by the lymphatics and lacteals only, and apparently
gave the death-blow to the ancient doctrine of absorption by veins.
Here again, however, later physiologists, by new and more  varied
inquiries,  have succeeded in throwing  considerable doubts  on the
correctness  of  Hunter's inferences,  and have  brought forward
evidence, which, if  not decisive, yet affords strong  ground for
believing that the veins are to a  certain extent absorbents.  What
 are the relative  parts taken by these two sets of vessels in carrying
 on this function, or whether the apparent absorption by veins is not
 a mere effect of simple imbibition, still remains to be discovered.
   It was one time Hunter's intention to have made a series of pre- 
THE LIFE OF JOHN HUNTER.
23
parations of the whole system of lymphatics, and to have published
engravings of them.  With this  view he had completed  a prepara-
tion of the lymphatics of the lower extremity, from which Rymsdyk
had executed a drawing;  but ill health, and a variety of occupa-
tions, prevented his carrying the plan into effect.
  Hunter had  now been ten years engaged in  the study of human
anatomy, and having found that there were many parts the structure
and functions of which required to be elucidated by a reference to
other sources,  he  began with the  same diligence to  pursue his
researches  in the wide field of comparative anatomy.  His health,
however, was beginning to suffer seriously from his incessant labours.
In the spring  of  1759 he was attacked with  inflammation of the
lungs, which left behind  it symptoms that threatened to end in con-
sumption.  He was strongly advised, therefore, to leave London for
a time, and seek a more southerly climate.  With  this  view he
applied for an appointment  in the army, and  was immediately
made Staff-Surgeon by Adair, who  was then  Inspector-General of
Hospitals.
  Europe was at this time engaged  in  the  seven  years' war, one
of the most sanguinary of those in which nations were formerly so
often involved, by their  mutual  jealousies, or the ambition of their
rulers.  England was, as usual, amongst the foremost in the contest,
and early in 1761, a powerful armament was sent from this country
under General Hodgson  and Commodore Kepple, to lay  siege to
Belleisle, an island off the western coast of France.  With this
 armament Hunter embarked ; and  as the siege, though short, was
 extremely  sanguinary, he was at once furnished with ample oppor-
 tunities for practice in the treatment of gun-shot wounds.
   By the following year England had embroiled herself with Spain.
British troops were sent out  for the protection of our Portuguese
allies, and  with these  Hunter proceeded to the Peninsula.  Here
he remained  on  active duty until the end of the year, when all
parties being heartily tired of the contest, the preliminaries of peace
were agreed on.
   Notwithstanding his constant employment in the practical duties
of his profession whilst with the army, Hunter found time to pursue
those physiological researches in which he took supreme delight.
 He made several  experiments  on lizards  and snakes,  to ascertan
whether digestion continues during  their torpid state; and he was
also engaged in some  inquiries on the faculty of hearing  in fishes.
 It was during  these campaigns, too, that most of his observations
 on gun-shot  wounds were made, and  that many of the peculiar
 views which  his work  on  inflammation  unfolds, first suggested
 themselves to his mind, though they were  not published until more
 than thirty years afterwards, as he  constantly endeavoured during
his whole  life to confirm  and amend them, and to build ' them up
 into a work on which his future fame should depend.
   We have no authentic account of Hunter's private life during the
 time he was with the  army.  Jesse Foot  accuses him  of  exciting 
24                THE  LIFE OF JOHN HUNTER.
jealousies and quarrels amongst his colleagues; but to Foot s state-
ments no sort of credit is due.   He  wrote what  he is pleased to
call the Life  of Hunter with  the same view that he  made all his
other  attacks on  him, under  the hope, namely, that he might suc-
ceed in dividing the town into two parties, and himself become the
Magnus Apollo of one of them.   His hope of rivaling Hunter was
certainly sufficiently ridiculous, and it  need hardly be added that he
utterly failed in his  aim.  Whether he carried his abuse so lar as
to disgust those he wished to please, or that  his talents were not
equal to filling a high station, certain  it  is  he never  made much
figure  in  his profession; and whilst Hunter's  name and works have
been year after year rising into higher  and still higher  esteem,
those of his traducer, Foot, are already well  nigh buried in merited
oblivion.*                                                 ,  u
   In  the spring  of 1763, peace having  been proclamed, Hunter
accompanied the forces  home, and on arriving in England imme-
diately returned to the metropolis.

  * When Hunter published his work on the  Venereal Disease, Foot followed
with a book of  his own on the same subject, filled  with abuse of the doctrine
and practice of  his predecessor.  Hunter was too wise to give consequence to
his petty foe by publicly replying to his attacks, but  the following comments
were written by him on a couple of scraps of paper, destined for pipe-eights, but
rescued from the flames by Mr. Clift.  » One  may say of Jesse Foot as we say
sometimes of young men, < It was well their fathers were born before ^them.  It
was well for Jesse Foot that I published my book before he wrote his."  " Jesse
Foot accuses me of not understanding the  dead languages; but I could teach
him that on the dead body which he never knew in any language dead or living.
Foot's best work was the life of his relative Murphy, the translator of Tacitus;
but by an unfortunate blunder in the motto  prefixed,  he has betrayed how little
pretence he, at least, had for reproaching Hunter with  his want of classical know-
ledge.  This motto he solicited and obtained from  Mr. Thomas  Copeland of
Golden Square, a gentleman as distinguished  in his  profession as he is for true
taste in classic  literature ; but by an absurd mistake Foot perverted its meaning,
and thereby entirely destroyed its  beauty.  The following is the motto as it
stands in his work.  " Non hoc prsecipuum amicorum munus est, prosequi de-
functum ignavo quaestu, sed quae voluerit meminisse,  quae mandaverit exsequi."
Tacit. Jinn. lib. ii.   By substituting quaestu for questu, as in the original, he has
spoiled an elegant motto.
  It is said that Foot received four  hundred pounds from some of Hunter's ene-
mies for writing his life ; if so, he deserves only to be remembered in connexion
with a homely remark of Hunter's,  in answer  to a gentleman who was condemn-
ing this sort of conduct, " O,  sir ! we all have vermin that live on us." 
THE LIFE OF JOHN HUNTER.
25
                        CHAPTER III.

                          1763 to 1771.

Hunter settles in London.—Alienation  between the brothers.—His straitened
  circumstances ;—his favourable position in othej. respects.—Patience and for-
  titude  required  of young surgeons.—Obstacles  to Hunter's success;—his
  contempt of humbug;—his thirst for fame and knowledge greater than his
  love of wealth ;—delivers lectures on  anatomy ;—his persevering industry—
  The state of surgery at this period.—The plan of  his vast future labours con-
  ceived and entered  upon.—The Baconian philosophy.—Earl's  Court.—His
  encounter with a bull and two leopards ;—is made F.R.S.—His description of
  the Proteus ;—ruptures his tendo-Achillis ;—is elected surgeon to St. George's
  Hospital ;—removes to Jermyn-street.—Dr. Hunter's liberal offer to the Go-
  vernment rejected.—Mr. Hunter's house-pupils.—The pupils of distinguished
  surgeons themselves become distinguished.—Dr. Jenner;—his immortal dis-
  covery of vaccination.—Mr.  Hunter's treatise on the teeth;—his marriage.—
  Mrs. Hunter.

A termination  having been put  to  the  late war,  at the  earnest
desire of all parties, there  was little  probability that Hunter would
be again called into active service by a renewal of hostilities; and
as his health was re-established, he determined on immediately set-
tling himself in London.
   The situation which he had occupied in Dr. Hunter's school was
now filled by Hcwson, who had been taken into partnership  soon
after Hunter  quitted  England ; and as this gentleman's talents, both
as a lecturer  and as  a practical anatomist, were of a high order,
and enabled him to fill the post with credit  to  himself and advan-
tage to the establishment, there was no prospect of a vacancy soon
occurring in this quarter.   It  may indeed  be doubted, even  if the
situation had been open, whether  Hunter would have again entered
into  partnership with  his brother; for  it  would appear from Sir
Everard Home's statement, that  their former connexion  had not
been one of entire harmony ;  and that  indeed  the only tie which
bound them  together, long after  other considerations would  have
led to a separation, was  John  Hunter's extraordinary  skill as  an
anatomist, and  the valuable contributions which  he was  continually
making to Dr. Hunter's museum.
   For  the future, then, Hunter was to depend on his own  unaided
exertions: consequently, though his situation was one of more  in-
dependence than that he before occupied, it  must also  have  been
one of more anxiety, as he had nothing certain to depend on beyond
his half-pay.
   The circumstances  under which he commenced his career  in
London must be considered, however, to have been on the whole
unusually  advantageous.   His age was sufficiently advanced  to
inspire his patients writh confidence; he  had a brother  established 
26
THE LIFE OF JOHN HUNTER.
in extensive practice as a physician and accoucher; and the abilities
he had manifested in his former situations had made him favourably
known, not only in the  army, but to  many of  the  most eminent
literary and scientific men of the day.  With such  advantages, it
might have been expected that his unwearied industry and eminent
natural endowments, improved as they had been by an  education
under the first surgeons of the day, and by the personal experience
which three years of active service had afforded him, would have
certainly and speedily introduced him into a large share of profitable
practice.
  Hunter was, however, destined to undergo a long trial of those
qualities of passive fortitude and active perseverance, of which few
situations in  life  demand a  larger share than  that a young man
commencing practice in the higher branches of the profession of
law or medicine in London ; for  assuredly it needs no small degree
of fortitude to  bear up against the disappointment  of a young man
so placed must experience, in finding his merits  overlooked, whilst
the world is showering wealth on many  around him whom  he, at
least, thinks far less deserving than himself.   It requires,  too, much
steady perseverance  constantly to keep in  view the  destined goal,
resisting  the allurements which have so often led  men of  superior
talents to desert the arduous contest, and devote themselves to the
pursuits of literature or of science ; pursuits which, though delightful,
can seldom be extensively followed without the neglect of objects
more essential to those who seek for fortune, as  well as fame, from
the practice of a profession.
  Various circumstances  combined to render Hunter's  success in
practice far less rapid than might have been anticipated.   Of these,
one of the most obvious was that of the field being already occupied
by several men of real merit in their profession, and who  by their
writings had  contributed largely to the  improvement of  surgery.
First of these, and facile priiiceps, stood Pott, in the prime of life,
and in the zenith  of  his fame, who though he had never received,
because  he had  never solicited, those titles and posts  cf honour
which  are usually bestowed on the leaders of our  profession, yet
had  raised himself by his eminent abilities and  industry, and by
his gentlemanly manners, to the  highest place in the esteem of his
professional brethren and the public.
  The second stations were ably filled by Bromfield and Sir Ccesar
Hawkins, surgeons to St. George's Hospital; and  Samuel Sharp
and Warner, of Guy's.  These divided amongst them the  greater
part of the civil practice, whilst  Adair  and  Tomkins, from  their
long connexion  with the  army, enjoyed the chief  share  of what
accrued from  that quarter.
  The narrowness of his income was  no doubt also  an obstacle to
Hunter's success: for though his personal habits were very  inex-
pensive, his scientific inquiries required more money than he could
wrell afford.  He was therefore obliged to be content with establish-
ing himself in the plainest manner, and living a retired  life ;  and 
THE LIFE OF JOHN HUNTER.
27
though this no doubt enabled him with more freedom to pursue
those important objects  in which he was  about to engage, yet it
would not  be likely to conduce to his speedily increasing  his pro-
fessional connexions.  It is in this respect, that, cceteris paribus, a
man commencing with a moderate share of fortune has a decided
advantage  over the fortuneless ;  for though  it has been truly said
that " moneys are not the sinews of fortune, but  the  sinews and
steel of men's minds,—wit, courage, audacity, resolution, temper,
industry, and the like,"  yet even he who declared this, has allotted
the second place to " wealth and means."
  But besides these external difficulties which most  men  have to
struggle with in a greater or less degree at the outset of life, there
were in Hunter's case some great impediments arising out  of  his
own character.  He  was deficient in  those refined gentlemanly
feelings, and those conciliating manners, which in all situations  go
far to win  the good will  of  those whom  we are  in the  habit of
meeting in the daily intercourse  of life, and are especially  requisite
iri the medical profession.   Conscious of great mental superiority,
he was too apt to show this in  a  rude and overbearing  manner,
towards men who in station were his equals, and  exhibited  some-
what too large  a  share of  that " pride of port" which  the poet
assigns to those

             Intent on high designs, a thoughtful band,
             By forms unfashion'd,  fresh from Nature's hand.

Consequently, though the  intrinsic  excellences of  his character
insured him the friendship of a few, who  knew and  estimated  his
worth, this fault raised  up  against him many bitter  enemies, and
prevented him from  ever  becoming a  general favourite  with  the
profession.  It might probably with justice be said, that of all who
have attained to the highest rank as surgeons, no one ever rose so
entirely by the pure force of superior talents as  John  Hunter, or
was less indebted than he was for his success to the good  will and
assistance  of his contemporaries.
  Hunter had also a great contempt for those minor  tactics,  which
constitute so large a part of what has been aptly called the art of
rising in the world; and they who have carefully watched the pro-
gress of  men to fortune, know full well how much of their success
has often been due to the judicious management of these auxiliary
means.   It would be egregious folly to suppose that a man could ever
attain to high repute as  a surgeon in London, without possessing a
large share of the essential requisites for the practice of his pro-
fession ;  but, on the other hand,  it requires no  great  penetration to
perceive that  the vast  difference in  the  amount  of her  favours,
vouchsafed by Fortune to her different votaries, must be accounted
for in some other  way  than by  the amount of  professional talent
possessed by each.   " He that is  only real had need have exceeding
great parts of virtue," says Bacon, " as the stone had need be rich, 
28
THE LIFE OF JOHN HUNTER.
that is set without foil;" and we need not a better illustration of the
truth of this observation, than is afforded by Hunter's tardy progress
in the path to fortune, compared with the rapid  strides of others,
who in professional attainments would  be the first to acknowledge
themselves but the humble disciples of this great master.
  But after all, perhaps, the principal reason why Hunter was so
long in obtaining a large share of practice was, that he looked not
as most men do, to the  acquisition of fortune as the end  for which
he was labouring;  but, on the contrary, considered wealth only as
a  means  by  which he might advance  the  far  more  important
objects he had  in view.   His  powerful  mind was  unceasingly
stimulated by an ardent desire to forward the acquisition of those
branches of knowledge which to him appeared  best  fitted  to pro-
mote the improvement of his profession ; to this object was devoted
every hour that  he could spare from his daily avocations, or snatch
from the time allotted by others to sleep, and to promote this end he
was always ready to sacrifice the claims of worldly prudence  and
self-interest.   To witness an interesting  or extraordinary case he
would take  any trouble,  or  go almost  any distance,  without a
chance of pecuniary recompense; but to the daily routine of prac-
tice he always returned unwillingly, and even when he had acquired
a lucrative and  extensive  business he valued  it  only  as affording
him the means of pursuing his  favourite  studies.  This-feeling he
would often express to his friend  Mr. Lynn, when called to see a
patient, by saying, as he unwillingly laid by his dissecting instruments,
" Well, Lynn, I must go  and earn this d-----d  guinea,  or  I  shall
be sure to want it to-morrow."#
  As a means  of increasing his  income, Hunter determined on
delivering lectures on anatomy and operative surgery to a  private
class.  These he  continued for several years;  but so  far were his
talents and his enlightened views, from exciting  the attention they
merited, that his hearers never amounted to  twenty.   Amongst
them, however, were numbered Cline, Lynn, Brande, Adams, Vaux,
and Justamond.   " Dr. Garthshore,f too," says our modern Demo-
critus, the late worthy  and facetious William Wadd, "occasionally
looked in, wound up his watch, and fell asleep."
   Hunter's leisure hours were never allowed to remain  unemployed.
He returned to the study of comparative  anatomy with increased

  * Hunter was much addicted to swearing, and constantly interlarded his con-
versation with expressions of  this sort.  In  relating anecdotes respecting  him,
the author has generally omitted these expressions, since the objections to in-
troducing them appeared to him greatly to  outweigh any  advantage that  such
verbal exactness could afford.
  -f- Dr. Garthshore was quite a physician of the old school, always well dressed,
and exceedingly polite, and a great favourite with the dowagers.  He was in-
 timate with John Hunter, who did not however treat him with much ceremony.
 One day the Doctor, on entering the dissecting-room where Hunter  was at work,
 began as usual with great empressement, " My d-e-a-r John Hunter"—" My dear
 Tom Fool," replied Hunter, looking up and imitating the  tone  and manner of
 the astonished Doctor. 
THE LIFE OF JOHN HUNTER.
29
 delight; and to furnish subjects for his researches, he obtained the
 refusal of all animals which chanced to die in the Tower, or in
 those smaller zoological collections, which used at that time, more
 frequently than at  present, to perambulate  the  country;  and to
 insure the good will of the owners, he used to allow them a life in-
 terest in any rare animals he was  able  to purchase, oil condition
 that their carcases  were restored to him after their decease.  All
 the money he could spare was devoted to procuring curiosities of
 this sort, and Sir Everard Home used to state, that as soon as he had
 accumulated fees to the amount of ten guineas, he always purchased
 some addition to his collection.   Indeed, he was not unfrequently
 obliged to borrow of his friends, when his own funds were at a low
 ebb and the  temptation was strong.  " Pray, George,"  said he one
 day to Mr.  G. Nicol* the bookseller, with whom  he was  very
 intimate,  " have you got  any money in  your pocket?"   Mr.  N.
 replied in the  affirmative.   " Have you  got five guineas 1 because
 if you have,  and will lend it to me, you shall go halves."  "Halves
 in what ?" inquired his friend.  " Why, halves in a magnificent tiger,
 which is now dying in Castle Street."  Mr. Nicol lent  the  money
 and Hunter got the tiger.
   It was probably about this  period that Hunter laid  the  plan of
 those vast researches  into the animal ceconomy, to the execution
 of which the best hours of his future life were to be devoted.
   At the time he  commenced his labours, surgery, though holding
 a far more respectable station as a practical  art than it had  done
 fifty years before, was yet destitute of those sound  general views
 of the nature and treatment of disease which  constitute  the founda-
 tion of practice in  the present day, and  the possession of which
 justly entitles it  to  claim the rank of a  science.  The able  men
 who,  in this  country and on the Continent, immediately preceded
 Hunter, had  succeeded, by the exercise of correct observation and
 sound judgment, in removing a load of absurd practices with which
 the art had been clogged; but the improvements suggested by them
 depended for the most part on isolated experience, and were  defi-

  * Mr. Nicol,  bookseller to the king, and a highly accomplished  scholar, was
 father to the present Mr. W. Nicol of Pall Mall, who probably owes his life to
 Hunter's interference.   Mrs. Nicol, who was asisterof Cruikshank, had lost five
 children, and was in the family-way for the sixth, the present Mr. N.  Hunter,
 in passing one  day, dropped in, and asked Mr. Nicol whether he intended to
 kill this, as  he  had killed all the  rest of his children.  Mr. N., who was a
 North-countryman, had  on false principles endeavoured to inure his children to
 cold and rough usage, thinking that if they could  not survive  this they would
 never live to be reared to manhood.  Not understanding such a question, there-
 fore, he demanded of Hunter what he meant.  " Why," said Hunter, "do you
 know what is the temperature of a hen with her callow brood ? because if you
 don't, I'll tell you."  He then proceeded to explain the necessity of warmth to
young animals, and convinced Mr. Nicol of the propriety of changing his plan ;
which he did, and with  complete success.  The justice of Mr. Hunter's remarks
on this subject, which is one of great importance, has been beautifully illustrated
by Dr.  Edwards's admirable experiments  in his  work "On the  Influence of
Physical Agents on Life," &c. 
30
THE LIFE OF JOHN HUNTER.
cient in a solid and  satisfactory foundation upon well known prin-
ciples of the animal ceconomy.   As yet little had been done towards
explaining the real nature of diseases, by showing in what particulars
they are allied to natural processes, and what  are the aberrations
from those processes, which give them  their peculiar character.
Nor were the actions by which  Nature  operates  in  the  cure ot
diseases at  all better understood,  and the  most vague  notions pre-
vailed respecting the  important functions of nutrition and absorp-
tion, and the processes of adhesion, suppuration, granulation, &c;
the right understanding of which, forms as it were the  very corner-
stone of a good  surgical education at the present  day.
  Hunter perceived  the  want of  this knowledge, which in his
opinion could alone  furnish a sure foundation for the future im-
provement  of surgery;  and it was to contribute towards supplying
the deficiency that his  labours were hereafter to  be unceasingly
directed.
  He clearly saw, that in order  to  obtain just conceptions of the
nature  of those  aberrations from healthy actions which constitute
disease, it was necessary first to understand well the healthy actions
themselves: and these required to be studied, not  in man alone, but
throughout the whole animal series, and even to  receive further
elucidation by comparison with the functions of vegetable life.   It
was no less an undertaking, then, than the study of  the phenomena
of life,  in health  and disease, throughout the whole  range of organ-
ised beings, in which Hunter proposed to engage ;  an undertaking
which  required a genius like his to plan, and from the difficulties of
executing which, any mind less energetic, less industrious, and less
devoted to  science than his own would have shrunk.
   In pursuing  these researches, he  strove not, like  many  of his
more learned but less philosophic predecessors, to unravel the mys-
teries of nature by taking up some principle d, priori, and seeking
for facts to  support his theory.   On the contrary, he followed, in
the strictest  manner, the  inductive method laid down by the great
father of modern philosophy, as the only sure though arduous road
to  knowledge.  He  aimed not at discovering the essence of life,
satisfied that  this was  beyond  the  province of philosophical  re-
search ; but he  sought  to know how the various organs are con-
structed, and how they act in accomplishing those various processes
'by which the presence of this  principle is manifested.   Nor was he
content to  acquire his information at  second hand.   Instead, there-
fore, of referring to the discoveries detailed in books,* he appealed
directly to  Nature herself, and rested nothing upon  the facts related
by others,  until, by the evidence  of his own senses, he had  ascer-
tained their truth.
   As the labours of Hunter in this  field  of knowledge were con-

   * It often, therefore, happened to him, as it has done to others, to find that he
had been anticipated in many discoveries : such confirmations, however, of pre-
viously discovered truths are always valuable, particularly when they depend on
 a distinct line of proofs. 
THE LIFE OF JOHN HUNTER.
31
tinued  during his whole life,  and as the various discoveries he
made will require to be mentioned in noticing his publications, and
more fully in the chapter devoted to a description of his museum, it
will be unnecessary to enter into a detail of them in this place.  As
many of the inquiries which he was  desirous of instituting  could
not be carried on conveniently, if at all, in the centre of a crowded
city, he purchased a piece of ground called Earl's Court, at Bromp-
ton, about two miles from London, and built a small house, where
he used to spend much of his  time, and where he pursued most of
those researches which form the subject of his papers in the  Philo-
sophical Transactions, or are detailed in  his work  on the Animal
CEconomy.   Here  it was his delight to spend  an hour or two,
amono-st the strange inmates congregated  from all  parts  of the
globe,°engao-ed in observing their habits and instincts,  and amusing
himself in making them exert their various methods of self-defence
 against  his playful attacks.   As might be expected, he sometimes
 got himself into perilous situations in his character of assailant. On
 one such occasion he was thrown down by a little  bull which the
 Queen had  given him, and with which he had been  wrestling; and
 had not one of his servants accidentally seen his danger, and driven
 off the victor, he would not have escaped without severe  injury.
 In another  of his adventures,  still more serious consequences might
 have ensued.  Two leopards, which he kept chained in an outhouse,
 broke from their confinement, and got into the yard with the dogs:
 a  fierce encounter immediately commenced, the  noise of wntch
 alarmed the neighbourhood, and  quickly brought out  Hunter to
 inquire into its cause.  He found one of the leopards engaged with
 the dogs, whilst the other was making his escape over the wall, and
 instantly, though quite unarmed, he ran up and laid hold of both
 the  animals, which fortunately submitted to  be  led  back to theu-
 den and secured.  When the danger was over, however, he became
 «o agitated at the  recollection of it, that  he fainted.
    In 1767  he was elected a Fellow of the Royal Society;  and
 although persons,  except on account of their rank,  are not gene-
 rally admitted  members before they have furnished  some paper of
 original research to be read before the Society, yet this  custom
 seems not to have  been rigorously enforced in Hunter's case, as the
 only communication  he  had made was an appendix to  a paper by
  Ellis on a new marine animal, the Proteus ;  nor did he contribute
  anv entire paper to their Transactions until five years after:  he was,
  however, a very regular attendant at the meetings of the Society,
  and, with  Sir  C.  Blagden  and others, used to meet and  discuss
  papers, which had been presented, on topics of interest.
    It is somewhat singular  that John  Hunter  should  have been
  elected before his  brother William, who had been  ten years longer
  in London, and certainlv at  this time occupied a higher station in

  P1!iCw0aPsitn,htanyeardttt he —! his tendo-Achinis whi,,
  dancing, after the muscles of  the leg  had been fatigued.   He  did 
32
THE LIFE OF JOHN HUNTER.
 not confine himself to bed  for this accident, but continued to walk
 about during the cure.  His mode  of treatment was  to  keep the
 heel raised, and to compress the muscle gently with a roller, by
 which any fresh separation of the ends of the tendon by spasmodic
 and involuntary contractions of the  muscles was prevented, for he
 found that by no voluntary  impulse could he excite them to contract
 after the rupture of their tendon, '• the muscle refusing to act as if
 from a sense  of imperfection," as he expressed it.  This  accident
 led him  to examine into the process  by which divided tendons are
 reunited. He divided the same tendon in several dogs, by introducing
 a couching-needle under the skin at some distance from it, and killed
 the dogs at different periods to see the progress of the union, which
 was found to be similar to  that of fractured bones where  the skin
 is not wounded.  It was ascertained  at Mr. Hunter's death that the
 union of the ruptured tendon was by ossific deposition.
   In 1768 a vacancy occurred  at"St. George's Hospital, by the
 retirement of Gataker,  the translator of Le Dran; and Hunter
 became  a candidate for the situation.  He was opposed by Mr. D.
 Bayford, but being supported by the powerful interest which Dr.
 Hunter possessed, he  was elected surgeon on the 9th of December
 by a  majority of 114 votes against  42.   Soon  after this he was
 chosen a member of  the Corporation of Surgeons; but he  seems
 not to have  assimilated  well with his brother corporators, for he
 gave them but little of his society.  By his election to the hospital
 he was ensured the means of making his talents as  a surgeon more
 generally known, and was  enabled to obtain as private pupils, on
 advantageous terms, young gentlemen coming to town to complete
 their  medical education.*  This  was further facilitated by his re-
 moval to a more commodious  house in  Jermyn-street, which his
 brother had just vacated.
   Dr. Hunter had, in  the year 1765, in the most liberal way  pro-
 posed to the then Ministry  to build a public theatre of anatomy, at
 an expense to himself of 7000/.,  and to endow a professorship of
 anatomy in perpetuity, on condition that they would grant a  piece
 of ground in the Mews as a site for the building.  But Lord Gren-
 ville and his colleagues, with the apathy which the English Govern-
 ment has too often shown to the interests  of science, declined the
 offer.  Lord Shelburne was desirous that the plan should be exec uted
 by subscription, and generously requested his  name  should be put
down for one thousand guineas.   Dr. Hunter's delicacy, however,
led him  to  decline this  proposal, and he determined to erect a
building at his own expense.  For this purpose, he purchased a spot
of ground in Great Wind-mill-street, where  he built  a  spacious
house, with a theatre and museum, to which he removed in  1770
passing over the lease of his  house in Jermyn-street to his brother
 John.                   t

  * Hunter received a fee of 500 guineas with each of his  pupils, who were
 bound to him for five years. 
THE LIFE OF JOHN HUNTER.
33
  Amongst those gentlemen  who  successively became  inmates of
Hunter's house,  as private pupils,  were Dr.  Jenner,  Mr. Guy of
Chichester, Mr.  Kingston, Dr. Physick of Philadelphia,  and" Sir
Everard Home.  Mr. Lynn and Sir A. Carlisle, although not living
in his house, were admitted there on the most intimate terms, assisted
in his dissections, and contributed  several valuable preparations to
his  museum.  All of these gentlemen have risen to high reputation
in their various stations, and  it is not unworthy of remark, that of
the eminent surgeons of which this country has had to boast, by far
the greater number have pursued the most  important part of their
professional education under  the roofs, and as the private pupils, of
the most able of  their predecessors in the art.  This may no doubt,
in some cases, be accounted for by supposing that the  disciple had
previously shown such talent as to lead his friends to seek the best
situation for its improvement;  but more has been probably due to
the stimulus imparted to their energies by the examples before them,
and still more to the advantages derived from daily witnessing the
best modes of practice,  and  receiving information on  those  nicer
distinctions  in treatment which can never be fully conveyed in
lectures, but the  knowledge of which forms a  distinguishing mark
of the  accomplished surgeon.*
  It is to the credit of the gentlemen above named that they con-.
tinued on friendly terms  with Hunter until his death,  for  he not
unfrequently conferred his friendship rather hastily on young men if
he  perceived any thing in their characters which pleased  him, but
as  suddenly threw  them off again on finding them to be of less
sterling metal  than he had  anticipated.!                          ■
   Dr. Jenner was amongst the earliest  of Hunter's pupils,  having
become one in 1770,  when  he was in his twenty-first year, and
Hunter in his forty-second.   His mind was ever strongly impressed
with respect and esteem for  the  character of  his  great master,
whose vigorous and independent intellect excited the  admiration,

  * Thus we find that most of the surgeons who in the present  day enjoy the
largest share of the  public confidence are, as it were, the direct mental descend-
ants of the men who a century ago introduced the first important improvements
into modern surgery.  Cheselden,  Nourse, and Douglas, were  then the leaders
of our profession, of whom  Sharp, Pott, and the Hunters  were the  immediate
pupils ; they, again, became the instructors of Cline, Lynn, Home, Abernethy,
Carlisle, Macartney, Sir James Earle, and Cooper; and  from them  the mantle
has descended to a Brodie, a Lawrence, a Green, an Earle, and others, who now
occupy with so much  credit to themselves the  places  which their great prede-
cessors adorned.
  f Hunter set a high value on anatomical skill, and especially on dexterity in
making preparations.  Sir Anthony Carlisle stood high in his good  graces on
account of his ability in this art;  but he used to abuse Sir Everard's clumsy
fingers, swearing "  that his fingers were all thumbs, and that he would never
have sense enough to tie down a bottle."  This was of course a  mere sally of
passion : his engaging him as his assistant, and leaving him the care of all his
patients when unable to attend them himself, sufficiently proved the  good opi-
nion he entertained  of the abilities of his brother-in-law, who was, there can be
no doubt, a very skilful surgeon.
                                5* 
34
THE LIFE  OF JOHN HUNTER.
while his kind, free, and manly nature insured the affection of such
a pupil.  Their  intercourse  did  not cease on Jenner's leaving
London, but was kept up  by letter until  within  a  short  period  of
Hunter's death.  Many of the letters written by the latter have been
published in Dr. Baron's Life of Jenner ; and these, as well as some
additional  ones  which  Robert  F. Jenner, Esq., of Berkeley,  has
kindly permitted to be introduced into this work, furnish interesting
and  truly characteristic memorials of the mind of him who penned
them ; for though generally but brief, and  often faulty in orthography
and  in grammatical construction, they everywhere show the vigour
and  originality of his  thoughts, and the untiring ardour with which
he  prosecuted  his researches.   Several of these letters will be
inserted in the next chapter, but the following,  though written two
or three years later, may be introduced here, as evincing the interest
Hunter felt in  the  welfare of a  deserving  pupil.  Jenner, on the
other hand,  never  mentioned Hunter but in terms of regard  and
affection;  his usual appellation for him  was "the dear man," an
epithet which is used, in speaking of him, by others  of his friends
who still survive,  and which shows how  strong  a  hold he  had
acquired on the esteem  of those who were  on  sufficiently intimate
terms with him to  know his real worth.
    "Dear Jenner,
  " I received yours, and was  extremely happy to hear of your success in  busi-
ness : 1 hope it will continue.   I am obliged to you for thinking of me, especially
in my natural history.  1 shall be glad of your observations on the cuckoo, and
upon the  breeding  of toads :  be as particular as you possibly can.  If you can
pick me up anything that is curious and prepare it for me, either in  the  fish  or
flesh way, do it.  Pictures* have been very cheap,  but the season is now  over.
There will be but  one sale, viz. Fordyce's ; but I believe all his  pictures are
exquisite, and will go beyond you or me.  Since you wrote to  me I purchased
up a  small landscape of Barrett's, of cattle and herd : I gave five pounds seven
shillings and sixpence : it is one of his eight-guinea pictures. You shall have it
or not, as you please.  I have one of the same size that I bought of him  some
time  ago.
  " I saw the  young lady, your patient: I do not know well what can be done.
If it is possible to pass a bougie from the nose up the duct to the sac, it mioht
be of service; but  nothing  but a solid can be of any use  as a local application.
Her general habit should be attended to, such as sea-bathing, or cold bath, using
a good deal of gentle  exercise, such as getting up early  in the morning, riding,
&c.  She might take gentle mercurials with the bark and cicuta.  Let°me hear
from you soon.
                                   "  Ever yours,    John Hunter."
   At the time this was  written Jenner was practising as a surgeon
at Berkeley in Gloucestershire.   Here he remained for many years,
and conducted those inquiries  which, led  to  the introduction  of
vaccination.  It seems  that  whilst  in London  he frequently men-
tioned the opinion  that prevailed in the dairy districts, that persons
who had had the cowpox were safe against the infection  of  small-
  * Hunter was very fond of pictures, and valued himself on his connoisseur-
ship in the art: his other pursuits, however, prevented his indulging his  taste
by the purchase of many oil paintings, but of prints he had a large and valuable
collection. 
THE LIFE OF JOHN  HUNTER.
35
pox.   Hunter  considered  the  subject  worthy  of  investigation,
mentioned the opinion occasionally in his lectures, and recommended
Jenner to  prosecute further inquiries into  its truth.  There is no
ground, however, to suppose that Hunter assisted him in the investiga-
tion, as has sometimes been insinuated.  On the contrary, it is quite
evident that the merit of conducting every part of it belongs exclu-
sively to Jenner.   As his letters to Hunter have been destroyed, it
is not possible to say what  communications he made to him on the
subject, for no allusion is made to  the inquiry in  Hunter's letters.
It would seem that in  1788 Jenner was  in  London, and on  that
occasion showed a drawing of the vaccine  pustule, as it appeared
on the fingers  of milkers, to several medical men, and amongst the
rest, no doubt, to Hunter.   Indeed there exists, amongst the Hun-
terian drawings, a rough sketch of the pustule, as  seen under the
above circumstances, on the envelope of  a ietter  from  Jenner,
without date.   It was not, however, until  eight years  after  this,
and three years after Hunter's death, that the question was subjected
to the experimentum crucis,  by actually inoculating  a  boy  with
lymph from the hand of a person affected with cowpox, and after-
wards submitting him, without effect, to inoculation with variolous
matter:  and even then  nearly  two  years elapsed before Jenner
considered the inquiry sufficiently complete to be made public*
   In May 1771, Hunter published the first part of his "Treatiseon
the Teeth."f  This contained the natural history of those organs in
their healthy state, and was followed in 1778 by a second part, in
which he  treats of  their diseases.  It was  the  first work on the
subject, which, in  addition  to an  accurate anatomical description,
furnished  comprehensive views of the physiology and pathology of


   * Various attempts  were made to deprive Jenner of the credit of his discovery,
but unjustly.  That an opinion  prevailed extensively in the dairy districts, that
a person who had been infected with cowpox was no longer liable to smallpox,
is certain ; but no one who is acquainted with the utter groundlessness of  many
prevalent opinions on  medical matters would put much faith in such an opinion
until supported  by direct experiments, instituted by a competent person.  It
would further appear, that a farmer Jesty had actually inoculated  some of his
family with matter taken from the teat of a cow ; and claims to the discovery of
vaccination  were made on behalf of a Mr. Nash of Shrewsbury, on similar
grounds.  But was Dr. Jenner acquainted with either of these cases 1  And if
not, how do they affect his merit any more than the existence of printing  at an
early date amongst the Chinese detracts from the merit  of the  discovery in
Europe]  With  regard to Mr.  Nash's  case, Dr. Baron  states that they were
proved to have been cases of smallpox inoculation.  But supposing them to have
been cases of vaccination, does not his silence on the subject until the publica-
tion of Jenner's work argue either a want of faith in his own powers of investi-
gation, or a want of courage to  publish  the facts'?  Does not the  whole  merit
belong to Jenner of distinguishing the true from the spurious vaccine—of tracing
the origin of the disease—of subjecting the opinion to the test of rigid experi-
ment, and of conducting his inquiries to a triumphant conclusion, amidst diffi-
culties and opposition of no ordinary kind ?
   t It is said that the proceeds of this publication, which came out only two
months before his marriage, were appropriated to defraying the expenses attend-
ant on that event. 
36
THE LIFE OF JOHN HUNTER.
these organs.  Like  all Hunter's productions, it  evinces marks of
accurate observation and sound judgment; and though too brief in
some of its descriptions, and not aTtogether free from errors and
omissions, which subsequent inquiries have pointed out, it continues
to hold its place as one  of our standard surgical  works.  It needs,
indeed, but  to  receive  the  additions  and corrections of the able
practitioner and accomplished  naturalist who has  undertaken to
revise it for this edition  of  Hunter's works, to become one of the
best treatises on the subject in this or any other language.
  Hunter had for some years been engaged to Miss Home, daughter
of Mr. Home, surgeon to Burgoyne's regiment of light  horse, and
sister of  Sir Everard Home. "As she was without  fortune, and as
his income, at the time they first became acquainted, was consider-
ably under a thousand a "year, and scarcely sufficed for his own
expenses, their  union was deterred until  he was able to arrange
his affairs  sufficiently to  allow of  their  marrying.   This he had
now succeeded in  doing; and as his practice was yearly augment-
ing, they were married  in July of the present year.
  Mrs. Hunter was an agreeable, clever, and handsome woman, a
little of a bas bleu, and  rather fond of gay society, a  taste  which
occasionally interfered with her husband's more philosophic pursuits;
for, though fond of mixing in society at his own house and at the
houses of others, it was not exactly in  such as  is generally to be
found at fashionable soirees.   He sought company, not so much as
a  relaxation as because he  preferred  acquiring knowledge from
conversation rather than from books; and this  being the case, he
naturally preferred the company of able and scientific men, to that
of  the gay circle  in which  Mrs. Hunter's brilliancy  was fitted to
shine.  So far was he indeed from finding relaxation for his mind
in mixed society, that he really experienced fatigue from remaining
long in  company  where the conversation wanted connexion ; and
he  therefore  occasionally   interposed [his marital  authority to
check the inroads of these troops of idlers.*  No serious disturbance
to their concord, however, seems to have arisen  from  this  very
natural difference  in the tastes of Mr. and Mrs. Hunter, and there
is every  reason to believe that this  alliance was  a  source of great
consolation and happiness to him during the remainder of his life.
The fruits of their union were four children, two  of  whom  died
young;  the other two are  still living,—John his eldest son, and
Agnes, who married Captain, afterwards  Sir James Campbell.

  * Hunter's mode  of exerting  this  authority was occasionally somewhat too
unceremonious.  On returning late one evening, after a hard day's fag, he unex-
pectedly found his drawing-room filled with musical professors, connoisseurs, and
other idlers, whom Mrs. Hunter had assembled.   He  was greatly irritated' and
walking straight into the room, addressed the astonished guests pretty much in
the following strain :  " I knew nothing of this kick-up, and I ought to have been
informed of it beforehand; but as  I am now returned home to study, I hope the
present company will retire."  This intimation was of course speedily followed
by an exeunt omnes. 
THE LIFE OF JOHN HUNTER.               37
                     CHAPTER  IV.

                         1772  to  1778.

Mr. Hunter's paper on the digestion of the stomach ;—his museum ;—his private
  practice;—his illness, attended with a cessation of the heart's action ;—his
  correspondence with Dr. Jenner ;—his paper on the torpedo ;—his lectures on
  surgery ;—his character as a lecturer.—Hunter effects a revolution in surgery ;
  __his paper on the receptacles for air in birds, and on the stomach  of the
  gillaroo trout.—The general character of his monographs.—Mr. Bell.—Mr.
  Hunter's warmth of temper;—his method of employing his time;—his punc-
  tuality.—Anecdote of Mr.  Cline.—Dictates his various compositions ;—his
  domestic habits;—contemplates the establishment of a school of natural his-
  tory ;—his paper on the heat of animals and vegetables;—is appointed surgeon
  extraordinary to  the King;—his paper on the recovery of drowned persons ;—
  Croonian lectures;—correspondence;—is attacked with an alarming illness,
  attended  with peculiar symptoms;—his visit to Bath ;—his character as an
  experimentalist;—his  second  part on  the teeth;—his expenses and difficul-
  ties.

Hunter had now been five years  a Fellow of the Royal Society;
but  deterred, partly by  the difficulty he experienced in  literary
composition, and  partly  by an  unwillingness  to make any of his
observations public until he had thoroughly satisfied himself of their
correctness, and  investigated a subject in all its bearings, he had
contributed no  paper to  the Philosophical Transactions since his
election.   About this time an opportunity offered for making known
his opinions  on a physiological  phenomenon which  had hitherto
entirely escaped investigation, and on which, at the instance  of Sir
John Pringle, he was induced  to communicate  his thoughts  in  a
memoir to the  Royal Societv.   Pringle was at this period the
President, and had distinguished himself in this honourable post by
the learned and eloquent orations he had  annually delivered, on
presenting the Copley medal to those who had successively gained
it by their  important contributions to  science.  He  and 'Hunter
were on intimate  terms,  and occasionally met in consultation, and
on the present occasion chanced to be engaged together in examin-
ing the body of a man who had died  under  Sir J. Pringle's care,
of "some disease in which the  stomach was thought  to  have been
not  implicated.   To Pringle's surprise, however, on  opening this
organ an extensive perforation was observed at its great end, an
alteration of structure for which he could not account, until Hunter
informed him that he had frequently met with such an appearance,
both in men  and  animals,  and attributed it to the  action  of the
gastric juice  on the  coats  of the  stomach, after the death of this
organ.   This explanation  forcibly  struck Pringle, who was  the
more interested in the  subject  from  having himself been engaged
some years  before in experiments on digestion.  He accordingly 
38               THE LIFE OF JOHN HUNTER.
urged Hunter to commit his thoughts to paper, and  communicate
them to the Royal Society, a request with which the latter, though
somewhat unwillingly, complied.   His  memoir was accordingly
presented, and read on the 18th of June, and was published in the
Transactions for  the  year.  This curious question in physiology
did not at the time excite much attention.   Spallanzani, who made
several experiments, with a view to its further elucidation, concluded
by rather  throwing  doubt on  the possibility of  this post  mortem
digestion, and the point was thus  left sub judice.  Of late years
more attention  has been  paid  to  the inquiry, and though  several
continental pathologists,  and  amongst  others  Cruveilhier,  have
maintained that the  appearance  described by Hunter is  always
caused by morbid action going on during life, the  experiments of
Dr. Carswell, detailed in the  Edinburgh Medical  and Surgical
Journal  for  October  1830, have  fully proved  the  correctness of
Hunter's explanation.  This gentleman killed several rabbits during
digestion, and hung them up by the hind legs, when the depending
part of the stomach was always found more or less digested.  The
gastric juice of one rabbit was conveyed into the stomach of another
previously killed, and  digestion of a part of its stomach was  the
consequence.
  In the autumn of  this year  Hunter's brother-in-law, Mr., after-
wards Sir Everard Home, became his pupil.   He  describes  the
museum as at this time beginning to  assume an  imposing degree
of  magnitude.  All the  best  rooms in the house  were  already
devoted to its reception ;  and though, from the increase of his pro-
fessional engagements, Hunter  had less  time to devote to compara-
tive anatomy, yet as he  always spent three  or four  hours before
breakfast, and as much time as he could spare during the remainder
of the day, in the dissection of animals, he was constantly adding
to its size and value.   His increasing reputation as a naturalist,
also, facilitated to him the acquisition of objects on which to pursue
his researches,  as it induced scientific travellers to send him speci-
mens of rare and curious animals, assured that they  could not bet-
ter forward  the cause of science than by conferring  them  on one
so ardently devoted to its promotion.  " Hunter's private practice
and professional character," adds Home,  " were  at  this time  ad-
vancing fast;" and yet his income, until 1774, never reached a
thousand a  year, a convincing  proof  how much his fame as a
naturalist had outrun his fortune as a surgeon.
   In the spring of the year following  Hunter suffered under an
alarming attack of spasm, apparently seated about  the  reo-ion of
the pylorus,  but attended with  a  cessation of the  heart's action,
which lasted three quarters of an hour, in defiance of various active
remedies suggested  by Dr. Hunter, Sir George Baker, Dr. Huck
Saunders, and Dr. G.  Fordyce, who were hastily called  in on  the
occasion.  The complaint was probably of a gouty nature, for he
had this year escaped  a regular fit of gout, such as he had  suffered
from during the spring of the  three preceding years; but  the  im- 
THE LIFE OF  JOHN HUNTER.
39
mediately exciting cause was a violent mental affection, the nature
of which Sir Everard Home  does not mention.  During this attack
the sensation and voluntary actions continued unaffected, and Hun-
ter continued  to respire  by  a voluntary  effort,  with a view of
keeping himself alive ;  though, as he afterwards observed, the con-
tinuance of respiration was probably of no service, as the circulation
had ceased.*   This seems to have  been the first warning he  re-
ceived  of the existence of disease about the heart;  although it never
again manifested  itself by an exactly similar attack; nor was it
until  several years  after that this organ became permanently  de-
ranged in its actions.
   It  has  been  stated,  in the preceding  chapter, that soon  after
Jenner settled at Berkeley, Hunter entered  into a correspondence
with  him, which was kept up nearly to the period of his own death.
Hunter's letters alone have  been  preserved, and  these  consist, for
the most part, of requests to his former pupil to procure for  him
various objects of natural history, which a residence in the country
rendered easily attainable, or of directions respecting  experiments
to elucidate those inquiries into  the vital  actions,  in which  Hunter
was  constantly engaged, and in the  prosecution  of  which  Jenner
was  always ready  to lend his valuable aid.   The letters seldom bear
any date, but when this can be  ascertained, either from  the  post-
mark  or from  the  nature of their  contents, it will serve  as  the
guide for their insertion in this and the succeeding chapters.  The
following one appears  to have been written somewhere about this
time.
     " Dear Jenner,
   " I received yours, as also the cuckoo's stomach : I should like to  have a few
more, for they do not all show the same thing, f  If possible, I wish you could
remove  the cuckoo's egg into another bird's nest, and tame the young one, to
see what note it has.   There is employment for you, young man !  If you collect
eggs, you should also collect the nests, and I do not care  how many you send.
I wanted a crow's nest as  also a magpie's, in the branches of the trees where
they are built, but I am afraid it is now too late.
   "This evening, looking into my book of patients to scratch out the name of
one who had paid me,  and whose  name began with M., I saw a Mr. Matthews
of  Berkeley, recommended by you.  He did not pay me.  I forget  whether he
was recommended by you as a friend to serve him or me ; if it was to serve him,
I scratch him out of my book.  Do you keep an account of the observations on the
  * This  curious  fact in physiology has never been  satisfactorily explained.
Bichat and his school insist on the necessity of arterial  bjood constantly circula-
ting through the brain in order to the continuance of its functions, but here we
find its functions going on though the circulation had  ceased.  In the collapse
of cholera, the sensorial functions continue perfect for hours after all perceptible
circulation has ceased, and when the blood is as dark as pitch.
  j The internal coat of the cuckoo's stomach is found  thickly set with the hairs
of caterpillars on which it feeds.  These hairs are laid circularly over each other
in one direction, showing the circular motion of the two portions of the gizzard,
on each other, in grinding the food.   It is to this, probably, that Hunter alludes,
as there is a preparation in the museum showing this fact.  Jenner  had  now
commenced his observations on the hatching and rearing  of  the cuckoo, which
were communicated many years after to the Royal Society. 
40
THE LIFE OF JOHN HUNTER.
 cuckoo, or must I refer to your letters ?  I want a nest with the eggs in it;  also
 one with a young cuckoo ; also an old cuckoo. I hear you saying, there is no
 end of your wants.
                                            " Ever yours,
                                               "John Hunter."

   The phenomena of electricity had of late begun deeply to engage
 the attention of scientific men.   Mr.  Walsh was one who  had
 devoted much  attention to the subject, and who had been making
 experiments, to ascertain whether the shock communicated by the
 Torpedo is analogous to that of an electrical battery.  Being anxious
 to learn the exact'anatomical arrangements of the  parts in which
 the peculiar power resides, he  requested Hunter  to  examine  them,
 a request with  which the latter willingly complied, and in July com-
 municated, in a paper to the Royal Society, an accurate description
 of the electric organs of the Ray, and pointed out the vast nerves
 with which they are supplied as the probable source of their pecu-
 liar power.
  In the autumnal  session of  this year, Hunter  for the first time
 delivered  a course  of  lectures  exclusively on surgery.   These
 lectures were for the first two years given gratuitously to the pupils
 attending  St. George's  Hospital, but after that  the  usual fee for
 admittance was required.
  It has been before observed that he appeared but to little advan-
tage as a  lecturer; his language, though forcible, was inelegant,
 and often coarse ;* his delivery was heavy and unengaging, as  he
rarely raised his eyes from his book;  and  as, in addition  to this,
the doctrines he taught were new, and often obscure  and theoreti-
cal, his  hearers were never numerous.  The many who found it
troublesome to think, and  desired  only straightforward directions
 for every day practice, sought other teachers ; for notwithstanding
the length of the course, which in late  years extended to eighty-
six lectures, he  entered but little into the minuter  details of practice,
 and gave little or no account of the, operations of surgery, but con-
 fined himself almost exclusively to the theory and principles of the
 art.
  It was  an instance of  Hunter's perseverance,  that though his
 dislike to  delivering himself in public  was so great that he never
 commenced a course of lectures without having  recourse to lauda-
 num to relieve his uneasy feelings, he notwithstanding continued the
 practice of lecturing for many years.   He was induced to this  by
 other motives besides the more obvious one of increasing his repu-
 tation : his opinions were for the most part peculiar to himself; he
 was desirous of subjecting them to the  test of public opinion,  and
  * In speaking, for example, of a case of gun-shot wounds, he described  the
 ball, as " having gone into the man's belly and hit his guts such a d—d  thump,
 that they mortified."  And in relating his own case, where secondary symptoms
 had ensued on inoculation with the matter of chancre, he repeated over so often,
 and in so peculiar a tone, " I knocked down the disease with mercury and I
 killed it," that the whole class at length burst  into a loud  fit of laughter. 
THE LIFE OF JOHN HUNTER.
41
thought this the best mode  of doing it, until  they were sufficiently
matured in his own mind to be committed to print; he felt also that
the practice of lecturing was beneficial to himself, by discovering
to him the amount of knowledge he possessed on any subject, and
when this knowledge was deficient.*  In this respect he was accus-
tomed to compare the process of preparing a lecture to that of a
tradesman taking stock.
   Boldness and independence in the pursuit  of truth,  one of the
striking characteristics  of  Hunter's mind, was  well exhibited in
these lectures.  He attached no value to opinions, except they could
be shown to be firmly based  on fact: fallacious  reasoning, though
ingenious,  he  quickly saw through, and instantly demolished; and
he was not more indulgent  towards his own theories when  he dis-
covered  them to be erroneous.  To a pupil (Sir Astley Cooper)
who asked with surprise, whether he had not the year before stated
an opinion on some point, directly at variance with one he had just
put  forth; he replied, "Very  likely I did;  I hope I grow wiser
every year:"  and to the same purport he answered Professor Cole-
man  (another of  his pupils), who asked whether he had  not  writ-
ten so and so; " Never ask me what I have said, or what I have
written; but  if you will ask  me what my present opinions are, I
will tell you."   Occasionally, too, he would say to any of the pupils
whom he saw taking notes, " You had better not write  down  that
observation, for very likely  I  shall think differently next year:" and
on one occasion, after lecturing for  a considerable time, he stopped
short, raised his spectacles, and said, " Gentlemen, I think you had
better omit what I have been  saying; the  fact  is, I had an  idea
when I wrote down this, but I have lost the train of thought  con-
nected with it, and I cannot now  recall  it."f   Such a  mode of
lecturing was not likely to become popular; his class consequently
never exceeded  thirty, and  not half that number derived much
benefit by their attendance.   Those, however, who would take the
pains to understand what  they heard, set a  high value  on these
lectures, by which, perhaps even more than by his writings, Hunter
originated  that  revolution in surgery, of the occurrence of which
none  can doubt, who compares  the best surgical works written half
a century since, with those  of the present time.

  * " Reading," says Lord Bacon, " makes a full man, conference a ready man,
and writing an exact man."  Public lecturing, and more particularly  extempore
lecturing, combines these advantages  in a remarkable degree.
  f This was a difficulty he not unfrequently experienced. After thinking deeply,
he would make short notes of his thoughts, on looking at which some time after
he would find them unintelligible until his mind was prepared to fall  again into
the same train  of reasoning.  It may fairly be questioned, when Mr. Hunter
had got so deep, whether he had  not got out of his depth. At least from the
specimens we have  of his hypothetical reasoning, we have no reason to regret
that he did not oftener indulge in it.   Dr.  Beddoes observed: "John  Hunter
fancied that  what he could not  find  words for was very profound : but he was
mistaken; whenever he found himself at a loss for words, he  was  labouring
with the delivery of nothing."—Dr. Beddoes's Common Place Book.
                                6 
42              THE LIFE OF JOHN HUNTER.
   We find, accordingly, that  most of the eminent surgeons who
immediately succeeded to the time of Hunter, were at  one period
or other attendants  at  his lectures; and that in effecting those im-
provements which they were  the  means of introducing into the
practice of surgery, they pursued that path  into which he  had
directed  their steps  at the very  outset of their career.   Besides
those before mentioned, we must enumerate the names of Home,
Carlisle, Abernethy,  Astley Cooper,  Wilson,  Chevalier, Macart-
ney, Coleman, and" Physick; and others might no  doubt  be men-
tioned, who have, like them, done honour to the surgical profession
in this century.
  In  1774  two papers  by  Hunter were read before  the Royal
Society, and published in  the  Transactions.  The first of these
contains a  general account of the receptacles for  air which  are
found in the abdominal cavity, the cellular tissue, and bones of birds.
In the second, a description  is given of the stomach of the Gillaroo
Trout, a peculiar species of trout found in some of the  lakes in
Ireland, the stomach  of which  is so thick and muscular, as to have
led to the name of Gizzard  Trout being applied to this animal.
  There  is  another  paper  on the subject,  in  this volume of the
Transactions,  by  Henry Watson, and  it is not uninteresting to
observe the different manner  in which the two men have handled
the same topic. Watson has contented himself with giving a plain
anatomical description of the organ, from which he draws the con-
clusion that it is not  properly a gizzard, but  only a very muscular
stomach.   Hunter arrives at the  same  conclusion, but has  given
interest to a rather meagre  subject, by introducing it with a general
view of the various  modes in which the  preliminary  process of
digestion, that of comminuting the food,  is effected  in  different
animals.  He points out the analogy between the gizzard of grani-
vorous birds and the grinders of mammalia; shows how, by imper-
ceptible gradations, we pass from the membranous stomach to the
gizzard ; and finally determines, that though the object to be effected
in the stomach of the Gillaroo  Trout  is very much the same  as in
the gizzards of birds, yet that in structure it more resembles a true
membranous  stomach  than a  gizzard.  The introduction of such
general remarks was a common practice with  Hunter  in treating
any anatomical question, so that the titles of his papers seldom afford
us any adequate notion of their contents. He  employs  the subject
treated of  as a text, on which he freely expatiates,  introducing
valuable original researches of a physiological  character  as a pre-
lude to some point in anatomy, which, separately considered, would
possess little interest.
  Hunter's increasing professional avocations began now to render
it impossible for  him  to devote as  much  time as he desired to
extending and perfecting his collection.   The field of his labours,
too, was considerably increased; on the one hand, by the opportu-
nities for the cultivation of morbid  anatomy, which his  connexion
with a hospital, and his increasing private practice afforded him; 
THE LIFE OF JOHN HUNTER.
43
on the other, by the augmented stores of rare and curious animals,
which the kindness of his friends, and  the  liberality of scientific
men, continually accumulated on his hands.  He therefore engaged
Mr. Bell, a young artist of considerable merit, to reside in his house,
and to devote himself, under his superintendence, to making anatom-
ical  preparations  and drawings,  and to  the  general care of the
museum.  Mr. Bell's engagement was for ten  years, and he even-
tually remained fourteen, in the course  of which time he became
an accomplished anatomist, and added a large number of valuable
preparations and several hundred admirable drawings to the collec-
tion.  He was also frequently employed by Hunter  as his  amanu-
ensis, and  some  of the catalogues  now in existence  are in  his
handwriting.
   The fact  that Mr. Bell remained so  much  longer  with  Hunter
than  he originally  engaged to do, is an evidence that he was not
dissatisfied with his  situation.   Probably,  like most  of  those who
were intimately acquainted  with this great  man,  he gradually
acquired a  strong personal attachment to  him, which  led him  to
tolerate the  violent sallies of passion to  which the inmates of Hunter's
house were not unfrequently subjected on  very trivial grounds.
Home states that " Hunter's temper was warm and impatient, readily
 provoked, and when irritated not easily soothed;" and this  account.
is confirmed by most of those who were intimately acquainted with
 him.  An intrusion  on his studies, even by one with whom he was
 on friendly terms, would call forth  expressions of strong  disgust
 and impatience:  an object of which he was in want being misplaced,
 would bring down all the vials of his  wrath on the  offender; and
 during these fits of passion he used to swear in the most outrageous
 manner, a vicious habit, which was  not uncommon, even amongst
 men of education, fifty years ago, and to which Hunter was greatly
 addicted.
   The accession of Mr. Bell to his staff did not lead Hunter  at  all
 to relax in  his own  exertions; on the contrary, every hour-of the
 day, and of great  part  of the night,  found  him busily employed.
 He commenced his  labours in the dissecting-room generally before
 six in the morning,  and remained there until  nine,  when he break-
 fasted.  After breakfast he  saw patients  at his  own house until
 twelve,*  when he made it a  point to  set forth on his rounds, even
 though persons might be in waiting for the purpose of seeing him ;
 for, said he, " these people can take their chance another day, and I
 have no right to  waste the valuable  time of other  practitioners by
 keeping them waiting for me." Hunter was a great economist of time,

   * The following note shows that Mr. Hunter went out at an earlier hour at
 one period of his life:
   " Dear Sir,—I can hardly be at home after 11 o'clock any day, but on Friday
 I will wait till  half-after, and if that should not suit your convenience, and  you
 do not come by  that  time, I will be at home by three to meet you.
                           " I am your most obedient servant,     ^
   « Wednesday Evening.                             John Hunter. 
44
THE LIFE OF JOHN HUNTER.
 and was always very punctual in fulfilling his appointments, to ensure
 which he kept a regular entry of his engagements  in  a book at
 home, and carried an exact copy of this in his waistcoat pocket, so
 that by a reference to the book he could always be found at  any
 hour of the day, in the event of his being wanted.   Any unnecessary
 discomposure of  these  engagements greatly annoyed him,  and
 caused him to give vent to his feelings in no measured terms.  The
 late Mr. Cline once excited his ire by an offence of this kind.  He
 had engaged Hunter to meet  him  in  consultation on a  case  in the
 afternoon, but in  the course of his morning rounds  saw another
 patient, respecting whom he wished  to take Hunter's opinion, and
 accordingly, without giving him previous notice, appointed to call
 with him  after the former engagement was ended.  When the first
 visit was  over, Cline mentioned the second appointment, on hearing
 of  which Hunter got into  a towering passion, and asserted that
 Cline had acted in the most unjustifiable manner in ihus deranging
 the whole of his arrangements for the afternoon.*   Cline, who was
 of a very placid temper, was  amazed to  see  such a storm excited
 by  so trifling a cause, and said what he could  to  appease it.  In
 this he succeeded, and Hunter soon recovering himself, turned to him,
 and in a very altered tone said, "Come along, then, let us go and see
 our patient."  Hunter was  equally strict in enforcing  punctuality
 on  his household; he dined  at four, then the fashionable hour, and
 gave strict orders that dinner should  be ready punctually whether
he was at home or not.  He was  a  very moderate eater, and set
 little value on the indulgence of the  palate.   During many  of the
 latter  years of his  life he drank no wine, and therefore seldom
remained  long at table after dinner, except when he had company;
but then, though he abstained himself, he was  not willing to allow
 his  friends to  follow his example.f
  After dinner he was accustomed to sleep for about  an hour, and his
 evenings were spent either in preparing  or delivering  lectures, in
dictating to  an amanuensis the records of particular cases, of which
he kept a regular entry, or in a similar manner committing to paper
the substance of any work on  which  he  chanced to be engaged.
When employed in the latter way, Mr. Bell and  he used to retire to

  *  This attention to punctuality  was also displayed by Hunter's nephew, Dr.
 Baillie, in  as remarkable a  degree.  When accidentally detained beyond his
time, he made it a point  to forfeit one appointment to save the rest. He used to
 say: "I consider it not only a professional, but a moral duty to meet punctually
 my  professional  brethren of all ranks.  My equals have a right to such a mark
 of my respect, and I would shudder at the apprehension oMessening a junior
 practitioner in the eyes of his patient, by not keeping an appointment with him."
  f " Come, fellow," said he, in his usual blunt way, to  Mr., now Sir William
 Blizard, " why don't you drink your wine "?" Mr. B. pleaded in excuse a whit-
 low, which caused him much pain.  Hunter would not allow the validity of the
 plea, but continued to urge him and ridicule his excuse.  " Come,  come John "
 said Mr^. Hunter, "you will please to remember that you were delirious for two
 days when you had a boil on your finger some time /ago."  This turned the
 laugh against Hunter, who now ceased from importuning  his guest. 
THE LIFE OF JOHN HUNTER.
45
the study, the former carrying with him from  the  museum  such
preparations  as  related to  the  subject  on  which  Hunter  was
engaged; these were placed on the table before  him, and at the
other end sat  Mr. Bell, writing from Hunter's dictation.  The manu-
script was then looked over, and the grammatical blunders, for Bell
was an  uneducated man, corrected  by Hunter.*  At twelve the
family went  to bed, and the butler, before retiring to rest, used to
bring  in a fresh argand lamp, by the light of which Hunter continued
his labours until one or two in the morning,  or even later in winter.
Thus he left  only about four hours for sleep, which,  with the  hour
after dinner,  was all the time  that he devoted to the refreshment of
his body.   He had no home amusements, as cards, for the relaxation
of his  mind, and the only indulgence of this  kind  he  enjoyed  con-
sisted  in an evening's ramble amongst the various denizens of earth
and air which he had  congregated at Earl's Court, where he slept,
and, with his family, spent  the greater part of  his time during the
autumnal months.
   In  1775 Hunter entertained thoughts of establishing a  school of
natural history, in which  he purposed  himself to take the  chief
part;  but as  it was necessary that he should obtain  the assistance
of some young man of talent in  carrying on the  undertaking, and
as none was  better qualified for  the office than Jenner, he applied
to him in  the following letter to  say if he felt disposed and at liberty
to join him.

    " Dear Jenner,
  " I have received many  things from you, and will thank you in the lump ; but
while I thank you, I have a great scheme to communicate to  you, and I want
you to take part in it; but remember, it is as yet a most profound secret.  My
scheme is to teach natural  history, in which will be included anatomy, both
human and comparative.   The labour of it is too much for one man,  therefore I
must  have some  one to assist;  but who that person shall  be is the difficulty.
When  running over a variety of people, you have come into mind among the
rest.  Now if it is a scheme you would like, and a possibility of your leaving
the country,—at the same time, able and willing to lay down one thousand
guineas,—I will send you  the whole  proposals; but if you cannot leave the
country on  any terms, then it is unnecessary to go any  further; and all I have
to beg is to keep it a secret.  I would  not have you mention it to Ludlow,----.
&c.  I proposed it to L---- before he left London, but his father objected, I
believe, to the money.  I know the scheme will be to your taste.  Before you
ask any of your friends, consult with yourself, and ask, Can I go to London, and
can I give one thousand guineas for any chance that may be worth it ? Let me
hear from you very soon.                              Yours,
  "London, May 24th.                                   J. Hunter."

  * Burke used to say that it was impossible for any man to arrive at great
eminence by his own unassisted  talents : the power to combine the assistance of
inferior men, in subserviency to his own views,  used always  to constitute an
essential part of his definition of a truly great man.  This power Hunter pos-
sessed.  All his pupils and intimate friends contributed more or less  to the
formation of his museum; fourteen years of Mr. Bell's life were devoted to this
object; he called in the aid of the ladies of his family in the prosecution of his
researches on the economy of bees, and he even carried  this so far as to call on
his coachman occasionally to act as amanuensis when Mr.  Bell was  otherwise
engaged. There were no drones in  his hive, 
46
THE LIFE OF JOHN HUNTER.
  Jenner declined the offer, for what reasons cannot now be known,
as his letters have been destroyed ; but it would appear, from Hun-
ter's next letter, that the refusal was not  unexpected, and we may
judge, moreover, from his language, that he had already given up
the project himself.

    "Dear Jenner,                                     August 2d.
  "I received yours, in answer to mine,which I should have answered.  I own
I suspected it would not do;  yet as I did intend such a scheme, I was inclinable
to give you the offer.
  " I thank you for your experiment on the hedgehog; but why do you ask me
a question by the way of solving it? I think your  solution  is just;  but why
think 1 why not try the experiment? Repeat all the experiments upon a hedge-
hog as soon as you receive this, and they will give you the solution.  Try the
heat: cut off a leg  at the same place ; cut off the head, and  expose the heart,
and let me know the result of the whole.
                                     " Ever yours,    J. Hunter."

  It is probable that Hunter abandoned his intention on finding that
it was not likely to be attended with success  proportionate  to  the
trouble  and expense it would  entail  on  him, since  the number of
persons who would have been willing to  become pupils in a school
of comparative  anatomy  was in those  days  extremely  limited.
This was  probably the  chief reason which weighed with him in
determining to abandon his scheme ;  but we may gather, from the
following anecdote, that he was  also in part deterred by the diffi-
culties  of the  undertaking  itself.   Hunter was  one  morning at
breakfast, when a young man, who was on intimate terms with
him as a friend and pupil, mentioned, as if casually, that he had
some thoughts of giving a course of lectures on comparative  ana-
tomy.   Hunter  looked up, and drily replied, " Sir, that is  a  bold
undertaking ; I  had thoughts once myself of doing the  same thing,
but the difficulties and necessary qualifications were  so  great that
I do not think myself competent to  the  task:  but you,  I dare say,
may feel yourself quite equal to it."
   In the  early part of  this year Sir C.  Blagden presented  to  the
 Royal Society the details of some interesting experiments instituted
 by Dr.  Fordyce, himself, and  others, to ascertain how far the living
 body possesses  the power of maintaining  its standard heat when
 exposed to air at high temperatures.  This drew from Hunter  a
 valuable  paper  on the heat of animals  and vegetables, containing
 an account of various  experiments  made some years before,* by
 which  the counterpart of the above proposition was proved, namely,
 that living bodies possess a power of maintaining their heat against

   * Hunter's experiments were made with a view to discover if it were possible
  to restore to life  animals which had  been frozen.  This was for some time a
  favourite inquiry,  and he used to speculate on the possibility of freezing human
  beings,  and thawing them to life two or three centuries after, a project which, if
  he could realize, he expected  would make his fortune.  Whilst his friends
  Lynn and Benjamin West, therefore, were warming themselves  with a bout  of
  skating on the Serpentine, Hunter staid at home freezing his fingers in pursuit
  of this his philosopher's stone. 
THE LIFE OF JOHN HUNTER.
47
the influence of external cold, and this in a degree proportioned to
their rank in the scale of organization.
   In January 1776 Hunter received the appointment of surgeon-
extraordinary to the King, the first and only one which brought him
within the atmosphere of Royalty.
   In the course  of this year  he  contributed to the  Philosophical
Transactions a memoir on  the means to be employed in the recovery
of drowned persons.   This paper was drawn up at  the  request of
the Humane Society, then newly established.  Its  contents are so
generally known, that it will be sufficient to remark, that the direc-
tions it furnishes are based on sound physiological principles, and
still  continue to guide the conduct of  those  who may be  called
to the  assistance of a fellow-creature suffering  under  this form of
asphyxia.
   He also commenced this year a series of six Croonian lectures,
on muscular motion, which he had  been appointed by  the  Royal
Society to deliver.
   In return for the assistance which  Jenner  afforded him  in his
pursuits, Hunter was enabled sometimes to give him the benefit of
his professional  advice, in such  cases of  difficulty as  the former
might  encounter in his practice.   The following letters are of this
kind, and relate in part to  the treatment  of a case of fungus cerebri
under Jenner's care.

    " Dear Jenner,
   " 1 don't know any one I would as soon write to as you.  I do not know any
body 1 am so much obliged  to. I thank you for a fish, but I should thank you
more if you had let me know who it comes from.
   " I beg for the future you  will always write when  you  send me anything.
Somebody  sent me a  cheese,  with a fish upon it; perhaps  it was you;  you
know I hate to be puzzled. Also let me know what things you have sent me
lately.   I have  not received the cuckoo's  nest yet.  Now  for your patient.  I
believe  the best thing you can do is to do little.  I would not touch the fungus
with an escharotic, for fear the  brain should be near: I would also use but very
slight compression, as the fungus will be a bandage to the brain ; and as to the
fungus itself you have nothing  to fear, for wherever the parts underneath are
sound, the  fungus will subside of itself.   Keep your  patient rather low, and
quiet.  Let me know how he goes on, and anything else you can.
                                           "Ever yours,     J. H."
    "Dear Jenner,                            [Post-mark, Jan. 10/A.]
  " You must think me very fond of fish when you send me cheese as much
fishified as possible: however,  it is an  excellent cheese, and every country has
laid claim to its birth.  The fish is called----*
  " I have but one order to send you, which is, to send everything  you can get,
either animal, vegetable, or mineral, and the compound of the two, either animal
or vegetable, mineralized.
  "1 would have  you do nothing with the  boy  but dress him superficially :
these funguses will die, and be  damned to them, and drop off.
  " Have you large trees, of different  kinds, that you  can  make free with ?  If
you have, 1 will put you upon a set of experiments with  regard to the  heat of
vegetables.
  " Have you any eaves,  where bats  go to at  night?  If you have, I will put

  * There  is an omission here, which  Hunter probably intended to  supply
before closing his letter, but forgot to do so. 
48                 THE LIFE OF JOHN HUNTER.
you upon a set of experiments concerning the heat of them at different seasons.
I should have been extremely happy to have had the honour of a visit irom i.ora
Berkeley.
                                       "Ever yours,     John Hunter.
  " Anny sends her compliments, and thanks you for all favours.  Write down
the case."

    " Dear Jenner,                              [Post-mark, Jan. 22rf.]
  " I  did  not  understand that  the  funguses which you described were brain ;
and I should still very much doubt that they are brain, for their keeping into one
substance would make me inclinable to believe that it is a new substance ;  but let
it be what it will,  I would advise you not to meddle with it: if it is brain, let it
drop off; if it is fumnis,  let it either drop or waste off: therefore be quiet, and
think  yourself well  off that the boy is not dead.  You do not mention a word
about  bats.  I have no particular experiments at present about fixed  air; it is
such a wide field that a man may make a thousand experiments before he deter-
mines anything.   Have you got the bones yet of a large porpoise? I  wish  you
had.  Is ever the salmon spawn seen after she has parted  with it?  If it is, 1
wish you could get some: I want to examine the spawn of fish in the progress
of the formation of the young one.                                      15
      " I am, dear Jenner, your most obedient Servant,     John Hunteu.

  In the  second of the preceding letters we have seen that Hunter
expresses a wish  that Jenner  would undertake  some  experiments
on  animal  and vegetable  heat.    This was  a  subject in  which
Hunter  was much interested, and about which  he  continued for
several years to institute experiments.  The following letters, which
appear to have been  written early in this  year, refer  chiefly to this
inquiry.

    " Dear Jenner,
  "I received the box;  also your letter.   I am very much obliged to you for
your kind attention to me, and how to rewaid you I do not know. Let that be
as it will, I must still give you commissions.  If you can  get me easily salmon
spawn, I should like to have it, and  out of different places, as it  will  be of dif-
ferent ages.  It should be put into bottles immediately, with spirits.   The spi-
rits should be proof,  and  there should be rather more spirit than spawn.
  " I will also take  any  specimens  of fossils you may send me, or indeed any-
thing else.   Did I send you  any of my publications in the Philosophical Trans-
actions? If I have not, let me know.  I want to put you upon some experiments
this winter.   What do you  think of examining  eels ?  Their sexes have not yet
been found out, nor their mode of propagation ; it is a thing of consequence in
natural history. I began it,  but could not get eels immediately  from the river,
and to get them of fishmongers, who buy them  in custom, does  not do.  My
intention was to examine several pretty large eels on the first  and fifteenth of
every month.   If the eels are plenty with  you, and if you like the proposal, let
me  know, and I will give you full  instructions  how  to proceed.  Also, next
spring, I would have you make the experiments on the growth of vegetables;
and if you have no objection, 1 will  set you upon a set of experiments  upon  the
heat of vegetables in the  winter.  If, in any of these  pursuits, you discover any
principle worthy of the  public, I will give it to the Royal Society for you.  I
must pick you up a picture this winter.  1 saw  Mrs. Black* at Mr.  Drum-
monds:  I suspect Mr. Black is dead, but I durst not inquire.  Cannot you  get
me a large porpoise for love or money ? What is the bird you sent me ?  also the
young animals, which I imagine to be guinea-pigs ?
                                      "Ever yours,     John Hunter."
* Jenner's elder sister. 
THE LIFE OF JOHN HUNTER.                 49
    " Dear Jenner,
  "I received your salmon, and very fresh, and just examined enough to want
another, but will wait till another season.  If I was to have another, it should be
one that had just spawned :  I will take a cock salmon when yo'u please.  If you
catch any bats, let me have some of them ;  and those you try yourself, open a
hole in the belly, just size enough to admit the ball; put the ball  down towards
the pelvis, and observe  the heat there; then up towards the diaphragm, and
observe the heat there ; observe the fluidity of  the blood.  Do all this in a cold
place.  Extraneous fossils  are all  vegetable and animal substances found in a
fossil  state.  See  if you can catch the number of pulsations and breathing in a
bat without torture.  If the frost is hard, see what vegetables freeze : bore holes
in large trees, and see whether the sap  runs out, which will show it is not frozen.
1 am afraid you have not a proper thermometer: I will send you one.
                       " Your very  much obliged Servant.    J. Hunter.
   " I have not  seen Dr. H., but I dare say he will be glad to have the cases."

   The two foregoing letters appear to have been written in Janu-
ary or February.   Hunter,  in the multiplicity  of  his engagements,
forgot to send the thermometer he had promised,  and Jenner, after
waiting for some time, began to fear lest he might in some way have
offended his  friend, and accordingly wrote to inquire  the cause  of
his long silence.  To this Hunter "replied  in the following letter,
which bears the post-mark of April 12th.

     " Dear Jenner,
   " I can never be offended with you.  The  reason for not sending  the ther-
 mometer was I entirely forgot it, but it shall be sent next week.  I shall be glad
 to present your paper if you mean to give it  to the public.   The large porpoise I
 would  have coarsely stripped,  and the  bones put into a cask and sent;  the
 young one, if not too large, put into spirits to be able to inject it.  If the breasts
 of the old one were taken off and put into the cask among the spirits, I should
 like it.  You  will find the  nipples on each  side of the vulva, and the  gland
 passes along under the  skin  of  the belly, almost to the breast, so that it would
 be only preserving the belly part.  Did I  write to  you some  time ago  about
 cuckoos ? I have forgot: if I did not,  I must give you a long order.
   "Friday night.             I am, dear Jenner, ever yours,    J. Hunter.
   "I was at my club last night,  and not coming home till twelve is the reason
 I did  not write."

     " Dear Jenner,                             [Post-mark, April \Qth.]
    "I have received ^your fish, as also your letter;  for both I  thank you.  It
 came quite fresh, and it.  is under dissection and drawing.   The bubbies of this
 are as flat as a pancake, but I have injected  the ducts.  Was the  milk sweet ?
 Could you  save some  of it? if but two drops, to see  if it grows sour.   Try it
 with  the syrup of violets.   Are  the breasts demolished ?  Are the kidneys
 demolished  ?  If not, could you send them ?  I will leave it to you what is to be
 done at present with the bones ;  either send them as they are, or steep them in
 water till the flesh rots off.  If you could, send me the stomach and a piece of
 intestine, if the largn one was different from  the small;  but if it had the same
 head, then you need not send them, as the present informs me of the class.  I
 have got the thermometer,  but let me  know to whose care I am to send it.  You
 did not in your last tell me if I wrote  to you about the cuckoo.
                                         " Ever yours,     J. Hunter.'

    Very soon  after the date of the  last letter, Hunter was attacked
 with an alarming fit of  illness, brought on  by anxiety of  mind, at
 being called on to pay a large sum of money for a friend, for whom
 he had become security;  a call  which  his  circumstances  made 
50
THE LIFE OF JOHN HUNTER.
 exceedingly  inconvenient.   The most distressing  feature of this
 complaint, which Sir Everard Home has described at considerable
 length, was a constant vertigo, which  rendered  him  incapable  of
 raising his head from his pillow for  ten  days:  this sensation was
 accompanied  by a morbid  acuteness of the organs of sense, with
 a feeling of being  suspended  in  the  air, of his  body being   much
 diminished in size, and of every motion of the limbs or head, how-
 ever slight, being both very extensive and accomplished with great
 rapidity.   This  complaint was unattended  by  fever.   Various
 remedies were employed, but without any perceptible effect  on the
 symptoms, which, at the  end of ten days,  began to disappear spon-
 taneously.   Sir Everard  Home dates this illness in 1776; but in one
 part of his memoir he says  it happened in the spring, and in another
 in the autumn.   The following letter  of Hunter's to Jenner, which,
 contrary to his usual practice, bears  the  date  of the  year,  shows
 that it occurred in  1777.

    " Dear Jenner,
  " I have before me two letters of yours, which I should have answered much
 sooner.  Your friend Dr. Hicks I have not seen.  I was not at home when  he
 called, and I have not had time to wait on him, as he lived entirely  out of my
 walk.  I should have been glad  to have seen him, but I suppose he stood upon
 ceremony.   I received the fossils, and should be glad of any that you can get.
 If any bones of animals are found, be sure and get them for me.  I should  be
 glad  to have some of the  salmon-fry.  I had  the pleasure of seeing your brother,
 but only for a time.  I  received the bird : I am not acquainted with it: send me
 some more if you can get them readily.  I sent with Mr. Jenner the thermome-
 ter: if you do not understand  it let me know.
  " Not two hours after I saw your brother I was taken  ill with a swimming in
my head,  and could not raise it off the pillow for  ten days : it is not yet per-
fectly recovered.  Have you begun the eels ? No porpoises. No salmon spawn
before it has hatched.  You see I am very greedy.  Be sure to keep an account
of all outgoings.
  "My compliments to Mrs. Black and your brother, and let me hear from you.
                             " Ever yoius,             J. Hunter."
  "London, May  11, 1777.

  In July  he wrote again to Jenner, explaining the mode of using
the thermometer, and  treating of divers  other  matters,  with  his
 accustomed brevity.

    " Dear Jenner,
  " Excuse me for not  answering your letters as soon as you could wish. Send
me all the fossils you find.  What I meant by bones was all the bones that are
found any depth below  the surface of the earth : many are found  in stones, &c.
 I suppose those skeletons are not complete,  but send me eome of them • and if
any history can be given, send it also.  The thermometer is a very  useful  one
when understood.  You will observe the scratch upon the glass  stalk, perhaps
about two inches from the globe, which is the freezing point: put 0, or nought,
which is upon the ivory scale, two degrees  below the" scratch, thenO becomes
the thirtieth degree, and the scratch, being two degrees above it, stands at  the
freezing point; then, from that count upwards : or  if the cold is below 30° then
put 1 or 2 at the scratch,  and count down : every No. is ten degrees.  What the
 devil becomes of your eels in the winter? but try them in summer, and see what
 you can make of them.
  " I do not remember Dr. Fordyce's ever  supposing a polypus vascular.  I 
THE LIFE OF JOHN  HUNTER.
51
 should rather believe that he supposed the contrary : you know it comes near
 my idea that the blood is the bond of union everywhere.  But  I should very
 much suspect that a polypus formed after death is not of that kind.  I am pretty
 certain that I have injected them in arteries after amputation.   1 have a prepa-
 ration which shows it, and which supports my theory.        Yours,
   " London, July 6th, 1777.                               J. Hunter."

   Hunter was disposed  to treat his late  illness as one of  trifling
 moment;  but his medical friends thought more seriously of  it, and
 as he  had never  fully  regained his  health,  urged  his resigning
 business for a time and retiring to Bath.  In compliance with this
 advice, he proceeded  thither in the autumn, after having deputed
 Mr. Bell and Mr. Home, in his  absence,  to  complete a catalogue
 of all the preparations  in his museum with which they were  ac-
 quainted, a task which had been hitherto entirely neglected.  Before
 leaving London he announced to Jenner his  intended visit to Bath
 in the following letter.

    " Dear Jenner,                                August 6th,  1777.
   " I just now found your last letter.  I think I answered it, but am not sure; if
 I did not let me know. Is there any judging whose these human bones are ?
 Let us have some of them, especially skulls, as complete as possible, with the
 lower jaw, &c.   1 am very well, but for all that I set out, in a few days, for Bath.
                                 " Ever yours,          J. Hunter."

   Soon after his arrival  at Bath he was visited by Jenner, who was
 greatly shocked to  perceive the alteration which had taken place in
 his appearance, and concluded, from the symptoms under which  he
 laboured, that his disease was angina pectoris, an affection not then
 well  understood, but which Jenner  had been led to believe,  by the
 dissection of former cases, depended  on an organic change in the
 heart.   He abstained  from telling Hunter his opinion, as he  feared
 the effect such an announcement might have on his mind, but com-
 municated it  to Dr. Heberden, one of Hunter's medical  advisers, in
 a  letter, which Dr. Baron has published in his  Life of Jenner.
   During the time Hunter remained in Bath he appears to have
 had  frequent  communication with his  friend,  and  the  following
 letter affords  a good example of the familiarity which  existed  be-
tween them.

    "Dear Jenner,
  "Till yesterday we did  not know from whom the  hare came;  but the cook
 found it out.  We thank you : it was a very fine one.  By your not taking any
notice of my letter, I do suppose you did not receive it.   Near  three week3 ago
 I wrote to you to meet us at the Hotwells, Bristol.  Some days after the date of
my letter we went to the place appointed, by ten o'clock in the morning; but no
Jenner there.  We breakfasted, we dined, we staid  all night, and set  out for
Bath the next day.   We would have come on to Berkeley, but we were afraid
you might not be there.  I am afraid it will not be in my power to come  and see
you, though I wish it much.  I shall be obliged to take Southampton in my way
home.  Are the  hedgehogs so saucy as to refuse coming without coming for
them?  See if you can coax them.  We are alive here.  The downs look like a
beehive.  Let me hear from you.  Mrs. Hunter gives her compliments to you.
  "Bath,\8lh.                             Yours,       J. Hunter."
  " My letter was sent to your friend in Bristol by the  coach, but perhaps the
coachman forgot to deliver it." 
52
THE LIFE OF JOHN HUNTER.
  After remaining three months in Bath, he became very desirous
to be at home again, and decided therefore on immediately return-
ing  to  London, though  his health  was  not  fully  re-established.
Fortunately, he felt no inconvenience from this step, but  continued
to improve after his return, and shortly regained his usual state of
health.
  He now recommenced his ordinary pursuits with unabated dili-
gence, and appears about this time to have been chiefly engaged in
confirming  and  extending his  inquiries  on vital heat.   He was
anxious to engage Jennet's assistance  in  conducting some of  the
experiments, for which  his  residence in the country afforded him
the  necessary facilities,  and  determined  to write to him on  the
subject; but as he had received no reply to several of his late com-
munications,  his  first  letter was  written to inquire the  cause of
Jenner's long silence.

    " Dear Jenner,
  " I wrote to you twice from Bath since I saw you, and have had no answer to
either; what  the d—1 is become of you ?  I  have got your candlesticks: to
where shall I send them?   Let me know by return of post;  and all the news
you can.                              Yours,
  " Nov. 6th,  1777.                                   John Hunter."

  Having ascertained,  to  his  satisfaction, that  Jenner had   not
become  a subject of " Pluto's dreary reign," he forthwith  trans-
mitted him  the necessary instructions for his guidance.

    " Dear Jenner,
  " I have sent you the candlesticks as you desired. I hope you will like them.
They cost  five pounds and  a shilling;  so I owe you four shillings.  I have
received the hedgehogs.  If you have time, see their natural winter haunts,  and
in the very cold weather run the thermometer into the anus, and observe the heat;
then open the belly by a shall hole, and pass the thermometer down towards the
pelvis, and observe the heat; then towards the liver or diaphragm, and observe
the heat:  you may do all  this in a very few minutes.  Observe the fluidity of
the  blood, by comparing it with another that has been kept warm for a few days.
I have heard of Mr. Cattgal's collection  of fossils, and not till I came to Lon-
don : I suppose he will not sell any. I shall  think of your lymphatics ;  and if
I can pick  up a preparation or two, I will. I am sorry you did not get my  first
letter, as we  intended going to Berkeley with you, but did not choose to come
without an answer, as it was possible you might not be at home.  I have seen
your old master, who has given me the use of a very curious  bone : I hope he
will give it me altogether.                  Dear Jenner, yours,
  " Nov. 23d.                                        John Hunter."

   Unfortunately, his  hedgehogs all died, either  from exposure to
cold or some other cause; he therefore  referred  the  experiments,
for the  present, to Jenner, until  he could learn what means were
requisite to keep them alive.

     " Dear Jenner,
   " I am always plaguing you with letters, but you are the only man I can apply
 to.  I put three hedgehogs in the garden, and put meat in different places for
 them to eat as they went along; but they all died. Now I want to know what
 this is owing to;  therefore I want you to find out their haunts, and observe,  if
 you can, what they do ; if they make a warm place for themselves;  if they have 
THE LIFE OF JOHN HUNTER.
53
any food by them, &c.   I would  have you kill one, and see its heat.   First,
make a small hole in the belly, and introduce the thermometer into it, first down
to the pelvis, then up to the liver and diaphragm, and see the difference, for I
believe they will answer the purpose as well as bats.  See if there  is any food
in the stomach ; what the intestines contain; examine if they are fat, and in  the
spring see if they are much leaner; see if the blood is as  fluid as common, or if
thicker.   In short, make what observations  you can.  Let me hear from you
when you have nothing else to do.                       Yours,
  "London, Dec. 17.                                      J. Hunter."

  His next letter, written in  March 1778,  is as follows:

    " Dear Jenner,
  " Your letter of December has lain before me ever since I  received it, to put
me in mind that it was not answered.   I am glad you liked the candlesticks : I
thought them pretty.  The fossils were none of the best; but 1 know you did
not make them, therefore it is not your fault.  The particular one you put the
Q? on is only the cast of a bivalve.  I wish I had seen E.'s collection.   I am
matching my fossils, as  far as I can,  with the recent.  Have you made any
experiments with the hedgehogs, and can you send me some this spring?  for all
those you sent me died, so that I am hedgehogless.
  " Mr. Ludero sent me the bone; it is a very curious one: whether he will let
me keep it or no I do not know.  I received  yours by Mr. Jones, with the bird.
I thank you for thinking of me.  Frogs live an amazing while after they are
dead ; as also all animals of that tribe.   The directions I gave you about the
blackbirds were, when you have a blackbird's nest, viz.  with four young ones,
take one and put it bodily into spirit by the head, extending the wings and legs.
Observe when the feathers begin to sprout; then  take another, and  serve it  in
the same way; then a third, and a fourth, so as to get a series of the growth of
the feather;  but the last, or fourth, must  not be so old as the feathers to cover
other parts where feathers do not grow.  This you will better understand when
you come to make the trial.   I have a picture of Bassan's that I lent a poor devil
three guineas upon :  he died and never redeemed the picture.  I intend sending
it to you: it is a good deal  damaged, but some  of the  figures are very good.
Get a frame for it, and hang it in a strong light.  There are some experiments of
mine publishing in the Philosophical Transactions, which I will send you with
the picture; accept them as a remembrance of the  trouble I put you to.  Let me
hear from you when  convenient.  Mrs. Hunter desires her compliments to you.
     " I am, dear Jenner, your most obedient and most humble servant,
  "London, March 29, 1778.                              John Hunter."

  It is not  very clear what  are the experiments to which Hunter
alludes in the foregoing letter as about  to  be  published; it  seems
most probable, however, that they  were those contained in his se-
cond memoir on  the  heat of animals and vegetables, which he this
year presented to the Royal  Society.   The only ground for doubt-
ing it is, that at the head of this paper, in the  Transactions, it  is
stated to have been read in part on the 19th of June, and the re-
mainder on the 13th of November, whereas  the date of  the  fore-
going letter is March.
  This was one of the most valuable of the  many excellent papers
which Hunter furnished to the Royal  Society, both on  account  of
the importance of the subject treated of,  and the valuable deductions
he has drawn from his experiments.  The inquiry was both  new
and  complicated, and it is not therefore surprising, that whilst ad-
ding much to what was  before  known  on the  subject, he yet left
some errors to be corrected, and  many parts requiring  to  be ex-
                                  7 
54
THE LIFE  OF JOHN HUNTER.
tended and filled up by the labours of later physiologists.   Hunter
never contented himself with the character  of a mere maker of
experiments, but alwavs aimed at drawing  general  conclusions;
and he perhaps occasionally  fell into  the error of generalizing from
insufficient data.  Hence we find that on the  present subject his
experiments  are sometimes not sufficiently varied, and are defective,
for want of those precautions against disturbing influences which
characterize the  inquiries  of Edwards, Marshall Hall, and other
physiologists, who have of late trodden in the same path.
   Hunter does not seem to have considered his own inquiries on the
subject as at an end, for he  recurs, in many  of his  letters written
after this time,  to his experiments on hedgehogs, as  the following
letter written about this time, evinces.

    " Dear .Tenner,
  "I received yours by Dr. Hicks, with the hedgehog alive.  I put it into my
garden : but I want more.  I will send you the picture ; but by what conveyance ?
or by what place?  I have a picture by Barrett and Stubbs.  The landscape by
Barrett; a horse frightened at the first seeing of a lion, by Stubbs.  I got it for
five guineas : will you have  it ?  I have a dearer one, and no use for two of the
same masters; but do not have it excepting  you  would like it, for I can get my
money for it.
  "1 am glad you have got  blackbirds' nests. Let me  know the expense you
are at, for I do not mean the picture to go for anything, only for your trouble.
                                          " Ever yours,   J. H.
  " N. B. I should suppose the hedgehogs would come in a box full of holes
all round, filled with hay, and some fresh meat put into it."

   Jenner had, about this time,become involved in an affaire du casur,
which, unfortunately, ended  in disappointment.   Hunter had heard
a rumour of his expected marriage,  but not of the  rejection of his
addresses;  and in his next letter expresses his  hopes that his infor-
mation may prove to  be correct.

    " Dear Jenner,
   " I don't know what I wrote to  you last.   I do not  know if I thanked you for
the cider.  The hedgehogs came, with one dead, which was a female with young,
and which I made a preparation of.  I have since got the blackbirds, which I
think will do vastly well.  I have not yet sent the picture; it is packed up ready
to go, and shall be sent immediately.
   " I was told the other day that you was married, and to a youno- lady with
considerable fortune.  I hope it is true, for I do not know anybody more deserv-
ing of one.  Let me know whether it is so or not.  I  hope you keep an account
of all expenses.  What is become of your paper on lead in cider ?  Let me have
it, and  I will send it to the Medical  Society. How do the fossils go on ?

   Jenner was of a rather sensitive disposition, and as he had  pro-
bably  calculated pretty  certainly on  success  in  his  suit, was  much
affected for  some time by the disappointment.   Hunter was more-
over, not exactly the  person  " to trust a love tale to," and  Jenner
accordingly delayed  to reply to  his  inquiries  until  the  receipt  of
the  following  letter,  which  requiring  an immediate answer, he
summoned courage to communicate  the real  state of affairs.

    " Dear Jenner,                            [Post-mark, Aug. 30 1
   "I hope this winter  to be able  to get you some preparations oftheeye'and 
THE LIFE OF JOHN  HUNTER.
55
lymphatics ;  but Hewson's preparations are to be sold this month ; now perhaps
for four or five pounds some preparations  may be picked up.   If you have no
objection to throw away so much money,  let me know, and what subjects you
would like best.  I shall give you some commissions about heat, cold, &c.
                                          Yours,     John Hunter."

  On  learning  how Jenner's  hopes had been  frustrated, Hunter
kindly expresses his regret, but, as might be expected, recommends
to the lover a summary dismissal of the lady from his memory, and
like a skilful physician, undertakes to find  him other  employment
for his thoughts.

    " Dear  Jenner,
  "I own I was at a loss to account for your silence,  and I was  sorry at the
cause.  I can easily conceive how you must feel, for you have two passions to
cope with, viz., that of being disappointed in love, and that of being defeated;
but both will  wear out, perhaps the first soonest.  I own I was glad when I
heard you was married to a woman  of fortune;  but ' let her go, never mind her.'
I shall employ you with hedgehogs, for I do not know how far I may trustmine.
I want you to get a hedgehog in the beginning of winter, and  weigh him;  put
him in your  garden, and let him have some leaves, hay, or straw, to cover him-
self with, which he will do ; then weigh  him in the spring, and see what he has
lost.  Secondly, I want you to kill  one in the beginning of winter, to see how fat
he is, and another in spring, to see what he has lost of his fat.  Thirdly, when
the weather  is  very cold, and  about  the  month of January,  I could wish you
would make a  hole in one of their bellies, and put the thermometer down into
the pelvis, and see the height of the mercury; then turn it upwards, towards the
diaphragm, and observe the heat there.  So much at present for hedgehogs.  I
beg pardon,—examine the stomach and intestines.  If Hewson's things go cheap,
 I will purchase some that I think proper for you ; those you mention will, I am
 afraid, be everybody's money, and go dear.            Ever yours,
   "London, Sept. 25th, 1778."                             J. Hunter."

   Hunter's next letter is dated in November, and relates  chiefly to
the physiological  experiments which he had requested Jenner  to
make, and  to another inquiry respecting the breeding of eels, to which
he had  directed Jenner's attention  in  a former letter.

     " Dear Jenner,                               London, Nov. 9, 1778.
   "I received  yours, with the eel.  The  spawn of the salmon was lost.  I shall
 send you hack the eel again, with the liver, stomach, and gut  removed,  and no-
thing left but a fringe which passes down  the sides of the backbone, which I took,
and still  take to be the spawn; but  I never saw any difference in it at any time
of the year;  and this one you have  sent is similar to all I have yet seen.  I think
your stopping  the eels a good plan, if you can ;  but I should suspect they would
ne more slippery than hedgehogs.  I do not know if hedgehogs burrow.  About
a month hence examine another, and compare him with your notes and memory
also.  Examine his heat in  the  pelvis,  diaphragm,  &c.;  a  month after that
another, &c.  I like your experiment on the  toad  and  snake; but bury them
 rather deeper,  and let the ground be  kept moist about them, especially in summer.
I shall keep all your letters, but I expect in the end all your notes.  I like your
friend Ludlow much ;  he is a lively sensible fellow.  I have got a few prepara-
tions for you ;  I am getting them put into a  little  order for you  before 1 send
them.  Are  there no bats in the old castle of Berkeley ?  I should like similar
experiments to be made upon them to those  of the hedgehog.  Mrs. H. desires
her compliments to you.
             " Believe me to be, most sincerely yours,     John Hunter."

   Hunter  this year completed his  work on the Teeth, by publishing 
56
THE LIFE OF JOHN HUNTER.
 the second part, containing an account of the disease which these
 organs are liable.
   Mr. Home had now resided six years with Hunter, in which time
 he had completed his education; and as he had no emoluments to
 expect by remaining longer an inmate of his house, since, says he,
 " his expenses had always hitherto exceeded  his income," he was
 glad to obtain the very eligible appointment of surgeon to the new
 naval hospital at Plymouth, where he was immediately called on to
 take charge of the men who had been wounded  in the late  action
 under Admiral Keppel.
   It may seem surprising, that after having been so long  in prac-
 tice, and after acquiring so considerable a reputation  as Hunter at
 this time enjoyed, his finances should still have been in an embar-
 rassed state ; but it must be remembered  that Hunter had for some
 years past  maintained his two  establishments in London and  at
 Earl's  Court; to supply the wants  of an increasing family,  and,
 what was probably most expensive of all, to provide for the outlay
 required for the maintenance and extension of his museum.   Mr.
 Hunter once declared to Mr.  Lynn that the museum had cost  him
 upwards of 70,000/.;  and when it is recollected  that  the whole of
 his professional income, which for the last ten years of his life  was
 very considerable, was, with the exception of his domestic expenses,
 wholly devoted to this object,  we canAot  doubt  that this  estimate
 was near the truth; at least the sum of 15,000/., voted for its pur-
 chase by Parliament, fell very far short of the actual outlay, to say
 nothing of the time and talent unceasingly devoted by himself and
 others to its completion.  Rarely, however, have the labours of those
great men who have advanced before the age they have  adorned
been duly appreciated, until another generation has arisen to weigh
their merits in an impartial balance. 
THE LIFE OF JOHN  HUNTER.
57
                          CHAPTER V.

                            1779 to 1788.

Mr. Hunter's paper  on  the hermaphrodite black  cattle;—his anxiety for rare
  specimens to enrich his museum;—renewal of the disagreement between him
  and his brother.—Mr.  Hunter's paper on small-pox during pregnancy;—his
  paper on the hen pheasant.—Trial of Sir T. Boughton.—Croonian lectures.—
  His paper on the organ of hearing in fishes;—removes to Leicester square;—
  assists in forming the Society for the Improvement of Medical and Chirurgioal
  Knowledge.—Charlatanism.—Correspondence.—Mr. Hunter's notion of the
  immateriality of matter from the theory of colours;—his paper on the inflam-
  mation of veins;—his  fame and practice at this time;—his merits as an opera-
  ting surgeon;—his illness returns ;—his second visit to Bath;—Mr. Home acts
  as his assistant.—Mr. Hunter's paper on the double-coned Terebella;—his
  operation for popliteal  aneurism;—is appointed Deputy Surgeon-general to the
  Army;—his Treatise  on the Venereal  Disease;—his work on the Animal
  OEconomy;—prints his own works at his own house ;—his paper on the Wolf,
  Jackal, and Dog;—his paper on Whales.—The  giant O'Brien.—Obtains the
  Copley medal;—opens his museum to the public.—Mr. Home and Mr. Keate
  appointed assistant surgeons  at St. George's Hospital.—Sits for his portrait
  to Sir Joshua Reynolds.—Sharpe's engraving.—Death of Pott;—comparison
  between him and Hunter.—Pott's character.

In  1779   Hunter's valuable memoir on the  hermaphrodite  black
cattle, or free martin,  was read  before the  Royal  Society.*  As
usual, he has by no means confined himself to a  bare  anatomical
description of the peculiar malformation of the genital organs in
these  animals, but has introduced the subject by a variety of obser-
vations on hermaphroditism in general, which render his paper  a
very important contribution  to this branch  of physiology.
   It will  be remembered that in his last letter  to Jenner,  Hunter had
requested him to make some further experiments on  the heat of the
hedgehog during its torpid state.   He had  as  yet received no com-

  * Amongst those present at the reading of this paper was the illustrious anato-
mist Von Soemmerring, then a young man, as the  following letter, written by
him on his being elected  a Fellow of the  Royal Society, will show :
                                " Franfurt am Mayn, 20th August, 1827.
  "Dear  Sir,—Feeling myself extremely honoured in being admitted as  a
foreign member by the  very first literary Society in  the world, I beg the more
from you the favour to return my best and sincerest thanks, as I always remem-
bered with  singular pleasure to have been present  in the year  1788, at the read-
ing of  John  Hunter's celebrated paper on  the free  martin, not imagining at that
time once to become  myself associated  to that illustrious assembly, by whose
exertions I profited infinitely in all my studies.
       I am, dear Sir, with great respect, your obedient humble Servant,
                           Samuel Thomas von Soemmerring, F.R.S.,
                         Privy Counsellor to H. M.  the King  of Bavaria,
                             Knight of several  I. and R. Orders.
  To Dr. Young, Foreign Secretary of the Royal Society."
                                  7* 
58                THE LIFE  OF JOHN HUNTER.

munication on the  subject, and accordingly wrote the  following
short note, as a spur to his friend's activity.

    " Dear Jenner
  " What are you doing? How do the hedgehogs get on ?  How cold are they
in the winter?  &c. &c.  Let me hear from you.  I have not yet sent the prepa-
rations for you.   I have added an eye to one of them of my own making.   ^
  "London, Jan. 16, 1779.                     Yours,     J. Hunter.

  Jenner had not been idle, however, but was able to give so good
an account of his proceedings that Hunter seems  to have resolved
not to allow so valuable a coadjutor to remain unemployed; accord-
ingly, though he rarely put confidence in any experiments  which
were not conducted by himself, or under his own eye, he suggested
to Jenner some further ones, respecting the state of the digestive
powers during torpor.

    " Dear Jenner,
  " I thank you  for the trouble you have taken.  I do not see another experi-
ment to  he made with the hedgehogs, but one: get a piece of meat into  the
stomach of one, during the very cold weather, and kill him  twenty-four  hours
after, to see if it is digested, which I have done with lizards.  This may be dif-
ficult; hut suppose he was made lively in a warm room, and then  fed, and put
out into the cold  immediately, with a little hay over him.  If this does, two or
three  may be  served in  the  same way, and kill them at different distances,
respecting  time.  Observe their breathing when in the cold ;  if possible, the
quickness of the pulse and fluidity of the blood.  If you chance to get more than
you use, I would take a few to put into my garden, to walk about in the evenings.
  "Is there no chance to see you  in London this winter?  Do come and see us.
I shall send you a paper of mine on the free martin, also one to  Ludlow.  I
wrote to him in answer to his letter; I  hope he received it.  If a good deal of
that air in the  hog's guts could be collected, see if a candle would burn in it as
large  as in common air.  I had a letter from Mr. Cheston, of an ossified thoracic
duct; I wish he would let me have it: you see  how greedy I am. You will
hear from me soon.
                                   " Ever yours,      John Hunter."

   The  above letter furnishes an example of the eagerness with which
Hunter sought to draw all curiosities connected with his researches
within the sphere of his museum.   He was indeed  a most resolute
beggar for every specimen  which particularly pleased  him by its
rarity,  and which chanced to be  in  the  possession of any of  his
friends.  The late  Dr. Clarke had a preparation of an extra-uterine
pregnancy, in which the  foetus had been  detained  in the fallopian
tube, and had  there undergone partial  development,  when  the
 mother died from  internal hemorrhage, consequent on the rupture
of the tube.   On this specimen he set a high value, and Hunter had
 often viewed it with longing eyes,  " Come, Doctor,"  said  he, " I
 positively must have that preparation."  " No, John Hunter,"  was
 the reply, " you positively shall not."  '; You will  not give' it me,
then V   " No."  " Will you sell  it ?"  " No."  « Well  then, take
 care I  don't meet you with it in some dark lane at night,  for if I do,
 I'll murder you  to get it."
   Winter returning, brought back Hunter's thoughts to his inquiries 
                   THE LIFE OF JOHN HUNTER.                5g

on vital heat, and  we find him accordingly writing to remind Jenner
to prepare for fresh operations against the hedgehogs.

    " Dear Jenner,
  " I have not troubled you  with  any letter this long time, nor have I heard
from you.  This moment, I do not know if I sent you the butterflies ;  if they are
not sent, they shall this week.   I want you to pursue  the experiments on the
heat of the hedgehog this winter ; and if you could send me a colony of them, I
should be glad, as 1 have expended all I had, except two : one an eagle ate, and a
ferret caught the other.*  Mrs. Hunter and I were at Bath the other day, and
came home by way of Gloucester; we wished much we could have staid a day,
to have waited on you. Let me hear from you soon.
                                  I am, dear Jenner, yours,
  "London, Nov. Slh, 1779.                            John Hunter."

   In 1780  that unfortunate disagreement took place between the
Hunters, of which mention has been  made in a former part of this
memoir.   It commenced in John Hunter's presenting  to the Royal
Society  a   paper  on  the  structure  of the placenta,  in which he
claimed for himself the honour of discovering the true mode of union
between  this organ and the uterus, a  discovery which Dr. Hunter
had communicated as his own, in his work on  the Gravid  Uterus.
What could have induced  Hunter to  bring  forward such  a claim
twenty-five years after the alleged discovery, and five years after
the publication of Dr. Hunter's work,  it  is  not easy to say.   The
probable explanation seems to be, that something unpleasant  had
previously passed between  the brothers, and that, under a consequent
 feeling  of  irritation,  Hunter  transmitted his   paper to  the Royal
 Society.f   Whether his  claims were well or ill founded ;  whether
 any part of the discovery  was his ; or what it was, it  is impossible,
 from the evidence now before us, to decide.  Dr.  Hunter, in a letter
to the Royal Society, denied  having derived  his  information from
his brother, and asserted that the discovery was the result of manv
years' patient investigation of the subject on his part.J  To  this a

   * Hunter's account of his hedgehogs reminds one of Magendie's remark on the
 dogs whose evil stars bring them acquainted with the  interior of his  physiolo-
 gical slaughter-house.  " Vous savez, Messieurs,'''' said the Professor to his class,
 " que les chiens ire s^amusent pas i'cj."
   f Such  an explanation has,  in fact, been commonly given,  but the  causes
assigned have been various.   Some confidently allege that  Hunter's resolute
determination to  marry Miss Home gave  offence to  his brother, who strongly
remonstrated against his forming  an alliance with a lady who had neither rank
 nor fortune, which, he asserted, would slacken his  endeavours after fame, and
 mar his fortune.  By others a dispute is  said  to have occurred between them
 respecting certain preparations,  now in  the  Hunterian Museum  at Glasgow, to
 which both brothers  laid claim ; but through the inquiries of Professor Badham,
 who has kindly investigated the subject, it has been shown that no jus^grounds
 for this account exist, although such a tradition  has certainly prevailed on the
 spot.  It is needless at this time to scrutinize further into so unpleasant an affair,
 although it was one which probably affected Mr. Hunter's feelings  more power-
 fully than any other event of his life.
     % Letter I.                        " Windmill Street, Feb. 3, 1780.
   " Dr. Hunter begs the favour that the  Secretary to the Royal Society will
 read to the Society what follows.
   "Mr. Hunter's account of the structure  of the  human plaeenta, explaining 
60
THE  LIFE  OF  JOHN  HUNTER.
 rejoinder was sent by Hunter, reasserting the truth of the account
 he had given of the "transaction, but adding that  as  his  brother
 seemed unwilling to allow him the  whole merit, the  former  should

 the connexion and  circulation between the mother and the foetus in utero, which
 was read at the last meeting of the Royal Society, informs us that it was a dis-
 covery which he made with Dr. Mackenzie, and that it was not claimed by me.
 The Society will be sensible that I am reduced to the necessity of taking notice
 of this mistake, when they are informed of the following facts :
   " First. That the doctrine has been many years ago published in printed books
 as my discovery, and had been communicated as such by myself.   See Baron
 Haller,  for instance, in  the second part of the eighth volume (p. 220) of his great
 Physiology, in quarto, printed  thirteen or fourteen years ago.
  "Secondly. Besides  treating of it as my own discovery, in my lectures upon
 the subject, I have always done  so for many years  last past, in the very first
 lecture  of  my course, which  is the most  public of all, because the door is then
 open to every person whose curiosity prompts him to be present.
  "In the third place, occasionally both  in what  I  have printed,  and in my
 lectures, I hope I  have not overlooked opportunities of doing justice to Mr.
 Hunter's great merits,  and of acknowledging that he had been an excellent
 assistant to me, in this and in many other pursuits.   By doing so I always felt
 an inward gratification, shall I call it, or pride?   I  had given him all  the little
 anatomical knowledge which I could  communicate, and  put him into  the very
 best situation that I could for becoming  what this Society has for  some time
 known him to be. May it  be presumed, then, that I stand  possessed of the
 discovery in  question, till proofs  shall be  brought to dispossess me ?  I shall
 most willingly submit to the  pleasure  of this  Society.  If they signify an un-
 willingness that this emulation (I will call it) should go on, I shall acquiesce,
 and  be  silent.  If curiosity, justice,  or the laws and  practice of the  Society
 should incline the  Council to seek out  and determine upon the  merits, I shall be
 equally ready to obey their commands.  And if it should appear reasonable to
 them, I  would first beg to know the grounds of Mr. Hunter's claim, as  I am too
 well acquainted with his  abilities not to think that he must be able  to  support
 his claim by something that I am ignorant of.  And if I should receive that satisfac-
 tion, I shall immediately  show that I am more tenacious of truth than even of
 anatomical discoveries.   But if that information should not alter my thoughts
 upon the question,  I shall show to the satisfaction of the Society, if I can at all
 judge of my own  employments and pursuits, that my pretensions arise out of a
 long series  of observations and experiments, made with a view to  the discovery
 in question :  that it was not a random conjecture, a lucky thouaht, or accidental
occasion, but a persevering pursuit for twelve or thirteen years°at least, the pro-
 gress of which was always publicly known here, and admits  of the most cir-
 cumstantial proof.                                     William Hunter."

                               Letter II.

                   " To the President of the Royal Society.

    "Sir,                                    Jermyn-street, Feb.  17, 1780.
  "Though I know the constitution of  the Society over which you preside too
 well to suppose that they will give their judgment on any subject, and respect it
 too much to  think it a proper field for waging the war of controversy  I cannot
 avoid requesting you to lay before that learned body a short answer to the paper
 given in by my brother, Dr. Hunter, as silence on my part, after his charge may
 be interpreted by my enemies into an acknowledgment that I have intentionally
 claimed to myself  a discovery in reality his due.  I am as tenacious as he is of
 anatomical  discovery, and,  I flatter myself, as tenacious, also, of truth  The
 discovery was made in the manner in which I stated it in my paper   Dr Mac-
 kenzie had  injected the  subject, and being unable, as I conceived,  to explain an
 appearance which  he had found in dissecting it, sent for me.  I came to him 
THE LIFE OF JOHN HUNTER.
61
be  welcome to share it, provided that a part at least of the discovery
was adjudged to himself;  which,  after  all,  would have probably
been the fairest mode of adjusting their claims.
   Here the discussion  terminated.  The Royal Society decided to
take  no further cognizance of the matter, and would not allow the
offending paper to be published in the Transactions.   Between the
brothers, unhappily, the estrangement produced  by the dispute con-
tinued undiminished until Dr. Hunter was on his death-bed, though
to John Hunter at least, if not to both, it was often a cause of deep
regret.  During Dr. Hunter's  last illness, which occurred  three
years after, his brother requested that he  might be admitted to see
him: this was acceded* to, and  he continued to visit  him daily, and
to afford him professional  assistance until his death.  Notwithstand-
ing this apparent  reconciliation, the feeling of  soreness seems not
to have been quite  obliterated from the  mind of Dr. Hunter, since
it did not lead  him to make any alteration in the  previous disposal
of his property, and he died without leaving any portion of it to his
brother.  Dr.  Baillie, however, to whom Dr.  Hunter left the family
estate, with great generosity ceded it to Mr. Hunter, as soon as the
will was proved.
   Two other papers of Hunter's were read before the Royal Society,
and published  in their Transactions for this year.   The first of
these, which was presented in January, contained the account of a
woman who had taken the small-pox during pregnancy, and passed
safely through the disease, but some weeks after fell into premature
labour, and was delivered of a dead child, bearing on  its body  an
eruption  precisely  similar in  its  character  to the small-pox in  an


and having examined it further, explained the appearauce in question, then,  for
the first time, to my own  satisfaction and that of Dr. Mackenzie; and in the
evening of the same day, full of the discovery, I came to Dr.  Hunter, and brought
hirn with me to Dr. Mackenzie, to see and judge of the explanation I had given
and Dr. Mackenzie  had agreed to.   This is my state of the fact upon which I
ground my belief of myself being the author of this anatomical discovery; but
as my brother thinks differently, after a period of twenty-five years, I am content
to abolish all remembrance of the successions of time in the course of that day,
and to suppose that Dr. Mackenzie, Dr. Hunter, and myself, inspected the parts
together, and made the discovery: by which means the honour of it will be divi-
ded into three, one of which I may surely be  allowed to  take to myself, the
other two may appertain to Dr. Mackenzie and Dr. Hunter, if they choose to
claim  and  be content with them ; though in this division we must make some
reserve for the claim of several ingenious  young men, at that time pupils, who
were with us, and, of course, entitled to some proportional share in the discovery,
though their present situations, settled at a distance from this  town, have pre-
vented them from getting early notice of the present claim, and, of course, of
making application to the Society for their share.  However, I may here declare,
that if Dr. Hunter will  produce to me any claim which I can allow of his having
discovered  this  anatomical  fact at any period of time prior to this conference at
Dr.  Mackenzie's, I shall first declare, in excuse for having troubled the Society,
that I  was not before acquainted with it, and immediately after declare that he is
entitled to the sole honour of it, at least in preference to myself.
  " I am, sir, your much obliged, and most obedient humble servant,
                                                   John Hunter." 
62
THE LIFE OF JOHN HUNTER.
advanced stage.  To the  details  of the case  are subjoined  some
valuable cansiderations, suggested by them to Hunter's mind.
  The second paper contains observations on a phenomenon  of
not unfrequent occurrence amongst  pheasants, and  several  other
species of birds; that, namely, of the hen bird's assuming a plumage
like the cock's.  This change is found to occur only when the hen
has ceased from breeding, and, as Hunter supposed, only when the
cessation was the result of old age;  but  more  recent researches
have shown, that a disease  of the ovary, unfitting this organ for
producing eggs, may give rise to the change of plumage  even in
young hens.
  The following letter  to Jenner, dated 4th of March, appears to
have  been written  this year, and  like most  of  the  others, relates
chiefly to various objects*  of  natural  history received or expected
by him from Berkeley.

    " Dear Jenner,
  "This very evening I was going to write to you, when  behold a basket came
with pea-fowls, lizards, and birds' legs.  I know nothing of the natural  history
of the viviparous lizard, but  shall ask Sir Joseph  Banks, who, I dare say,
knows ; but I should like to have them when with young, therefore beg you
will give  a genteel reward to those who will bring you several; and let me
know in what situations they are commonly found, that I  may  employ others to
hunt for me.  How did the puppy and you agree ?
  " Last night I looked over all your letters, to  see the one giving me  the
account of the porpoise, but  I could  not find it; therefore  I must beg your
account of them, and the milk, &c, which I hope you will send soon.  Lord
Berkeley has not sent for his dog.   Have you had any account of the bustard ?
  " Monday morning has produced nothing new ; so good day to you.
  " March 4th.                                        J. Hunter."

   In March 1781 Hunter appeared as a witness at  the Warwick
assizes,  in the famous  trial  of  Capt. Donellan, for the supposed
murder  of  his brother-in-law^ Sir Theodosius  Boughton.   Great
public interest was excited by this trial at the time, and the medical
evidence adduced en the occasion has furnished subject for comment
in almost every English  work on legal  medicine published since
that time.
   Sir  T. Boughton, a young  man, previously in  good health,
expired in convulsions about half an hour after taking a draught of
rhubarb and jalap, sent hirn  by his medical man, but with which it
was supposed Capt.  D. had subsequently mixed laurel water, as Sir
T. Boughton's mother observed  that  the  draught smelt of bitter
almonds.
   Suspicions of poison were excited, and  about ten  days  after
death the body was disinterred, and  examined  by several medical
 men,  who,  however,  made  but an  imperfect inquiry,  as they
neglected to investigate either the brain or  the  intestines.   At the
inquest  suspicion fell  on Capt. Donellan, who  was consequently
 arrested, and tried at the following assizes.
   On the trial, four medical witnesses gave it as  their opinion,
 from the symptoms, and  the appearance  on  dissection, that Sir T. 
THE LIFE OF JOHN HUNTER.
63
Boughton had been poisoned, and that  laurel water  had been the
means employed.
  Hunter, on the  other hand, with  that  proper caution which
resulted from  his extensive knowledge, avoided drawing so hasty
a conclusion.   He asserted that the appearances described as hav-
ing been seen on dissection, were such as might have  arisen from
putrefaction  alone;  and with  regard to the symptoms, that they
might have  been caused by apoplexy or  epilepsy as  well  as  by
poison, a point which an examination of the head would have gone
far to decide.  He allowed,  on his cross-examination, that the
occurrence of the symptoms immediately after taking the draught,
was a circumstance in favour of it having caused them; and "if"
said he, " I knew the draught ivas poison, I should say that, most proba-
bly, the symptoms arose from that." But he very properly, and indeed
with  the direction of the Court, separated  in his mind the circum-
stantial evidence adduced  to  show that the draught  was poison,
from the medical testimony he was called on  to draw from the
symptoms and dissection: [and having done so, he said he felt it
impossible to give any decided opinion as to the cause of death.
   Mr. Justice Buffer, who presided at  the  trial,  seems to have lost
his temper at not being able to draw a more decided opinion from
Hunter as to the real cause of death, and on summing up, threw out
 some sarcastic  remarks on  the  doubts  he  had suggested, and
 attached  no weight  whatever  to  them.   The  consequence was,
 Capt. Donellan was found  guilty and executed.   The  circumstan-
 tial  evidence against him, indeed, was rather strong, so that we
 ought not perhaps to consider this, as some have done, an instance
 of judicial  murder: assuredly, however, there  was not sufficient
 ground  for  conviction, and  the  conclusions of the medical men
opposed to Hunter rested, for the most part, on completely unsatis-
 factory data, and should have had but little weight in  the decision
 of the question.
   In  1781 Hunter was elected a Fellow of the Royal Society of
 Belles Lettres at Gottenburg.
   In  1782 he  completed his series of  six Croonian  lectures  on
 muscular motion,* of  which he had annually delivered one since
 1776, with the exception  of  1777,  when for  some  reason  he
   * From the following letter of Hunter's to Sir J. Banks, it would seem that he
 experienced some difficulty in getting paid the money allotted for the support of
 the Croonian lectures.  With whom the fault rested does not appear; but as
 Hunter was not fond of being troubled about money  matters, to cut short the
 affair he applied to the President.
                                       "Jermyn-street, July 25, 1781.
   " Sir,—The last lecture on muscular motion which I had the honour to deliver
 was  the fifth.  Sir John Pringle made a point of my applying for the money
 allotted  for such purposes,  which I did ;  but there were reasons given for my
 not receiving it then.  You  have also desired me to apply, which I have done,
 both  to Mr. Wegg and Mr. Robertson, but have been shifted from one to the
 other.  I thought it my duty, both to yon and the Society, to acquaint you of
 this.     I have the honour to be, with great respect,
           " Your most obedient and most humble Servant,  John Hunter." 
64
THE LIFE OF JOHN HUNTER.
 did not give any lecture.   In these  discourses he unfolded many
 novel and ingenious views respecting the causes of motion in vege-
 tables and animals, and on the various modes of progression employed
 by the latter, in swimming, flying, leaping, running, &c.  At  their
 conclusion the Royal Society expressed a desire of publishing them;
 but Hunter objected to it, as he did not consider his information suffi-
 ciently complete for this, and was accordingly allowed to withdraw
 them, with a view to publication at some future period.   He never
 found leisure, however, to carry this intention into effect; but some
 of his observations were introduced into the work on Inflammation,
 and others Sir Everard Home  embodied in his own publications on
 comparative anatomy.  The latter have met with general appro-
 bation amongst  continental  physiologists, but they have  not always
 been traced  up to their true author.
   He also presented this year a paper on the organ  of  hearing in
 fishes, in which  he gives a general account of the structure of the
 organ in this class of animals,  and shows that in the Ray tribe and
 some other fishes there is an external opening.  He was  the  first
 who pointed  out this fact, and,  as appears by the following letter,
 was anxious  to  secure himself the  credit of his  discovery, which
 he feared some other philosopher might run off with;  since, from
 the date of the  following letter, it would seem that his paper had
 been given in the  year before, but  for want  of opportunity could
 not be read.
    " Dear Sir Joseph,                                       1781.
  " If it was possible and agreeable to read a little bit of my paper  upon the ears
 offish, so as to be able to publish it, I should be glad,  as somebody now will
 rob me of the external opening in the Ray  kind, and in other fish.*  I have left
 it open for future inquiry, because I have a preparation of it, but cannot say what
 fish till I shall  learn  that  by future inquiries; but all this I  leave to you, as I
 know you have my credit at heart.
              " I am, dear Banks, your much obliged,    John Hunter."

   In 1783 Hunter was elected  a Member both of the Royal Soci-
 ety of Medicine and the Royal Academy of Surgery in Paris.
   The  lease   of his house in Jermyn-street expiring this year,  he
 purchased the remainder of the lease of some more  extensive
 premises,  now occupied  by the National  Repository of Arts, on
 the east'side  of  Leicester-square, consisting of a dwellino--ho\ise in
 the square, with a large  portion  of ground extending  to Castle-
 street, where there was a second smaller dwelling; between the
two he determined on  building a museum.  That this was a very
imprudent transaction, in a pecuniary point of view, there can  be
no doubt.  His lease was  only for twenty-four years, and  the sum he
expended  in the  building was not less than three thousand pounds.
 It  seems, however, that  his   mind had  been  so harassed with the
 difficulty of obtaining an eligible site, that it was a relief to be able
  • Dr. Hunter used to say that "philosophers lie like  the devil."  It would
 seem that his brother thought they  also thieved  like the devil;  and we must
allow him to have had some experience. 
THE LIFE OF JOHN HUNTER.
65
to conclude even such a bargain as this.  The new building was to
consist of a room above, for the reception  of his collection, fifty-
two feet long by twenty-eight wide, lighted from the top, and fur-
nished with a gallery all  around.   Under this were  two  apart-
ments, one of which he designed to employ as a lecture-room; the
other, for which no particular use was at first allotted, afterwards
became the place of meeting for the Lyceum Medicum, a  society
which Hunter and Fordyce were the  means of establishing, and of
which they were chosen two of the patrons.   All that Hunter could
spare from his income was for the next two or three years devoted
to carrying the  above plan into effect, and he used often to complain
to his friends that he was now obliged to spend in bricks and mortar
what would have been otherwise expended in enlarging his collec-
tion.   To the new building, the house in Castle-street was subser-
vient, and in the various apartments of it the different, departments
of human and comparative anatomy were carried on.   The house
in Leicester-fields was occupied by  Hunter and his family.
   Notwithstanding his architectural  engagements, Hunter  found
time  to take an active  part, with Dr. Fordyce  and others, in the
formation of the  " Society for the  Improvement of Medical and
Chirurgical Knowledge," which was established  in 1783, and con-
tinued  in  existence  about  twenty  years.  This, like  the  present
Medico-Chirurgical Society, had its appointed meetings for receiv-
 ing and  discussing treatises  on medical subjects, and  those which
 were judged worthy  of it were  reserved for publication.  During
 the whole existence of the  Society only three volumes of transac-
 tions were published; but these contain many valuable papers from
 the  pens  of  Fordyce, Hunter, Baillie, Home, Blane, Wells, Aber-
 nethy, and others.  Amongst  the early contributors we also find
 the name of Jenner, whose  attention had  lately been  turned to
 improving the mode  of preparing the emetic tartar, and who com-
 municated the results of his experiments in a  paper to the  Society.
 Several of Hunter's letters  to Jenner, written about this time, relate
 to the subject, in which, as usual, he took a kind and active interest.
     "Dear Jenner,                          [Post-mark Nov.  14/A.]
   " I received yours, with the experiments  on heat  and colours, but have not
 had time to pay sufficient attention to the colours.  I also received your little
 publication with the Tart. Emet. I have a great deal to say about it.  First, do
 you mean to take  out a patent ?   Do you  mean to advertise it? or do  you mean
 to let it take its chance ?   I approve of it much, and will do all in my power to
 promote the sale;  but I  would  advise you  to give it a new name, expressive
 either of the composition, or of  its virtues on the body, viz. sal antim., or sal
 sudorif., or sal antim. sudorif.  I would also desire you to burn your book, for
 you will have all the world making it.  Let me have your answer to all this.
                                      "Ever yours,   J.  Hunter."

    The piece of advice given  in the latter part of the foregoing letter
 affords an example of that want of  high  professional feeling oc-
 casionally displayed  by Hunter.   Perfect liberality in the com-
 munication of professional  knowledge which  may contribute to the
 general benefit should ever characterize the enlightened physician. 
66
THE LIFE OF JOHN  HUNTER.
 It is this conduct which forms the honourable distinction between
 quackery and one of the noblest of human pursuits ; and the prac-
 titioner who, in seeking after wealth, neglects to observe it, deserves
 to rank only with the venders of secret medicines and professors of
 secret modes of cure, who  in  all  ages have found  ready  dupes
 amongst the ignorant  and credulous, whether of high or low de-
 gree.*  Jenner had too high a respect for his professional character
 to follow the  advice, and, accordingly, made his  method  generally
 known, by publishing it, as has  been before  observed, in the
 Transactions of the Society for the  Improvement of Medical and
 Chirurgical Knowledge, a channel which, as will be seen in one of
 his future letters, Hunter himself recommended.
  The following letter was probably written soon after this proceed-
 ing, as it is filled with directions respecting experiments on colours,
 a subject on which, as we have there seen, Jenner had been making
 some experiments.  The want of this gentleman's letters leaves us
to guess at  the object  of the  experiments proposed, but from their
 nature it may be  inferred  that they were to be  conducted on  an
 individual  labouring under that incapacity for  discriminating be-
 tween certain colours which is not unfrequently found, ina greater
 or less degree, in different individuals.   Hunter's object  appears to
be, to ascertain whether the incapacity arises from a general defect
 in the perceptive  power, or  whether  certain  primary colours fail
 to make their accustomed impression, and  hence the compounds
 into which  they enter  appear different from what they really are.

    " Dear Jenner,
  " I thank you for your last letter: I want you to pursue the inquiry considerably
further: and to give  you an  idea of what I mean, I will first premise that there
 are in nature  but three  colours, viz. red, blue, and yellow, all the others being


  * Notwithstanding some late notable instances of successful  imposture, there
 seems fair ground for believing that quackery is on the decline in this country.
 We should hardly, in the present day, find a judge proclaiming from the bench
 his belief that a bone-setter was just as skilful  and efficient in his business as
 any surgeon ; nor can Sir Benjamin Brodie complain, as Mr. Pott did, that any
 Mrs. Mabb drives her carriage and four into London to take charge of the dis-
 located limbs of the nobility and gentry.  It would  appear, from the following
 anecdote, that in Hunter's time these worthies were even admitted into consulta-
 tion by well educated professional men; and we know that certain departments
 of surgery, as the operations on the eye, &c, were still entrusted to men ignorant
 of the first principles of medicine.  The Taylors of Whitworth were empirics
 who enjoyed much repute in treating diseases of the rectum.  Thurlow, bishop
 of Durham, and brother of the Lord Chancellor, laboured under stricture of  the
 rectum, for which the faculty promised little relief.  The Chancellor  invited
 Taylor to see his brother, and several medical men met  him in consultation:
 Hunter came late, and Taylor was  invited to proceed in the examination ; but he
 bluntly refused, and said he would do nothing till Jack Hunter came, for he had
 no opinion of any but him.  Hunter soon arrived : Taylor made his examination,
 and declared it a bad case; but passed a candle, besmeared with an ointment he
 had brought with him.  Hunter took up the box, and  asked what the ointment
 was made of.  "That," said Taylor, turning to the Chancellor, "is not a  fair
 question : no, no, Jack, I'll send you as much as you please, but I won't tell you
 what it's made of." 
THE  LIFE  OF JOHN HUNTER.
67
combinations of these three.  First, present him with these three colours singly
and see what he calls them; then altogether (not mixed), and see how far they
correspond with his first ideas of thern :  when  that is ascertained, then beo-in to
mix them;  for instance, blue and yellow (which make  a green), see what he
calls that; then a yellow and red (which  make a scarlet) ; next a blue and red
(which make  a purple).  Now to explain the intention of these experiments.
Suppose he has a perfect idea  only of one  colour; and although  you mix that
colour ever so much,  yet he sees  none of the  other, but  only that colour  in the
mixture.  Suppose all the three colours, when seen singly, or unmixed, with him
are blue; mix blue and red (making a  purple), he will  only see the blue, the
red not being visible to  him; and so on of the others, according as he sees  them.
Suppose that a simple colour makes no impression, but a compound one does, viz.
green (which  is composed of  blue and  yellow); then mix blue  and red  in all
proportions, to see what the colour is.  Then  mix yellow and blue in all pro-
portions, and see what colour these are:  if he sees no green in any of them, then
mix all the three colours in various proportions, and see what colours those  make.
When all the colours  are mixed in various proportions, and the whole is a green,
perhaps of different shades, according  to the quantity of  blue and yellow, then
you may fairly conclude that it is the mixture of the blue and the yellow which
produces it, the red never making any impression.
   "If there is any other simple compound that he sees, as scarlet, which  is the
yellow and the Modena  red ; or a purple, which is blue  and red ;  see if,  when
those two are predominant in the mixture, (although there are all three colours in
the mixture,) that the compound becomes the visible colour.
   "The drawing of the  skull has been made ever since you desired it, but  I had
forgot it.   I have a cast for you  of the  aneurismal varix, as described by Dr.
Hunter.  How shall I send both ?  Let  me know.
                         " Ever your much obliged,       John Hunter."

   The following  letter,* which  was probably  written  about this
time, relates to the  metaphysical inquiry as to the nature of matter.
It appears to have been nastily written, and certainly does not lead
us to regret  that Hunter did not more often quit natural philosophy
for metaphysics.   Both facts and  reasoning are unsound.

    " Dear Jenner,
   " I  received  yours, with the heron's legs.  Could  you  not get a live heron or
bittern,—or see how they make that noise,—and send them  to  me ?  I will pay
expenses.   By the by, you were to have sent me some hedgehogs.  I am putting
my things into some order, and shall find some  Don Saltero's for you.
   " My proof of the non-existence of matter is in colours, there being no such
thing  as a primary colour, every colour being a mixture of two, making a  third.
Thus, green is a mixture of blue and yellow;  blue is  a  mixture of purple and
green ; yellow is a mixture of green and  orange; and so on of the other colours.
Therefore all colours  are compounds.  But what are they compounds of  ?  Of
nothing but themselves.  And  what are  themselves ?  Nothing.  If there were
three colours that were permanent, (for with less  than three we can hardly com-
pound to"  any extent,) which could not  be  produced from any compounding of
colours, then I would say, there  is something  immutable in matter, although
metaphysicians might say this was only an immutable idea, or an idea of im-
mutability ; but that is  only applying abstract reasoning  to matter, or what we
call matter; but when we see that there  is no such thing as permanency in one
species of matter, viz. light, and that it  can be proved from the matter itself, it
then  comes more home to  our understandings than all  the reasoning in  the
world.
                                             " Yours always,     J. H."

   His next letter, written  in  December, relates   almost  entirely to
Jenner's new medicine. 
68
THE LIFE OF JOHN HUNTER.
    " Dear Jenner,                              [Post-mark Dec.  15/A.]
  " I have delayed writing longer than I intended, and longer than what  I should
have done, and even now I do not know well what to write.  I love a new name
so well that I could have wished it had been christened.   Mr. Jones intormed
me that tliere was a man of some fortune making experiments with  the same
view; he may hit on  some method better than the  present, and which may or
may not be as good as yours; or it may be thought to be as good.  I asked Jones
if he had any objection to  have it advertised at his shop : he did not give me a
direct answer, and he is now out of town.  I should be glad  to have a few of the
printed accounts.  I could send them to different people ; to Black and Cullen,&c.,
amongst the rest.  I like your  experiment upon the dogs with  it:  if you make
any more, let me have them.   The experiment on the dog's thigh  you did not
finish.  You told me he had extracted the plug.and that the ball of the thermometer
went in with ease, but you did not say how  high the  mercury rose.  Let me
know what service I can be to you.
                                                       " J.  Hunter.

   Hunter's next communication appears to have been made  early
in the year following.   He again recurs to the  tartar emetic ; but
other subjects are mentioned, especially the question as to the mode
in which the young cuckoo is reared, a point which Jenner was at
this time, at Hunter's request, endeavouring to  clear up.

    "Dear Jenner,
  " I am puffing off your tartar, as the tartar of all  tartars,  and have given it to
several physicians to  make trial, but have  had no account yet of the success.
Had you not better let a bookseller have it to  sell, as Glass of Oxford did hia
magnesia?  Let it be called Jenner's Tartar Kmetic, or anybody's else that you
please.  If that mode  will  do, I will speak to some, viz., Newberry, &c.
  " You are very sly, although you think I cannot see it: you very modestly ask
for a thermometer; I will send one, but take care those d—d  clumsy fingers do
not break it also.  I should be  glad to have a particular account of the cuckoo,
and, as far as possible, under your own eye.   To put all matters out of dispute,
if the cuckoo's eggs were  taken  out of the  hedge-sparrow's nest in which they
were laid, and put into another's, by human  hands, there could be no supposition
that the parent cuckoo would feed or take care of them.   I also want some young
ones.  I had a series from you, but a moth got in among them, and plucked them.
Let me hear from you when you can.
                                            "Yours,    J.  Hunter."

   Jenner had been also engaged in making some observations on
the migration of swallows, the  result of which he  communicated to
Hunter, who, in his reply, suggests a difficulty  with regard to one
of the observations.

    " Dear Jenner,
  "To show you how much 1 am pleased to hear from you, I sit down to acknow-
ledge the receipt of yours this evening.   Somebody  before told  me, of your
experiment on swallows; but you should not have made  the same experiment on
both the old and the young of the same nest, for you do not  know whether it was
the old or the young that returned.  I have been for some time goina to write to
you, to  inform you there" is a medical society set up here,* who intend to give
papers in medicine and surgery, and also to receive.  1 think your paper on the
Tart. Emetic would make a good paper, and probably the one on the ophthalmia,
which you may probably take a little more pains about.  If you should like  to
have them published,  I can communicate them.  If your account of the cuckoo
is not so full as you see it may be, keep it to another year, for I am in no hurry.
                         " I am, dear Jenner, ever yours,
   » Jan. 26th.                                         J0HN Hunter."
* Society for the Promotion of Medical and Chirurgical Knowled 
THE LIFE OF JOHN HUNTER.
69
   In February Hunter's paper on Inflammation of the Veins was
 read before the Medical Society above mentioned, and is included
 in the first volume of their Transactions.  Hunter was the first who
 understood and explained the nature of this affection, which he has
 described in  several of its more usual forms.   Little attention seems
 to have been excited by it  at the time.  Mr. Abernethy indeed, not
 long after, contributed some additional information on the subject;
 but  from that time until  1815, when Mr. Hodgson recalled the at-
 tention of the profession to the question, no pathologist had pursued
 the inquiry farther.  Since that time much additional light has been
 thrown on the nature of these affections  by the labours  of Car-
 michael, Travers, Guthrie, Arnott, and Dr. Lee in this country, and
 MM. Bouillaud, Velpeau, Breschet, and Ribes in France, by whom
 it has been  shown  that many of the important and dangerous
 symptoms  following venesection, amputations, parturition, &c, are
 due  to inflammation of the internal coats of the  veins.
   In May Hunter wrote again to Jenner, and  requested him to
 draw out his process for making tartar emetic, that he  might pre-
 sent it to the Society for the Promotion of Medical and Chirurgical
 Knowledge.
    "Dear  Jenner,
  " You must  excuse me if I am not very punctual in my answers :  it is my
 loss, not yours.  In my last but one you mention my having anything of the
 porpoise I wanted.  I should be glad of one of the nipples.   I hope you have
 got the thermometer.  I want the cuckoo cleared up : I  am afraid it is now too
 late.   I wish you would shoot an old one for me, and send its gizzard in spirits.
   " I wish you would draw  out the process for making the tartar emetic.  The
 physicians that I have given it  to  speak well of it as a more certain medicine
 than  the other; however, I am afraid it will be too late for  this year's publica-
 tion ; but put it to paper.  Your paper must  be published before you can think
 of being a member, and then we will stir for you,      Ever yburs,
  " May 29th,                                      John Hunter."

   Jenner immediately complied with his directions, and his paper
 was  read at the first meeting  of the Society,  in June.
   In the course of this year Mr. Home returned  to London on leave
of absence from Jamaica, where  he had  been  acting as  Staff-
 Surgeon, and on his arrival  was permitted  to  exchange  on half
 pay.  " I found Mr. Hunter," says he, " advanced to a very con-
 siderable share of practice, and a  still greater share of public  con-
fidence :" and he afterwards adds, " at this period Hunter  may be
considered as at the height of his chirurgical career ; his mind and
body were both in their full  vigour;  his  hands wrere  capable of
performing whatever was suggested by his mind; and his judgment
was  matured by former experience;" in confirmation of which he
goes on to  mention some of the remarkable operations which Hun*
ter- successfully performed  about this time.
  With regard to this latter point, namely, Hunter's talents as an
operator, a remarkable diversity of opinion exists amongst  compe-
tent judges.  By some, Sir  Everard Home's  account of his  great
                               8* 
70                THE LIFE OF JOHN  HUNTER.
skill is  most fully confirmed, whilst  by others  his  ability in ihis
department of  surgery is rated very  low.   In the opinion  of  Sir
Astley Cooper, whose judgment on the subject must be considered
as at least as likely to be correct as that of any man living, Hunter
scarcely deserved to be considered  a  dexterous operator, certainly
not an elegant  one: but his large experience, and his extraordinary
skill as an  anatomist almost always enabled him  successfully to
complete  any operation he undertook:  though slow, he was sure.
Hunter does*not seem, indeed, to have been ever ambitious of par-
ticular renown in  this field.   He used frequently  to  say, " To per-
form an  operation, is to  mutilate a patient we cannot cure; it
should therefore be considered as  an acknowledgment of the  im-
perfection of our art."
  The new building which Hunter had been erecting for his museum
was completed in  1785, and Mr. Home, Mr. Bell, and Mr.  Andre,
whose services Hunter had  engaged, were employed in superin-
tending the removal of the preparations to their new site.
  If Hunter's building-expenses had of late prevented his purchasing
objects  for his  collection, he appears now to have again begun to
add to its stores.   We accordingly find him making his accustomed
calls on Jenner for objects of natural  history, and, amongst  others,
for a bustard, the  largest and one of the  rarest of English birds.

    " Dear Jenner,
  "I am very much obliged to you for your attention to me.  I will very readily
give three  guineas for the  bustard, therefore give such orders as you think fit.
I request the whole history of the cuckoos this summer from you.   I have
bought a house in Leicester-fields, and shall move this summer, when I shall be
able to pick out some things for you.  Give my compliments to Clench, and I
hope to see him before he sets out for Newfoundland ; if I do not, let him think
of the white hares, to tame a buck and doe, and send them to me.  Let me know
in your next what you are doing.   I hope to see you in  London in about two
years hence, when I shall be able to show you something.
                      " I am, dear .Tenner, ever yours,     John Hunter.
  " When the bustard arrives, I will write to you."

   The  bustard was accordingly procured and sent, and the receipt
of it acknowledged in the following letter.

     " Dear Jenner,
  " I have received the bustard safe, as also the bones. Your friend Mr. Haze-
land has been very kind, for which I wrote to him and thanked him ; but when
you see him or  write to him, express  the same, as an indirect thank is better
than a thousand direct ones.  Are hedgehogs in great plenty ? 1 should like to
 have a few.  You must pursue the cuckoo this summer.   1 am employed build-
 ing, moving, &c.  I  wish this summer was  well over.  When I am fitted up, I
 hope you will come and see me.                   Ever yours,
   "April22.                                          J.'Hunter."

   Soon after the date of the foregoing letter, Hunter beo-an to suffer
 from a very painful and distressing affection of  the  heart and  ar-
 teries ; an affection, to the recurrence of which  he was  constantlv
 liable during the remaining years of his life.   He had been troubled,
 as usual, during the early part of the spring, with slight symptoms 
THE LIFE OF JOHN HUNTER.
71
of gout;  after a time these subsided, but were succeeded by irre-
gular spasmodic affections of the face, arms, chest, and stomach,
and finally, by a violent  spasm  of  the heart, which, after half an
hour of agonizing pain, ended in syncope.  The faintness continued
about ten minutes, at the expiration of which he started up, without
any recollection of  his  previous illness.   Similar attacks, though
slighter in degree, returned  very frequently for  some time after,
especially on occasion of any extra exertion or  mental  anxiety;
and indeed the latter cause seems to have been mainly instrumental
in exciting the first incursion of the disease, for when pressed by
Dr. D. Pitcairn on this point, he admitted that his mind had been
much harassed with a  fear lest  he  should be  attacked  by hydro-
phobia, in consequence of a wound  which he had  received  in  the
hand whilst examining the body of a person who  had died of that
disease.   After a  time  the spasms  became  less frequent, though
even now they were easily re-produced  by a fit of anger, or by
trifling anxiety of mind,  as about the hiving of a  swarm of bees,
the fear lest an animal, which he wished to procure, might escape
before a  gun  could be  brought to shoot  it, and similar causes.
Various remedies were of course tried for the relief of his sufferings,
but with scarcely any effect; and,  amongst other means, he  was
advised to try the waters at Tunbridge.   Thither he accordingly
went in August; but after a fortnight's trial, finding himself rather
worse, he resolved on repairing to Bath, where  he had formerly
derived  much benefit.   He  arrived at  Bath early in September,
and in the following letter we find Mrs. Hunter communicating to
Jenner the presence of his friend in  his neighbourhood.
    " Dear Sir,                               Bath, Sept. 13, 1785.
  " I take it for granted you  will not be sorry to hear Mr. Hunter is so near you,
though  you will lament that  want of health is the occasion. He has been tor-
mented  with a flying gout since last  March, and we are come here in hope of
some favourable crisis before the winter.   He has been inquiring for the post to
Berkeley, and I find within this hour that it goes off this evening:  as he is now
asleep after dinner, I rather  write myself than disturb his nap, to inform you of
our being in your neighbourhood, and that Mr. Hunter will be glad to hear from
you.                    I am, dear Sir, your obedient Servant,
  "No.  12, South Parade.                               A. Hunter."
  Hunter remained in Bath  about  five  or  six weeks, and derived
some little amelioration  of his sufferings.  At the end of that  time
he returned to  London, and resumed his occupations.
  During the whole of this illness,  and of his absence  from home,
his brother-in-law, Mr. Home, was intrusted with the care of his
practice.   This gentleman therefore necessarily became an inmate
of his house, and as Hunter's state  of health, even after  his sojourn
at Bath, was too infirm  to allow him to dispense with the presence
of an able assistant during the performance of important operations,
and to attend to night calls, Mr. Home  continued to act in this
capacity up to the time of Hunter's death.
  Hunter's continued ill  health  had prevented his contributing  as 
72               THE LIFE OF JOHN HUNTER.
 largely as usual to the Transactions of the  Royal  Society.   The
 only communication which he made this year was an appendix to
 a paper of Mr. Home's on the Double-coned Terebella, an animal
 which he had brought with him from the West Indies.  The infir-
 mity of his  body had not, however, abated his ardour for the im-
 provement of his profession, and it was in December of the present
 year thai he planned, and carried into execution, his famous opera-
 tion for the  cure of aneurism ; that of tying the artery at a distance
 from the tumour, and between it  and the heart, instead of laying
 open and emptying the sac,  and  then  seeking for  the  orifices of
 the vessel, according to the old operation.   He was led to propose
 this improved method in consequence of the frequent failure of the
 operation by the old mode,  and  thus  introduced into surgery an
 improvement which has been more fruitful in important results than
 any since Pare's invention of the ligature for divided arteries.
  Our Gallic brethren have stroven hard to  dispossess Hunter of
 the honour of this invention, and have adjudged the whole merit to
 their own countrymen.  This of course.  Three candidates, Guille-
 meau,  Anel, and Default, have accordingly been brought forward,
 to each of whom they have decreed a certain portion of the honour,
 and whose united services, as they assert, entirely forestalled  those
 which  it has been generally thought that Hunter  rendered to sur-
 gery by his  successful operations.   The following are the grounds
 on which these pretensions rest.   Guillemeau, a pupil of Pare, in a
 case of  aneurism of the brachial artery, caused  by a  puncture
 in bleeding, tied the vessel  immediately above the tumour, then
 opened and emptied the sac, and healed it from the bottom.   Anel,
 about  a  century after, in a similar case, tied the artery as Guille-
 meau had done, but left the sac unopened.   Desault, a few months
 before Hunter's operation, placed a ligature on the artery in the ham,
 above the tumour, in a case of popliteal aneurism: the sac inflamed,
 suppurated, and discharged its contents; a fistulous sore remained,
 and the man died at the end of seven or eight months.
  Now, of these three operations,  that of Guillemeau appears  to be
 absolutely devoid of any shadow of claim to be considered as even
 a first  step  towards  Hunter's.  It was simply the old operation
 reversed ; instead of first opening  the sac and then tying the artery,
 he lied the  artery first, and  opened the sac  afterwards.  Anef's
 operation undoubtedly merits more consideration, and it  must be
 admitted that he first  demonstrated the truth of one of the impor-
 tant  principles on which Hunter's operation is founded, namely, that
 theimpulse of the blood into the  aneurism being restrained by a ligature
placed on the artery above the tumour, the further progress of the dis'
 ease will be checked, without the necessity for a ligature being also
 placed on the  artery below  the  tumour.  Two other  principles
 however remained to be proved.   First, That the powers of absorih
 tion would suffice for the removal of the coagula in the sac, and the
 necessity for opening  it be thus done  away with.  Second  That 
                 THE  LIFE OF JOHN HUNTER.                73

the anastomosing vessels of the limb, in their natural state, would be
capable of immediately taking  on such increased action as icould
suffice for carrying on the  circulation to the parts  below the point at
which the main artery  was tied.
  With respect to the  first of these two principles, Anel's operation
proved nothing, for he succeeded, or thought he succeeded,  in first
emptying the tumour of its contents by pressure, before tying the
arterv.   Neither  did Desault's operation  prove this  point,  for we
have'seen that the  sac burst, and discharged its  contents.  It is
true that the removal of the tumour, in the cases of natural cure of
large aneurisms, related  by Valsalva, Guattani, and others, must
have depended on this power in  the absorbents, but these authors
were not aware of this, and attributed their dispersion to the effect
•of pressure, resolvents, &c.  Nor was the possibility of the coagula
being so removed  generally admitted by later  authors, until after
Hunter's operation.   Although  it  would appear,  therefore, that
 Desault intended to trust  to the  action of the absorbents when he
tied the  arterv in the  ham, without opening the sac, yet  it was
 Hunter's operation that reallv proved the sufficiency of this action.
 With regard to the third  principle, I think a candid examination of
 the  question will satisfy any one,  that previously to Hunter's opera-
 tion it was universally disbelieved  that the anastomosing  vessels,
 when not previouslv enlarged, would be equal to  carrying on  the
 circulation of a  limb, after a ligature of the main artery._  It was
 by  acting in  opposition to this general disbelief, and proving their
 sufficiency for this office, that  his operation  became the fruitful
 source  of the numerous  improvements  in the treatment of lesions
 of the arteries which  have since been introduced into surgery.
   No doubt, both Anel's and Desault's operations required, for their
 success, that the circulation should be carried on  by the  anasto-
 mosing vessels, just as the  old  operation did ; but that it was so
 carried on was accounted for by supposing that the anastomosing
 vessels  in the neighbourhood of the tumour had undergone a gradual
 dilatation, in consequence of the pressure of this on the main artery.
 No one had hitherto generalized on the fact, and to place a ligature
 on  the artery in the middle of the thigh, where no such dilatation
 of the anastomosing vessels had taken place, would have  been, in
 the general  opinion,  to  ensure  mortification  of the parts below.
 So deeply rooted was this opinion in men's minds, that some years
 after Hunter's first operation, we find Pott, in a case of popliteal
 aneurism, recurring to Desault's operation in  the ham, rather than
 risk mortification by placing the ligature as Hunter had done; and his
 pupil, Sir James Earle, following his example as late as 1792: and even
 long after this, many of the French surgeons continued  to employ
 various preliminary measures to cause a dilatation of the branches
 previously to operating,  until repeated successes, without these  pre-
 cautions, had shown their uselessness. If, as it is pretended by French
  surgeons, Anel's operation was the prototype of Hunter's, how are we 
74               THE LIFE OF JOHN HUNTER.
 to account for the fact, that during the three quarters of a century
 which intervened between them the former was never once imitated,
 whilst the latter was not only immediately imitated, but speedily led to
 other most important improvements in the operations on  arteries !
 The truth is, neither Anel, nor any other surgeon  before  Hunter,
 conceived that it was possible to make those  important modifica-
 tions in  the operation which the latter introduced, and which could
 alone render it generally applicable: modifications so important,
 as in fact to render it a new operation  based on  new principles.
 A convincing proof of this is afforded in the very operation of De-
 sault which has been  adduced to deprive Hunter  of part of the
 honour which is his due.  Had Desault believed in the feasibility
 of tying the artery in the thigh, would he, in reviving Anel's ope-
 ration, have followed it so closely as  to seek the artery in the ham,
 where the operation is more  difficult, not only from the greater
 depth at which the vessel is placed, but from  the consolidation  of
 parts by previous inflammation?   Assuredly  not.  Another impor-
 tant advantage, too, which Hunter's operation possesses  over that
 of Desault, is the greater chance it affords of finding the artery in
 a sound state, a consideration  so important as to have formed the
 principal inducement with Hunter to  propose his operation.
  The difference, then, between the operations of Hunter and De-
 sault, was not, as M. Velpeau pretends, merely that of the ligature
 being placed two or three inches higher in the one case than in the
 other; they were essentially different in  principle, and justice de-
 mands that we should  vindicate the claim of Hunter  to  the  entire
 credit of inventing an  operation the  importance of which was
speedily estimated as it deserved, and which has  led to those valu-
 able improvements in  the treatment  of the lesions of  arteries  of
which modern surgery is justly proud.
  It will  be seen in  the account of the operation  given by Sir
 Everard Home, that Hunter  committed some  errors, in  the first
two cases, in the  mode of applying the ligatures, which  he after-
wards corrected.   He separated the  artery from its connexions to
 a much  greater extent than was safe,  and this in order that he might
apply four ligatures, which  were intended to  afford  increased se-
 curity ;  but  so far from producing this effect, did in reality greatly
 augment the dangers  of the  operation.  These points, however,
 belong rather to the history of surgery than to a memoir like the
 present, and as the observations  on  the subject  have already ex-
 tended to an almost undue length, I must hasten to resume the thread
 of this narrative.
  In 1786, in consequence of  the death of Mr. Middleton, Hunter
 was appointed Deputy-Surgeon-General to the armv.  In the earlv
 part of the same year  he published his work on  the" Venereal Dis-
 ease, which had been long expected by the public, and which met
 with a rapid sale.  On this  work Hunter had bestowed great pains,
 and before publication he submitted every part of it to a committee 
THE LIFE OF JOHN HUNTER.
75
of his friends, consisting of  Sir  Gilbert  Blane, Dr.  Fordyce, Dr.
David Pitcairn, and Dr. Marshall.   It is said that the amendments
introduced by these gentlemen were numerous; some have wished
that they had been still more so,  at least as regards  the  purely
theoretical parts of the treatise.  A great diversity of sentiment
has prevailed as to the specific or non-specific nature of the disease.
The former was decidedly the most prevalent theory at  the  time
Hunter  wrote, and he adopted it in all its latitude, and endeavoured
to point out the peculiar laws by which it was regulated.  Of late
years the latter opinion has been gaining ground, and  few  would
now be disposed to go the length which Hunter did when he proposed
as a test whether certain diseases be or be not syphilitic, their re-
quiring or not requiring  mercury for their cure.   Whatever  may
be thought, however, of Hunter's theory,  it cannot be denied  that
his work contains many ingenious and striking views, and a variety
of valuable observations on  the various stages  and forms  of the
disease: hence,  notwithstanding some improvements which have
been since introduced into the treatment of these affections, Hunter's
still remains by far the best general work, and requires only the
corrections of the  gentleman who has undertaken this part  of the
subject,  whose  experience of these affections have been  of the
most extended kind, to render  it the universal book of reference on
this complicated and Protean disease.
   Towards the end of this year he published  also his work  on the
Animal G3conomy,* consisting chiefly  of a collection of his  most
important papers in  the  Philosophical Transactions, to some of
which he has made considerable additions.  Besides these, the work
contains his paper on the descent of the testis in the foetus,  with
large additions ; his account of the structure of the placenta, which
the  Royal  Society had declined to  publish;  and  other shorter
memoirs, of minor importance.  This  volume is undoubtedly one
of Hunter's ablest productions, consisting as it  does of accurate
anatomical descriptions of various parts of the  animal  structure,
together with original  and ably  conducted researches  and  sound
and striking conclusions on some of the most important questions
in general physiology.   It  has  been  before remarked, that we can
seldom form an adequate notion of the  contents of Hunter's various
papers from the titles which he gave them.   This remark  is fully
exemplified in those contained  in the Animal CEconomy, a  know-

  * Hunter adopted the plan of printing the first edition of this work, as he did
several of his previous works, under his own eye, and indeed in his own house.
His reason for doing this was, that before the  Irish Union it was no unfrequent
proceeding with booksellers to send  a copy of the manuscript, or else the  proof
sheets, of any valuable work to Dublin, where a cheap edition was hastily got
up and imported to England so as to be ready for sale  as soon as the  original
work, by which means the author was deprived of the profits which would have
accrued to him from a second edition being called for. This proceeding, how-
ever, gave great offence to the booksellers; and as some of them were old friends,
with whom he did not wish to quarrel, he gave the publication of the second
edition to Mr. Nicol, of Pall Mall, and Johnson, of St. Paul's Church-yard. 
76
THE LIFE OF  JOHN HUNTER.
ledge of which is necessary to such as desire  to  become well ac-
quainted with the Hunterian museum, or with the style and strength
of his reasoning on physiological  subjects.   We  may also  easily
discern, in some of his remarks, the germs  of important  doctrines
in physiology which have been since  enlarged on and given  to the
world as new discoveries.
  The  correspondence between Hunter  and  his friend Jenner had
gradually become more infrequent; not from  any decrease of .their
mutual  esteem, but from the increasing occupations of both.   The
following  letters,  however, appear to have  been written during
the latter part of this year,  and refer to a subject which  had been
frequently mentioned before, namely, Jenner's researches respecting
the cuckoo.

    " Dear Jenner,
  " I have been long  expecting  a  long letter from yon, informing me of your
method of curing ophthalmias, history of cuckoos, &c.   I received your dog-fish ;
are you sure that the spawn or egg came from her?  there were none in her: if it
did, then there is a species of dog-fish oviparous.   Let me hear from you soon.
  "Sept.1th.                         Ever yours,         J. Hunter."

    " Dear Jenner,
  "I have all your letters before  me, but whether I have answered a«iy of them
or not I  cannot recollect.  First, I thank you for  your account of the cuckoo,
and what further observations you can make  I shall be  glad to have them, or
even a repetition of the former will  be very acceptable.  I received the bird: it
is well known; but I look upon myself  as equally obliged  to you.   I also  re-
ceived your cocks, which were very good.  I have bought the print  of Wright,
viz. the Smiths, which is his best.  There is one more 1 would have you have,
I mean Sir Joshua Reynolds's print of Count Ugolino : it  is most admirable,
and fit only for a man of taste.  We had a sale of bad pictures  lately, but there
were some good heads : I gave  a  commission for them for you, thinking they
would come cheap, but unluckily there were some that saw their merit as well
as I, and they sold above my commission.  Pictures seem to be rising again. I
will not  send you yours till I hear from you.
  "I am told there is the skin of a toad in Berkeley Castle that is of prodigious
size.  Let me know the truth of it,  its dimensions, what bones are still in it, and
if it can  be stolen by some  invisible being.   I buried two toads  last August was
a twelvemonth ; I opened  the grave last October,  and they were  well and lively.
  " Have you any queer fish?  Write to me soon, and let me have all the news,
&c. &c.
  " Anny sends, with little John, their compliments.    From yours, &c.
                                                    John  Hunter."

   Jenner having at length completed, as  he supposed, his observa-
tions on the  cuckoo, drew them up in the form of a paper, to be
read before  the  Royal Society, and transmitted it for this purpose
to Hunter, who in the following  letter, states the reasons why he
had not already presented it.

    " Dear Jenner,                               [Post-mark April 26.1
  " I received your papers, and should have presented  them to the Royal Society
before now, but for almost the whole, of  this winter  we have  had nothing  but
disputes in  the Society, and giving up of Secretaryships,  &c, and are  not yet
settled ;  but when we are I will give in your paper, but shall take a copy of it,
that in  case they should  not publish it in the Transactions, it may be probably
published by the Medical Society, who will make it of more use than the Trans- 
THE LIFE OF JOHN HUNTER.               77
actions.  The person you mentioned, who was attempting to make the medicine,
called on me and left his name.  When you  have anything new, let me hear
from you.
  " I pity poor Cheston, for the loss of his son.      Ever yours,
                                                " John Hunter."
  Shortly after this Jenner's memoir was read, and  would  have
been published in the Transactions  for 1787, but since delivering il
he had  discovered the fact that the  eggs and  young of the hedge-
sparrow are ejected from  the nest  by the  young cuckoo, and ribt
by  the  parent bird, as he had at  first supposed; he was therefore
allowed to withdraw the paper, in  order to correct this error, and
its  publication was put off till the year following.
   Whilst  Jenner was pursuing  his  observations  on the cuckoo,
Hunter, it would seem, was busied  in trying to make pearls, by
introducing extraneous substances  into  oysters,  as nuclei, for them
to form on.  What success he met with does not appear, and indeed
the following letter of his to his friend Sir J. Banks gives us all the
information we possess respecting this inquiry.
    "Dear Sir Joseph,                                      1787.
  " I have these two days been draining  the pond, or rather fishing for pearls,
the success of which you will see by the specimens. Those I had made the ex-
periments on were dead, but there is one recent. I have a few alive that I mean
to put under experiment; but I shall open the  shell and  put in  the extraneous
body.  If any other method suggests itself to you, be  so good as to inform me.
I would not have you make Lady Banks a present of them; I hope to get  better,
at least as large as  my thumb.  I lately got a tall  man, but at the time could
 make no particular  observations. I hope next  summer to be able to show you
 him.               " I am, dear Sir Joseph,
                            " Your much obliged,     John Hunter."

   Hunter presented two papers to the Royal Society in the course
of this  year.  'The first contains observations  tending  to show that
the Wolf, Jackal, and Dog are of  the same species.   The second
is a long and valuable treatise  on  the  structure  and economy of
Whales,  illustrated by  a  number of very excellent  engravings.
Hunter had pursued  his  researches on these animals with  great
diligence and success, considering his necessarily limited opportu-
nities for making observations.   In this paper he  mentions a fact
which  shows how little  he spared expense  in  the pursuit of his
favourite studies.  As he found it impossible  to obtain proper sub-
jects on which to pursue his inquiries to the extent he desired, he
engaged a surgeon, at his own  expense, to proceed to the North in
a  Greenland whaler,  after having  given him such anatomical
instruction, and provided him with  such other means as would, he
supposed, enable him to obtain some valuable  information respect-
ing the Whale tribe.  But  his  choice of a messenger proved an
unfortunate one: for all that he  got, in return for his trouble and
expense, was a bit of whale's skin, with  some barnacles stuck  on it.
This eagerness of his to obtain  rare and valuable specimens for his
museum, often led him to pay more than its worth for an object he
desired to make  his own, as the following account of the manner
                               9 
78
THE LIFE OF JOHN HUNTER.
in which  he acquired the skeleton of  Byrne, which  heads the
osteological collection, will probably be thought to prove.
  Byrne, or O'Brien, the famous  Irish giant, died in 1783.  He
had been in a declining state of health for some  time previously,
and Hunter, anxious to procure his skeleton, sent his man Howison
to keep watch on his movements, that he might be  sure of securing
his body at his death.  Byrne learned this, and as  he had a horror
of being dissected, determined to take  such precautions as should
ensure his not falling info the hands of the doctors: he accordingly
left strict orders that his body should  be watched day and  night,
until  a leaden coffin  could be made, in which it was to be inclosed,
and carried out to  sea and sunk.  Byrne died soon a|ter, and, in
compliance  with  his  directions, the  undertaker engaged  fsome
men  to watch  the body alternately.  Howison soon  learned this,
found out the house where  these men went to drink when off duty,
and gave information to  Hunter, who forthwith proceeded thither
with the view of bribing them, to allow the body to be carried off
He had  an interview  with  one of the party at the ale-house, and
began by offering  him fifty pounds if he would allow the body to
be kidnapped; the man agreed, provided his companions would con-
sent, and went out to  consult them.  He  returned shortly, saying
that they must have a  hundred pounds.  Hunter consented to this,
and thought the affair  settled;  but  the  men finding him so eager,
soon came back with an increased demand, which  was also agreed
to; when further difficulties were found, and larger  and  larger,
demands made, until, it is said, they raised the price to five hundred
pounds !   The money  was borrowed from Pidcock to pay  them  ;
and in the dead of night the body was removed in a hackney coach,
and after having been  carried through  several streets, was trans-
ferred to Hunter's own carriage, and conveyed immediately to Earl's
Court.  Fearing lest a discovery should take place, Hunter did not
choose to  risk the delay  which the ordinary mode of preparing a
skeleton would require ; accordingly, the body was cut to pieces,
and the flesh separated  by boiling;  he»ce  has arisen the brown
colour of the bones, which in all other respects form a magnificent
skeleton.
  The Royal  Society this year conferred on  Hunter the Copley
medal, as an honourable testimony to the  importance  of his dis-
coveries  in natural history.  He  also received,  about the same
time, another mark of the estimation in  which his labours were
held, by being elected  a member of the  American  Philosophical
Society.
  The arrangement of Hunter's museum was now completed, and
he had the gratification of opening  it for the inspection of his friends
and acquaintance during two months in each year; in  October to
the medical profession, and in May to those noblemen and o-entle-
men who felt an interest in such subjects.
   Hunter's private practice was now so extensive, whilst his bodily
health had so much diminished, that he determined on  applying 
THE LIFE OF JOHN HUNTER.
79
to the Governors of St. George's Hospital to allow him an assistant.
His colleague, Mr. Gunning, determined on making a similar ap-
plication at the same time;  and we  accordingly find amongst the
minutes of the Committee for this year the  following entry :
   " Mr.  Gunning  and Mr. Hunter  present their compliments to
the gentlemen of the weekly board, and beg the favour of  them to
summon a Special General Court for the purpose of electing  two
assistants, a favour which has been formerly shown to  Mr.  Mid-
dleton, Mr. Hawkins, and Mr. Bromfield, in consideration of their
many years'  services to the hospital.
   " The persons whom they beg leave to recommend to this situa-
tion are Mr.  Keate, Surgeon  in ordinary to His Royal  Highness
the Prince of Wales,  and Mr. Home, who  has been bred up under
Mr. Hunter.
   " They flatter themselves the propriety of their recommendation
will render this indulgence the less exceptionable."
   The  request  was complied with, and these  gentlemen elected,
the Court suspending a by-law which forbade physicians or surgeons
of the hospital to recommend assistants or deputies.  Mr.  Gunning
 and Mr. Hunter at the same  time declared  that it was far  from
 their intention to give up  the necessary attendance at the hospital.
   Hunter's friends had long been  desirous to  engage him  to sit  to
 Sir J. Reynolds for his picture ; but  he had always hitherto declined
 to do so, not choosing that it should be  done  at  the expense  of
 others, and thinking  the  price too  high for  himself  to pay.  He
 was, however,  at length induced to comply, chiefly to oblige Sharp,
 the eminent engraver, who had received much notice from Hunter,
 and was very anxious to be permitted to make an engraving  from
 Sir Joshua's picture.  Reynolds found Hunter a bad sitter, and had
 not been able to satisfy himself with  the  likeness, when  one  day,
 after  the picture was far advanced, Hunter fell into  a  train  of
 thought, in the attitude in which  he is  represented in the present
 portrait:  Reynolds,  without  saying  a word, turned the canvas
 upside down, made a fresh sketch, with the head between the legs
 of the former figure, and so proceeded to  lay on over  the former
 painting the colours of that which now  graces the walls of the
 library at the College of Surgeons.   From this portrait Sharp exe-
 cuted his engraving, which  is admitted by the best judges to  be
 one of the finest, if not  the  very finest specimen of the art ever
 executed.  The doubt rests  chiefly between this  and another en-
 graving  by the same artist,*  " The consultation of the Doctors  on

   * Poor Sharp, though a man of extraordinary talent in his art, was singularly
 devoid of common sense.  He was a devotee, and a  firm believer in the preten-
 sions of the prophet Brothers and the aged virgin  Johanna Southcote; but at the
 same time a man  of profligate habits.  Hunter was a  great admirer of his talents
 as an artist, and possessed a large portfolio of splendid engravings by Sharp  and
 other eminent masters in the art.  Sharp always considered his engraving of
 Hunter as one of his happiest efforts, and was found poring over it with admiration
 forty years after he had executed it.  Hunter took fifty copies of the engraving,
 at two guineas each, and the plate proved a milch-cow to the artist.  One of the 
80
THE LIFE OF  JOHN HUNTER.
the  immaculateness of the  Virgin," after  Guido,  for both are
thought to be superior to the best efforts even of Raffael-Morghen
or Desnoyers.
   Hunter's increased professional engagements prevented his con-
tinuing to be any longer so large  a contributor  as formerly to the
Transactions of the Royal Society.  During  the next five years we
find but one  short paper of his, namely, a  Supplement, in 1789, to
his Observations on the Wolf, Jackal, and Dog, given two years
before.  Nor do we find that  he  contributed  anything this year  to
the Transactions of the  Medical Society before mentioned ; and for
the future he generally entrusted to his brother-in-law the business
of communicating an account  of such improvements, or observations
of a professional kind, as he thought deserved to be recorded.
  We find also that his  correspondence with  Jenner for this year
was confined to a single letter, and  that  principally in  reply to a
consultation respecting  a  case of disease of the   urinary organs,
which Jenner had under his care.

    "Dear Jenner,                                       May, 1788.
  "I have been going to write to you  some time past, but business and a very
severe indisposition for three weeks  past has prevented me ; but when two guineas
rouse me, I cannot  resist.   Have  you  tried a  bougie, to find if there is any
mechanical stoppage ?  As there is  blood in the urine, is there no stone ?  Would
it not be right to try both ?   But suppose no stoppage  nor no stone, then I would
push the cicuta: at the same time he should be very temperate in eating,  drink-
ing, and exercise; eat no salt nor made dishes ; drink no  fermented liquors ; but
plentifully of everything else, and be very quiet.
  " Your paper has been  read, passed  the Council, and  is in print, for I had a
proof sheet this day, and I  have ordered  fifty copies, twenty-five for you and
twenty-five for  myself, to give  to friends.  I spoke to both Sir Joseph Banks and
Dr.  Blagden about your wish.   Sir Joseph has not the least objection, and will
give us all his assistance, but he thinks the paper had better be first printed and
delivered, and let the people rest a little upon it, for he says there  are many who
can hardly believe it wholly.  This will put off the certificate till the beginning
of next winter, when  we shall hang you up.   I  have received  a box, with a
wapping landlady and two lizards.  Mrs. Hunter's and my compliments to Mrs.
Jenner.
            " I am, dear Sir,
                      "  Your most obedient Servant,     John Hunter."

  In December of the present year an event  occurred which left to
Hunter the undisputed  title of the  first  surgeon in England; this

means by which Sharp succeeded  in attaining to such perfection in his works
was the following: he always kept a number of engravings in hand at the same
time, in various stages of their progress ; it was his practice to commence working
on those parts which required least delicacy in the execution, and when he had got
his hand well in, or when he felt particularly in cue, immediately to transfer his
operations to those plates which were in a state to  require delicate manipulation.
For the engraving of Hunter, which was prefixed  to the first edition  of his
work on Inflammation, edited by Home, Sharp received fifty guineas, a large
sum at that time.  It  is so  exact a copy of the portion  of the large engraving
which it represents, that it was supposed by some to have been actually abortion
cut out of the original plate ; there  is, however, every reason to believe that  this
latter is still in existence. 
THE LIFE OF JOHN HUNTER.
81
was the death of the veteran Pott.  It is true that for some years
past Hunter had been  in possession of a larger share of practice
and of public confidence than any other member of the profession;
but as Pott still lived,  and, notwithstanding his advanced age, con-
tinued actively engaged in practice, the recollection of his former
fame maintained to him a  high  degree of public  esteem, and  left
it doubtftl to which of these  eminent men  the  priority of station
should be adjudged.  On the 22d of December,  however, this  able
surgeon and excellent  man expired, at the age of seventy-five, after
an illness of  only a few days, having retained  the full use of his
faculties almost to his  last moment.   It will be recollected that Pott
was amongst the earliest of Hunter's instructors in  surgery, but in
after-life they gradually assumed  somewhat of a hostile attitude
towards each other.   A great dissimilarity existed in their charac-
ters and attainments ;  and as, from the position  which each occu-
pied, and from other circumstances, comparisons were often insti-
tuted between them, it may not be uninteresting to endeavour briefly
to show in  what this dissimilarity chiefly consisted.
   Pott was a man of quick  natural  talents  and  of sound sense,
which  had  been  improved  and strengthened by a  good classical
education, and by constant assiduous attention on  his own part in
after-life.   As a surgeon he was thoroughly versed in the history of
medicine in all ages, and knew  well  how to bring  this knowledge
to bear on  the practice of his profession.  His correct observation
enabled him to discover many of the errors of his predecessors,  and
his ingenuity and  judgment, to correct them; and thus by the com-
bined'effeets of his own and  others' experience, he was the means
of introducing many valuable improvements  into  the practical
departments of surgery.   He was not fond  of employing physiolo-
gical reasoning to guide his practice, but aimed rather at founding
his treatment on immediate analogy and induction from established
facts than on broader general  principles;  the  theoretical part of
our profession, therefore, he did little to improve.  As an operator
Pott was eminently skilled; as  a lecturer, clear, energetic, and fluent;
as a writer, classically correct and  elegant.  In society  he  was
agreeable,  witty, and abounding in anecdote,  and at the same time
kind and gentlemanly in his  manners.  Though hospitable in his
mode of living, he was  prudent  in regard to  pecuniary matters,
and though he commenced his  profession poor,  brought up a large
family liberally, and left them well provided for at his death.           t
   The account already given  of Hunter has  sufficiently  shown
how destitute he was  of many  of those acquirements which added
lustre to  the character  of Pott, and which mainly contributed to
obtain  for him the high esteem  which he so long and deservedly
enjoyed. But in  spite of these deficiencies,  Hunter, by the force
of hi's own genius, which was unquestionably of a much higher order
than that of Pott,  and  by his unwearied industry, forced his way at
length to the summit of his profession; and, as Dr. Beddoes observed,
                              9* 
82                THE LIFE OF JOHN HUNTER.
" when one heard that Hunter was  at length the  first  surgeon in
London,  one felt a satisfaction like that which attends the distribu-
tion of poetical justice at the close of a well told tale."
                      CHAPTER  VI.

                         1789 to 1793.

Mr. Hunter's high station in the profession at this period ;—anecdote of his early
  rising.—Mr. Thomas.—Sir A. Carlisle.—Mr. Lynn.—Instance of Mr. Hunter's
  generosity ;—stands godfather to Dr. Jenner's first child ;—his paper on intus-
  susception ;—his paper on paralysis of the oesophagus.—Mr. Home's paper on
  the formation of loose cartilages.—White's New South Wales.—Mr. Hunter's
  illness ;—his violence of temper ;—his style of living ;—his fondness for bees ;
  —his Tory politics__Funeral of Sir Joshua Reynolds.  Mr. Hunter's paper on
  bees ;—his letter to Sir Joseph Banks on this subject;—his surgical lectures ;
  —his work on the Blood and Inflammation.—Veterinary College established.—
  Mr.  Hunter's disagreement with his colleagues at St. George's Hospital;—his
  death, and character as a private man and as a philosopher;—his will and effects;
  —the purchase of his museum.—Correspondence between  Lord Auckland and
  Sir Joseph Banks on this subject.—The  terms on which this  purchase was
  finally made.—Rebuilding of the College of Surgeons.

We have thus  traced  Hunter's career from  the  time when, as a
raw  and uneducated youth,  he first made  his appearance on  the
stage of his future labours and his future fame, upwards through

                    " What rugged places lie between
                 Adventurous virtue's early toils
                 And her triumphal throne,"

to the period when, after forty years of almost unexampled industry,
he had raised himself to the highest  place, not  only in  the estima-
tion of the public, but in the more valuable, because more discrimi-
nating, judgment of the most intelligent amongst the rising genera-
tion  of professional men.   By the latter he was looked up to as [the
author of a new asra  in surgery; and his  opinions were  current,
not  only amongst those who had been  his immediate pupils, but
amongst all the younger  members of the profession who aspired to
keep themselves on  a  level with the advancing   state of medical
knowledge.  Hunter's  behaviour was well  adapted also to secure
him the  regard and the homage of his junior brethren ; for he was
by no means backward in encouraging the advances of young men
of talent who desired to cultivate his acquaintance, readily afforded
any slight attentions in his  power to those coming to London to
finish their studies, and recommended such as had completed their
education  to situations in the army if he  found  them industrious
and intelligent.  It may be worth while to mention a few instances 
THE LIFE OF JOHN HUNTER.
83
of this sort, which, though trifling perhaps in themselves, will not
be without value if they tend  to  illustrate the  character  of this
eminent man.
  On his arrival in London, Mr. Thomas, in  company with Mr.
Nicol, by whom he was to be introduced, called on Hunter:  they
found him dressing.  " Well, young gentleman," said Hunter, when
the first ceremonies of introduction were over,  " so you are come
to town to be a surgeon ;  and how long  do  you intend to stay 1"
" One year," was the reply.  " Then," said he, " I'll tell you what,
that won't do; I've been here a great many years, and have worked
hard too,* and yet I don't  know the principles of the art."  After
some further conversation, Mr. T. was  directed to  call again  in
an hour, which he  did, and accompanied  Hunter to the hospital,
where he said to him, after the  business was over, " Come to me
to-morrow morning, young gentleman, and I will put you further
in the way of things; come early in the morning, as  soon after
four as you can."  "it was summer:  Mr. Thomas kept the appoint-
ment, and found Hunter, at that early hour, busily engaged in dis-
secting beetles.  Mr. Thomas afterwards became his dresser at the
hospital, and was finally recommended by him as surgeon to Lord
Macartney's embassy to China, on returning from which he found
that Hunter had died during  his absence from England.
  Sir A. Carlisle, whilst a pupil at the Westminster  Hospital, was
anxious  to become  personally acquainted with Hunter.  He  in-
troduced himself by calling and requesting his acceptance of a very
delicate  and well-executed preparation of the internal ear.  Hunter
was highly delighted with it, detained him to breakfast, and in the
course of conversation encouraged him by saying, " Any man who
will set about a business, and do it as you have  done that ear, may
do  anything he pleases  in  London."  On finding that Mr.  C. had
not yet  attended his lectures, as a  reason  for which he assigned his
not being sufficiently advanced in  professional knowledge to profit
by  them, " That, Sir,"  said  Hunter, " is  very complimentary, but
I will give you  a perpetual  ticket, and  shall be glad  to see you
whenever you will call."  This invitation was  not  neglected, and
Mr. Carlisle's  anatomical skill soon made  him a  favourite  with
Hunter, to whose collection he contributed several valuable prepa-
rations.
  Nor did Hunter confine himself to such minor attentions as these,
but occasionally assisted young men whom he saw  struggling with

  * It is a not uncommon practice with great men to conceal the amount of labour
bestowed by them on their works, in order to heighten the opinion of their genius.
Hunter seems to have been above this artifice;  he worked hard, and he cared not
who knew it. His contemporaries might under-value his labours, because they
could not understand their object, but he never doubted their usefulness.  "Ah,
John Hunter, what still hard at work!" said Dr. Garthshore, on finding his friend
in the latter years of his life busy in his  dissecting-room.  "Yes,  Doctor," said
Hunter,  "still hard at  work; artd you'll find  it difficult to meet with another
John Hunter when I am gone." 
S4
THE LIFE OF JOHN  HUNTER.
 pecuniary difficulties at the outset of their career, by sending them
 valuable  patients; or even  extended  his  kind consideration still
 further, as  the  following  anecdote,  which  is not quite correctly
 related by Mr. Abernethy in his Hunterian oration, will show.
   Mr.  Lynn, who was for  many years on intimate  terms with
 Hunter, suffered a long illness in consequence of having wounded
 his hand in opening the body of a man who had died from a syphi-
 litic affection.   Hunter frequently called to see him, and one day,
 after expressing  regret  at his  misfortune, and  the  obstruction it
 caused to his business, offered to lend him two hundred pounds, add-
 ing, that though he was the  last man in the world to be able to do
 such a  thing, yet that he would stretch a point, in consequence of
 the esteem he had for  Mr. Lynn.   His friend had been more pru-
 dent, however,  than Hunter supposed, and did not then require
 assistance, but said, that should he have occasion for it he would
 not fail to apply to him.   " Nay," said  Hunter, " what I offer I will
 do now, but what I may be able to do a week hence  it is impossible
 for me  to say.'*  On his recovery, Mr. Lynn went  to  thank him
 for his kindness.   Hunter had forgotten the  circumstance; " But,"
 said he, " if I did say so, you may depend  on  it I  meant what  I
 said."
  But to resume the thread of my narrative.  His old friend Jenner
 had  long ere this sufficiently  recovered  from the effects  of  his first
 disappointment to plead  his cause successfully with  another lady,
 and  he this year wrote to communicate to Hunter the news of the
 birth of his first child, to which  he requested him   to  stand god-
 father;  and as Hunter had no more intention than other godfathers
 of burthening himself with the performance of what  he undertook,
 he readily acceded to the request, as will be seen in  his reply.
    " Dear Jenner,                      [Post-mark, Jan. 29.]   17^9.
  " I wish you joy  : it never rains but it pours.  Rather than the brat  should
 not be a Christian I will stand godfather, for I should be unhappy if the poor
 little thing should go to the devil because I would not stand godfather.   I hope
 Mrs.  Jenner is well, and that you begin to look grave now you  are a father.
                                " Yours sincerely,    J. Hunter."

  Two  other letters of  his, written in the early part of this year,
to Jenner, show  the diligence with which he  promoted the interests
of his friends; they relate to the admission  of the  latter into the
 Royal Society, of which body he was made a Fellow, in consequence
of his interesting communication respecting the cuckoo.  The first
is as follows:
    " Dear Jenner,
  " You are to be balloted for next Thursday. 1 think there  can be no fear of
 success.  You shall have a letter from me by the Friday's post.
                               " Yours sincerely,     John Hunter.
  " I have wrote to Dr. Glass."

  The second communicates the intelligence of his election.
    " Dear Jenner,                               London, Feb. 26th.
  " You  was this evening voted into the Royal Society.  You will have a letter 
THE LIFE OF JOHN HUNTER.
85
from the Secretary; but as that may not be sent for some days, I thought it
would not be disagreable to have the earliest notice.
            " I am, dear Jenner, your most obedient,    John Hunter."

  His own contributions had, as we have before observed, become
gradually more infrequent.  The only paper he communicated this
year was a supplement to his observations on the Wolf, Jackal, and
Dog.
  To the  Transactions  of the  Society for  the  Improvement  01
Medical and Chirurgical Knowledge he furnished a paper on intus-
susception, where he ingeniously explains the mode  in which  the
several  forms  of the disease are produced.  In the same volume is
contained the  account of Hunter's operation for aneurism, as before
given in the Medical  and Surgical  Journal, and of a  number of
additional cases operated upon by Hunter and others.   This paper
was furnished  by Mr. Home.
   In the following year he furnished  to the same society a  paper
on Paralysis of the (Esophagus, and  pointed  out the mode  of nou-
rishing  the patient, now  commonly used  in  this and  some  other
diseases, by means  of a tube  passed down the oesophagus.  He
also provided  Mr. Home  with the  materials for another paper, on
the formation of Loose Cartilages in Joints, the presence of which
he  satisfactorily explains by a  reference  to  pathological prepara-
tions.
   In 1790 Mr. White,  Surgeon-General to the colony  of New
 South Wales,  published a journal of his voyage to that country, to
 which is added an appendix by Hunter on the best mode of collect-
 ing and sending home animals, and on the nomenclature and classes
 of animals, as also a description of the kangaroo, and several other
 animals of that country.
   The  following letter to Jenner relates principally to the subject
 of the presence of  hydatids  in the  body, a phenomenon to  which
 this  gentleman,  and  his biographer  Dr.  Baron after him, have
 attached much importance,  as giving  rise in their opinion, to the
 formation of many kinds of morbid growth.
    " Dear Jenner,
  "I have just  received the favour of yours.  I have, just now, forgot the case
 of hydatids ; but if there was anything that struck me, I dare say it was laid by.
 They are frequently in the kidneys ;  but I should doubt your oil of turpentine
having any merit in  bringing them  away.  My reason for supposing them
 animals  is because they  move after they have  been extracted.   I have taken
 them  out of the head or brain of a sheep, and they have contracted in different
 parts of  them when put into warm water.  I should  be glad to employ you if I
 knew in what, but if anything comes across my imagination I will think of you.
 The measly pork are hydatids.
  " I am afraid  of your friend Mrs. L.  There is a hard tumour that almost fills
the pelvis, most probably the uterus. How does Mrs.  Jenner  do ?  Do you
bring  her to London?  What family have you got?  My compliments to Mrs.
 Jenner;  and believe me to be, dear sir,
                " Your most obedient and most humble Servant,
  "Dec.  8th, 1790.                                   John Hunter."

   Hunter's health had continued very  precarious  ever since his 
86               THE LIFE OF JOHN HUNTER.
severe attack of illness  in  1785: in  December  1789 he suffered
under a sudden and entire  loss of memory, which lasted halt an
hour, and then as entirely left  him.   The spasms about the pne-
cordia were frequently re-produced by very slight causes, as trifling
bodilv exertion or mental irritation.   The latter cause was the most
frequent, to which the  uncontrolled hastiness of his temper rendered
him particularly obnoxious; and so sensible was he of the risks  to
which it exposed him, that  he was accustomed to say that " his
life was in the hands of  any rascal who  chose to annoy and  teaze
him;" a painful thought, that one possessing  a mind of such intel-
lectual vigour should,  from  neglecting earlier to  check this infir-
mity of temper, at length have allowed it " so to over-master
reason" as to reduce him to hold his life on such  a tenure.
  Notwithstanding, however, his ill state of health, Hunter  conti-
nued to enjoy life ;  his constant employment  prevented ennui, and
his natural  vigour and  courage enabled him to  bear up against
attacks  which would have dispirited weaker  minds.  He  does not
seem, like his contemporary Dr. Johnson, to have been  oppressed
with a fear of death;  but neither had he, any more than  the great
moralist, any longing to " shuffle off this mortal coil;" and when a
gentleman at his table spoke of Dr. Hunter's expressing, in his last
moments, a feeling of  satisfaction in  dying,  Hunter replied,  " Ay,
'tis poor work when it comes  to that."   Indeed,  he had  sufficient
reason for being anxious that his life  should be prolonged.  As yet
he had made no provision for his family; and his museum, on which
he had expended so  much, and  to  the sale of  which he  chiefly
looked as the source of  such a provision, was as  yet greatly defi-
cient  in proper catalogues, a want  which  could  not but greatly
detract  from its value, and to supply which formed one  of the
chief objects of his attention during the remaining years of his life.
  Although  Hunter considered his pursuits  too important to allow
of his devoting much  of his time to general society, yet he was
hospitably disposed, and, as soon as his income allowed of it, lived
in rather a handsome  style, kept a carriage and footman  for Mrs.
Hunter, entertained his friends at dinner, and opened his house  to
his medical  acquaintances  every Sunday evening.   His  house  at
Earl's Court had been gradually improved and enlarged  since his
marriage, and some of the rooms had been  tastily fitted up  under
Mrs. Hunter's direction  ; the drawing-room, in particular, was orna-
mented with moveable panels, elegantly painted  in water-colours,
and representing the story of Cupid and Psyche.    Here he used to
spend a good part of his time during  the autumnal months, return-
ing to London in the morning  after breakfast, and retiring to dine
and sleep with his family at Earl's Court.   The  grounds were,  as
usual, stocked with various denizens of earth and  air,  collected
from all quarters of the world, and the garden was well  furnished
with wall fruit; but this was  considered the sole property  of  his
bees, several hives of  which were contained in the  conservatorv,
where he used to pursue his observations whilst at home, and leave 
THE LIFE OF JOHN HUNTER.
87
some of his family to mount guard during his absence.   His fond-
ness for bees was very great, from whence he  derived a common
but expressive metaphor, which he was in the  habit  of employing,
that " his head was like a bee-hive."
  When residing in London his establishment was very numerous,
and as  he had  generally workmen engaged  about  the premises,
not less than thirty persons usually sat down to dinner in his house.
  In conversation he seldom displayed wit; but his  remarks were
often wonderfully pointed and  forcible, and showed him to  be an
original thinker.  In  politics he was as strenuous a Tory as  Dr.
Johnson or the  renowned  Christopher North could have desired,
and was not more lenient than they towards those who differed from
him in opinion.   He  used to say, that  " he  wished all the rascals
who were dissatisfied with  their country would be good enough to
leave it."  He had a great dislike,  as  may be easily imagined, to
taking  part in any public procession or displays  of  any kind,  and
fairly wished Sir J. Reynolds and his friends at the d—1 when called
on to take part  in the funeral of  this eminent  artist  and delightful
author.*
  In 1792 Hunter contributed'his  last paper  to the Philosophical
Transactions.   This contained  the results of his observations on  the
hive bee, continued,  with various interruptions, during a period of
twenty years.   The  variety of his employments rendered it impos-
sible that he should devote such continuous attention as some others,
and especially Huber,  have since  done to the habits of these very
interesting animals;  nevertheless,  his keen observation did not fail
to detect several errors which preceding naturalists had fallen into,
especially with regard to the formation of the wax, which he proved
to  be secreted,  not  collected, by the  animal; and  on the whole
his paper added largely to the general stock of knowledge respect-
ing the economy of the bee.
  He had not confined his attention to the hive bee only, but intend-
ed, as will be seen by  the following letter to Sir J. Banks, which
accompanied  his paper, to  treat also of the hornet, the wasp,  and

  *  Hunter, with Sir G. Baker and Mr. Home, attended Sir J. Reynolds in his
last illness, the nature of which was very obscure, and is said not to have been
understood until a fortnight before his death, when it was ascertained to depend
on enlargement of the liver.  The following is a copy of the post  mortem examina-
tion, the original of which is in the possession  of my friend  Mr.  Palmer, the
great-nepheiw of Sir Joshua, and editor of the present edition of Hunter's works.
  "In examining the body of the late Sir Joshua  Reynolds, we found no marks
of disease in the cavity of the breast,  except only a slight adhesion of the lungs
to the surrounding  membrane on the left. side.
  " In the cavity of the belly the only diseased part was the liver, which was of
a magnitude very uncommon, and at least double of what is natural: it weighed
eleven pounds, and was of a consistence which is usually called scirrhous. It
had  lost its natural colour, and become of a pale yellow.
  " We  found the  optic nerve of the  right side shrunk, and softer than natural.
There was more water in  the ventricles of the  brain  than what is generally
found at  so advanced an age.
  ~2Mh Feb. 1792.               G. Baker, John Hunter,  E. Home." 
88
THE LIFE  OF JOHN HUNTER.
several of the solitary bees; and we cannot but greatly regret that
his intentions were left unfulfilled.
                                               "February 21, 1792.
  "Sir,-A11ow me to present to you a paper on thPj natural h/.s*'y o^?^
mon bee.  It contains the result of experiments and  *n™Uo™^^™l
made in the course of the last twenty years.  They have been frequentlyMnter
rupted  by my other pursuits, which prevented  me from follow »"S t!l'^ ^"V™
regularly through any one season, and  consequently obliged me to renew i; n
others.  Unforeseen accidents have considerably retarded my progress . a very
sultry day melting the comb, the  bees removing some eggs  or magpote, o :a
hive dying under experiment, have  destroyed the chain of my observations lor a

W"ietwas°my intention to  have added some  remarks  on the management of
bees in this country, but I am induced, from the length of this  paper, to reserve
them for another opportunity.  If you  and your learned  Council  think them
worthy the attention of the Royal Society, I shall hope to have them  honoured
with a  place in your valuable Transactions.                   /..,•.■,   r
   " As I have gone a considerable length into the natural history of this tribe of
insects, I hope next winter to give  you the account of  the wasp, and  probably
the hornet.  I shall  afterwards be able to give the wild or humble bee, and many
of those called solitary bees, in which I have made considerable progress;  and
in time I hope to complete the history of the British bees.
          " I am, Sir, your much obliged and most humble Servant,
    "Leicester Square,                                  John Hunter.
   "To Sir J. Banks, Bart., P.R.S."
   He this year resigned to Mr. Home  the  office of delivering his
 surgical lectures,  and for this purpose passed over to him  all  his
 manuscripts, the  greater part   of  which  have   unfortunately
 been either  lost  or  destroyed.  On the  fly-leaf  of  each of these
 lectures were  inscribed  references  to the different preparations
 which he employed for the  illustration of  his opinions, which, did
 they exist, would manifestly afford  great aid  in determining  the
 specific object of many of these preparations.  The loss  of these
 lectures has been lately remedied in part by the publication of the
 late Mr. Parkinson's  notes  of them  by his son, under the  title of
 " Reminiscences  of John Hunter;" and Mr.  Palmer will  be able,
 in the present edition, still further to repair the loss, by  collating a
 number of copies, of  different  dates and by  different hands, with
 each  other.  To this  foundation  furnished by  Hunter, Mr. Home
 added a number of new lectures on particular diseases, and on the
 operations of surgery, which he continued to deliver for a few years,
 but was never a very popular or diligent lecturer.
   Mr. Hunter's  chief  reason for declining his lectureship at  this
 time was, that he might have more leisure to devote to the comple-
 tion of his work  on  Inflammation,  which, in  justice to himself, he
 felt it was now  time he should make public.  As it happened, he did
 not live to see the entire work through the press,  a  portion of it
 still remaining  at the time  that he died, the  office of correcting
 which devolved on Mr. Home and Dr. Baillie.  It was published in
  1793, together with a life of the author by Mr. Home.
    This work is one on which, above all his other writings,  Hunter's
  fame has hitherto rested;  perhaps  too exclusively  so, since it has 
THE LIFE OF JOHN HUNTER.
89
arisen from the circumstance that, with  the  exception of the trea-
tise on syphilis, his other works have been less generally read than
they deserve, in consequence  of their having been published either
in an expensive form or in detached treatises, scattered through the
volumes  of the Philosophical Transactions, or of the Medical and
Chirurgical Society.   There are not, however, any of his writings
which do not well deserve the attentive perusal of professional men,
not only  for the information they furnish, but as models of bold and
sagacious reasoning; and hence the present edition, which places
within the reach of every professional man the whole of his works,
heightened, too,  in value by the commentaries of the able men to
whose revision they have been severally entrusted, cannot fail to be
viewed as a tribute justly  due to the  merits  of Hunter, and as a
highly important accession to our medical literature.
  The Treatise on Inflammation and Gunshot Wounds must be con-
sidered as comprising the results of forty years' assiduous attention
to the subject, since, from his Introduction, we learn, that the doc-
trines it unfolds first  suggested themselves to  his mind  at the time
he was a student in the London hospitals, and were based on obser-
vations collected during that period. .These  doctrines he continued
during his whole professional career to submit to the test of his own
increasing experience and the experience of others, to whom he taught
them in his lectures,  ever  carefully and  candidly correcting  them
where more accurate observations  proved them to be faulty, and
extending them where fresh information  showed them to be defi-
cient;  and having thus brought them to  as high a degree of perfec-
tion as  his abilities and opportunities would permit, he at  length
submitted them to the test of public opinion  in the  condensed and
systematic form in which we now possess them.
  Notwithstanding the time and attention he  had  devoted to the
completion of a work on which his  future fame  was  mainly to
depend, he was himself fully sensible of its  still  possessing many
defects, and rather desired it  to be considered " as a new figure
composed from  rough  materials,  in which process little  or no
assistance could be had from any quarter," than  as a perfect work
which no further experience could have amended.  It must indeed
be acknowledged that it does, in many parts, exhibit imperfections
of style and diction, as well as repetitions, which not unfrequently
obscure the author's meaning; and illogical errors, such as that of
confounding proximate and final  causes, or  employing such ima-
ginary causes as  the  " stimulus  of necessity,"  "  the stimulus of
death," "the  force of a negative impression," &c, to account for
certain effects; phrases which cheat the ear  with a seeming expla-
nation, but leave the mind no whit the wiser as to the real  causes
of the phenomena to be accounted for.  These defects, though they
do unquestionably detract  somewhat from its value, are, however,
trifling in comparison with the great and varied excellence  of this
work, which, for the originality and variety of its experiments, the
accuracy of its observations, and the importance of its deductions,
                               10 
90
THE LIFE OF JOHN HUNTER.
can with difficulty be paralleled in the whole range of medical liter-

  Ab'out this period the London Veterinary College was first pro-
jected, and being liberally  supported by several influential noble-
men,  was speedily  established.  Hunter felt  much  interest in  its
formation, and, with several other gentlemen, took  shares in it to
the amount of two  hundred pounds,  and, furthermore, granted to
the pupils attending  there a free admission to his lectures.
  In addition to the  honorary distinctions which he before enjoyed,
Hunter had this vear conferred on him the title of  Member of the
Irish College of Surgeons, and of the Chirurgo-Physical  Society of
Edinburgh;  but neither these nor any others did he ever append to
his name, preferring the simple appellation of John  Hunter, which
he was fullv  conscious was  better able to confer honour on most
Societies than their  initials to add importance to it.
  We have now arrived at that period when it becomes necessary
to notice the  unhappy disagreements  which had for some time past
existed between Hunter and his  colleagues at the Hospital, and
which now broke out into more decided  measures of hostility.  It
would have been more agreeable, had it  been proper, to have pass-
ed over these without notice, since they reflect little credit on either
of the contending parties;  but they  are so  intimately  connected
with the fatal event which  terminated  Hunter's life and labours,
that  it seemed absolutely necessary, in the present narrative, to
notice them  somewhat more fully than his former biographers have
done.
   [Mention has alre.idy been made of the blunt  and overbearing,
manner which Hunter not unfrequently displayed towards  men of
his own standing in  the profession.  Devoted as he was to  physio-
logical pursuits, and firmly  persuaded that without an improved
knowledge of physiology it would be impossible to attain to  correct
general principles in surgery, which he looked on  as  still in  its
infancy, he viewed  with contempt those  who were content to guide
their practice by past experience alone, or by the erroneous theories
of their ancestors.  On the  other hand, the majority of Hunter's
contemporaries considered his pursuits to have little connexion with
practice, charged  him  with  attending  to  physiology more than
surgery, and looked on him  as*little better than an  innovator and
an enthusiast.  There could be little harmony between such dis-
cordant elements, and as it was with his colleagues  at the hospital
that  Hunter most frequently came into collison, it was between him
and  them that mutual  want  of  respect most easily  and surely
ripened into animosity.
   At the commencement of 1792, Hunter's colleagues at the hospi-
tal were, Gunning,  who was his senior, a man of good  talents and
high spirit, and leader of the opposition against him  ; Walker;  and
Charles Hawkins, the son of Sir Cassar, and a remarkably dexter-
ous operator.  Early in the year Hawkins resigned his situation,
and  a contest for the vacancy ensued between Keate and Home. 
THE LIFE OF JOHN HUNTER.
91
The latter was of course supported by Mr. Hunter, whilst all the
remaining medical officers, with  the exception of Dr. Baillie, lent
their interest to his opponent.   The contest was perhaps the warm-
est in the annals of hospital  electioneering,  and  several of the
Royal Dukes attended in person  to vote for Mr. Keate, who was
chosen by a  majority of 134 against 102.
   A contest  like this, however it might have ended, could scarcely
fail to heighten existing animosities; and soon after, Hunter, actua-
ted far more by a spirit of hostility to his opponents than by any
desire of  pecuniary benefit to himself, announced to them his inten-
tion to discontinue the  practice  of dividing equally amongst the
surgeons  the admission  fees of all the pupils attending the hospi-
tal, and for the future to retain  for himself the money of those who
should enter  under his name  as pupils; a  preference which is de-
termined  by various circumstances,  and which has never  been
regarded  in any other light than  as a compliment.   As a reason
for this step, he alleges his wish to stimulate the other surgeons to
pay some attention to  the education  of the pupils, which, as  he
asserts, they were far from doing, but on the contrary had  brought
disgrace on the hospital by their neglect.
   This measure  his colleagues resolved to resist, and determined
to submit the matter to the decision of the  Governors, a step which
seems, from  the  following letter, to have  met with  Hunter's full
concurrence.

    " Gentlemen,
   " As the time approaches when you propose referring to the Governors of
St. George's Hospital my determination respecting the money arising from the
surgeons' pupils, I beg leave to acquaint you that I entirely agree with you in the
mode that you  have proposed, a mode I did not myself adopt, as it took from you
the power of acceding to my proposal, and made  me appear to the  Governors
as an  accuser. But when you bring it before them I shall  meet it fairly and
very willingly.      " I am, gentlemen, your most obedient servant,
  " Leicester Square, Feb. 8, 1793.                      John Hunter."
    " Messrs. Gunning, Walker, and Keate.

   A Special  Court was accordingly summoned to meet in March
following.  Before the day of meeting, Hunter forwarded  to each
subscriber, for his  information,  a pretty long prjnted letter, explana-
tory of his reasons for the alteration which  he had determined to
make.   In this communication,  wjiich is certainly not remarkable
either for  its  liberality or modesty, he gives an account of the vari-
ous efforts he had made, since his connexion with the hospital, to
induce his colleagues  to improve the system of instruction; efforts
which, he says, all proved ineffectual: one man " did  not choose to
hazard his reputation  by giving lectures," and another " did not see
where the art  could be improved."   Disgusted  at his  want of
success, and  resolving not to encourage the indolence of others, he
had consequently slackened in  his attention to the pupils, and  an
immediate and constant falling off in their numbers had  been the
result.  He shows how large  a majority of the whole number of 
92
THE LIFE OF JOHN HUNTER.
students had always entered as his pupils, argues on the propriety
of each surgeon  profiting according  to his labours, and therefore
justifies his  present  intention, which  cannot justly be  ascribed  to
any avaricious feeling, seeing that the  whole number ot those enter-
ing at the hospital is now  so small.   Finally, he deprecates the
considering  this as a party question, affirms that he is actuated  by
the most disinterested feelings, and expresses his readiness to submit
to the decision of the Court.
  To this letter the hostile triumvirate replied, by denying the cor-
rectness of Hunter's account.  The  increase of pupils after his
accession  to the hospital, they attribute to the breaking out of a war,
and not to his presence;  the subsequent  decrease they state was
caused by the  establishment of medical schools at the other hospi-
tals, and'not by Mr.  Hunter's neglect.   They admit that the num-
ber of pupils entering with  him has been larger than with either of
themselves ; but this  has been owing to his connexion with the ana-
tomical school in Windmill-street^ and his power of conferring
posts  in the army, and not to his superior attention to the pupils.
To the charge of neglecting their duty, brought against them, they
reply  by stating that they have continued the usual plan of instruc-
tion  long followed  in  the  hospital.   That if the students  have
neglected  their duties there to follow physiological researches, it
was not their fault.  A proposal they state had been formerly made,
that each  of the surgeons  should  give six lectures at the hospital,
for which extra instruction the  admission fee was to be raised
from  twenty  to  five-and-twenty guineas, but for the following
rather curious  reasons the plan was not  put into execution.   1st,
Because they thought the old plan of  instruction best for surgeons.
2dly,  Because copies of the  lectures  might be taken by the pupils,
and might get abroad ! 3dly, Because, though the pupils might  be
pleased for a course or two, the  lectures would  lose  their effect
ultimately, and  might, from the  number  being lessened, in conse-
quence  of the rise of price, in  the  end prove disadvantageous.
They then  go on to  show, that  a  manifest disadvantage  to the
pupils would  arise from the proposed measure ; for whereas they
had hitherto enjoyed the benefit of instruction from all the surgeons,
they would for the future be limited to  the instruction afforded by
the surgeon alone under whom they  entered, should Mr. Hunter's
 intention  be carried into effect.
   The decision of the Governors was given against Mr. Hunter;  for
though his opponents neither fully disproved his statement,  that he
had been  the means of increasing the number of pupiis at the hos-
pital, nor could deny that he had done more towards their instruc-
tion than  any  of themselves,  yet the disadvantage of the plan he
proposed was so obvious,  as pointed out by his opponents, that
nothing but confusion and  discord could  have been expected from
 its adoption.  A Committee was subsequently appointed to draw up
 a.code of  rules for regulating  the  admission and instruction of
 pupils; and a set  of proposals was submitted  to  them  by  Mr. 
                 THE LIFE OF JOHN HUNTER.               93

Hunter's colleagues, which was agreed to without his having been
even consulted on the occasion !   Many of the regulations adopted
continue in force  to the present day; others, and especially those
relating to the better instruction of the pupils, soon fell into disuse;
and some seem to have been especially directed against Mr. Hunter.
Amongst these latter was one which determined that for the future
no person should  be admitted as a student of the  hospital without
bringing  certificates that he had been educated to the profession ; a
regulation which was  probably designed to  exclude Mr. Hunter's
countrymen, who sometimes came up to town recommended to him,
and entered as his pupils at the hospital, without having had any
previous medical instruction.  Nor was this clause long in taking
effect: for in the autumn, two  young  men,  who had come up  to
town ignorant, of  this  new regulation, applied to  Hunter to  be
admitted under him at  the hospital.  He informed them of the law
which had been passed, but undertook to press for their admission
at the  next Board-day, and directed them  to furnish  him  with a
statement of their  case in writing.  On the 16th of October the
Board was  to  meet,  and Hunter  prepared to fulfil his promise,
though he was so well aware of the risk he incurred, in undertaking
a task which he felt would agitate him, that  in mentioning the cir-
cumstance to a friend who called on him in  the morning, he
expressed his apprehension lest  some unpleasant dispute  might
occur, and his conviction that  if  it did it would  certainly prove
fatal to him.  At his  accustomed hour he left his house to com-
mence his morning rounds, and by accident forgot to take with him
his list of appointments ;  he had left the house but a few moments
when it was discovered, and Mr. Clift, who  was  then residing  in
his house, hastened with it to York-street, St. James's, the first place
on the list, where he found the carriage waiting.  Hunter soon
made his appearance, took  the list, and in an animated tone called
to the  coachman to drive to St. George's.  Arrived at the hospital,
he found the Board already assembled, and entering the room,  pre-
sented the memorial of the young  men,  and  proceeded to urge the
propriety of their being admitted.  In the course of his remarks
he made some observations which one of his colleagues thought it
necessary instantly and flatly to contradict.   Hunter immediately
ceased speaking, retired from the  table, and struggling to suppress
the tumult of his passion, hurried into the adjoining room, which  he
had scarcely reached when, with  a deep groan, he fell  lifeless  into
the arms of Dr. Robertson, one of the  physicians of the hospital,
who chanced to be present.  Dr.  Baillie had immediately followed
him from the Board-room, and Mr. Home, who was in the  house,
was also summoned to his assistance. Various attempts were made
for upwards of an hour to restore animation, under the hope that
the attack might prove to be  a fainting fit,  such as he had before
experienced, but in vain;  life had  fled ;  and all their efforts proving
useless, his body was placed in a sedan  chair and conveyed to Lei-
cester-square, followed by his now vacant carriage,
                             10* 
Dl               THE LIFE OF JOHN HUNTER.
  This most distressing event of course put an end to the business
of the  meeting: the Board broke up, and the  only  notice  to  be  .
found on  the books  of that day's proceeding  is the  following
minute:
  " Resolved,—That Mr. Hunter's  letter to this Board relating to
two of the surgeons' pupils, which was received  this  day, be pre-
served for future consideration."
  The body was examined after death,* when  the viscera of the
belly and head were found loaded with blood, but otherwise nearly
in a natural state, with the exception of the carotid arteries and their
branches within the skull, which were  in parts thickened and ossi-
fied.  In the chest, the left lung had become attached to  the costal
pleura by old and firm adhesions ; but the heart was found to be
the chief seat of disease.  The pericardium was  unusually thick-
ened, but did not contain much fluid.   The heart itself was small,
appearing too  little for  the  cavity in which it was contained, its
diminished size being the result of wasting, and not of strong con-
traction of its fibres"  Two opake white  spots were  seen on  the
left auricle and ventricle.  The muscular structure of  the organ
was pale, and loose in its texture.  The coronary arteries had their
branches which ramify through the heart converted into long tubes,
with difficulty  divisible  by  the knife.   The  mitral  valves were
much ossified.  The aorta was somewhat  dilated, its valves thick-
ened and wanting pliancy, and the inner surface  of the artery was
studded with opake and elevated white spots.
  Hunter's body was interred in a private manner, in the church of
St. Martin-in-the-Fields, accompanied  only by a  few of his medical
friends.                  •
  Some time after  his  death Mrs. Hunter felt anxious  to erect a
monument  to his  memory in Westminster Abbey;  but the fees
demanded for a permission to occupy a niche within that venerable
fane were too great for  her reduced fortunes,  and she therefore
abandoned her intention.  It may be thought that the  author of the
Hunterian museum needs no other memorial of  his worth than  the
proud  one he  has  himself erected ;  nor does he, to perpetuate  his
fame: still it would be a fitting act of respect to  his memory, from
those who enjoy the benefits of this rich legacy of his  genius, to
enrol his name amongst those of the other  gifted men whose worth
stands recorded in Westminster Abbey.
   Thus, in his sixty-fifth year, died  John Hunter, celebrated alike
as a surgeon and as a naturalist; in either of which capacities  has
he had many equals,—in his combined character, none.
   In person he was about the middle stature of a  vigorous and

   • It  has been  supposed  by some that Hunter had the same antipathy to the
 scalpel of the anatomist as was  felt by his brother ; but this was  by no means
 the case ; on the contrary, he always spoke of it as a matter of course, and used,
 in the  strongest language, to express his condemnation of those who should
 neglect to examine his body and preserve his  heart. It is to be regretted that no
 relic of this sort has been preserved. 
THE LIFE OF JOHN HUNTER.               95
robust frame, and free from corpulency ;  his  shoulders were high,
and his neck short.   His features were rather lage, and strongly
marked;  his eyebrow projecting, his  eyes of a  light colour, his
cheeks high, and his mouth somewhat under-hung.   In  dress  he
was plain and gentlemanlike ; and his hair, which in youth was of
a  reddish yellow, and in  his latter  years white, he wore curled
behind.
   On considering what was the distinguishing character of Hunter's
mind, we perceive that it was  rather that of  general strength and
vigour than of marked predominance of any one faculty, especially
adapting it for excellence in some particular kind of pursuit.  John-
son says  " a true genius is a mind  of large general  powers, acci-
dentally determined to  some particular  direction;" a  definition
which, though certainly  not universally true, seems thoroughly de-
scriptive of "Hunter's  mind.   To talents  for observation naturally
acute, and  heightened to  an  extraordinary  degree  by constant
practice, Hunter added strong reasoning powers, a sound judgment,
and an imagination  which, though not  brilliant, was sufficiently
active to aid him in  his researches, whilst it rarely drew him far
aside from the sure paths of induction into the regions of hypothesis.
Hence, though it might be  difficult to name any employments better
fitted  to call the faculties of his mind into full action than those  in
which he was engaged, yet it cannot he doubted that there were
many in which  those faculties, aided  by  his extraordinary powers
of application, would have as certainly  raised him  to a pre-emi-
 nence above other competitors as they did in medical science and
 natural philosophy.
   With regard to Hunter's moral character, though it was adorned    ;
 with  many noble features,—as  undeviating  honesty, an eminent
 love  of truth and candour, and a humane and generous spirit,*—
 and though as a friend  he was warm and disinterested, and as a
 husband and a parent kind and affectionate, yet his character was
defective for want of that  control over his passions and his temper,
 the possession  of which  is absolutely necessary to the attainment
 of moral excellence and true happiness.
   It is related of Mr. Pitt, that when asked in his last illness by the
 Bishop of Lincoln if he  had any objection to receive the sacrament,  -
 he replied,  " None whatever.   I will take it readily,, if  you wish;
 but, my dear Lord,"  he added, " the whole of my life has been de-
 voted to  Politics; and as  I have had  no  time to attend to religion,
 I must now trust to  the mercies of God."   As regards his attention
 to the all-important subject of Religion, it is to  be feared that a

   * In regard  to fees  Hunter was extremely liberal.  He used  generally  to
 reply,  when  asked to say what was due to him,  " Why, that you must deter-
 mine  yourself;  you are the best judge of your own circumstances,  and it is far
 from my wish to deprive you of the comforts of  life." He never allowed him-
 self to accept any remuneration from non-beneficed  clergymen,  professional
 authors, or artists of any sort,  and sometimes returned large fees when he found
 that the parties were in embarrassed circumstances.
« 
96
THE LIFE OF JOHN HUNTER.
 similar answer must have been given to a like  question by Hunter,
 whose mind had been directed with no less intensity and devoted-
 ness to his  peculiar pursuits than had that of the great statesman
 before mentioned.                                             ,
   In forming an estimate of Hunter's professional character, and of
 the influence which his labours have had on  the  improvement of
 surgery, we are not, as with ordinary minds, simply to enumerate
 the various practical amendments of which  he was the immediate
 author. His claims are of a far higher nature; and in as much as he
 was the first who taught us to bring the lights of physiology to bear
 upon the practice of our art, and by his writings, his teaching, and
 his example stimulated the minds of numerous able followers to pur-
 sue the track he had pointed  out, he justly merits to be considered
 as the author of a new aera in the history of our profession.
   In the character of a naturalist it is impossible for us 1o form a
 full estimate of Hunter's labours, either from his published works, or
 from his  incomparable Museum as it at  present  stands.   In  the
 course  of the numberless dissections,  which he prosecuted  during
 thirty  years of unwearied diligence,  he  necessarily made a great
 variety of  isolated observations, which, though  not immediately
 applicable to the objects he had in  view, would doubtless have con-
 stituted important contributions to the general stock of  knowledge
in comparative anatomy.   Such observations he  always recorded
 carefully in appropriate volumes; but by Sir Everard Home's extra-
 ordinary destruction of his manuscripts science has been deprived
 of these fruits of his industry, of which scarcely the smallest portion
 now remains in  existence.  But even in cases where the records of
his researches have been  preserved, either in the form of prepara-
tions or by  means of drawings forming part of his museum,  the
want of proper descriptive catalogues has often caused  them to be
 overlooked, whilst  more  modern naturalists have been reaping the
 honour of discoveries which were due in the first place to Hunter.
   Nevertheless,  though we  cannot estimate the full extent of his
 labours, enough remains  to  entitle  him to a place in the highest
 rank as a natural philosopher.*  His various papers in the Philoso-
 phical Transactions and  elsewhere give sufficient  evidence  of  the
 original and masterly manner in which he handled every subject of

  * The following extract from the obituary of Hunter, in the  Gentleman's
 Magazine, is much more flattering to the author, and affords a curious specimen
 of the stuff which these memorials often consist of:—" .... As a man of letters
 independently of his profound scientific studies, he had traced the practice of
 surgery to the earliest ages.  He was well acquainted with every practitioner
 mentioned by Pliny, with all the Greek and Roman authors who had written on
 the subject, as well as with every modern one who had  contributed to the  per-
 fection of the art.....As a man well versed in ancient history, the Egyptian
 chronology was familiar to him, as far as related to the antiquity of anatomy • as
 a  scholar, distinguishably classic, he knew that Homer was an anatomist at
 least had ideas of anatomy, as well as an epic poet," &c—One would imagine
 that the biographer had purposely selected the weak points of Hunter's charac-
 ter, in order to parody  them. 
THE LIFE OF JOHN HUNTER.
97
 inquiry; and the arrangement of some departments of his museum
 shows, that whilst his great contemporary Linnaeus was extending
 and perfecting  his beautiful  but  artificial arrangement  of living
 objects, Hunter had made considerable advances towards that natu-
 ral classification of the animal world which Cuvier has  so admira-
 bly effected in  modern times.
   By his will, of which Dr. Baillie and Mr. Home were  the execu-
 tors, Hunter bequeathed the estate of  Kilbride to his son.   Earl's
 Court  he directed to  be  sold; and the proceeds, after payment  of
 his debts, to  be divided equally between his widow and two children.
 His Museum he ordered to be offered, in  the first instance, to the
 British Government  (therein following the example of  his  elder
 brother), and on such terms  as  might be considered reasonable;
 and in case of their refusing it, he directed it to be sold either  to
 some foreign state, or in one lot, in  such manner as  his executors
 might  think proper.
   On examining, however, into the state of his affairs, it was found
 that his property, exclusive of the Museum, would  scarcely suffice
 to pay  his  debts; and it was accordingly to the produce of the sale
 of this that his family had to look for their  future  support.  The
 disposal of it to the British Government was on  all accounts most
 eligible: but  it was no easy task to bring this about.   The attention
 of Parliament  and the nation was wholly  directed to the  events  of
 the French  Revolution, and there was a great unwillingness  to
 expend money on  any objects not  essential to the conduct  of the
 war.   When Mr. Pitt was appliedpto on the subject, his  reply was,
 " What! buy preparations!  Why I  have  not money  enough  to
 purchase gunpowder."  And it was not until three  years after that
 Parliament could be induced even to  institute an inquiry into the
 value of the Museum, with a view to deciding how far it might be
 desirable to make it national property.  In the  mean time Hunter's
 family were  in very straitened circumstances.   Through the kind
 interposition  of  Lord Auckland,  Mr. Pitt was prevailed  on  to
 bestow a portion of  His Majesty's bounty on Mrs. Hunter  during
 the first two  years of her  widowhood; but the Act  of Parliament
 forbade its being given a third year.   The greatef part of Hunter's
 household goods were therefore sold to meet  the current expenses
 of his family and pay for the conservation of  the  Museum;* and

  *  Amongst these were a variety of valuable objects  of virtu which Hunter
 had collected from various quarters; ancient coats of mail, weapons of various
 dates and nations; and a very beautiful turning lathe, which had belonged to the
 Duke of Cumberland.  With such articles as these Mr. Christie, the fashiona-
 ble auctioneer of the day, who presided at the sale, found himself quite at home ;
 but when he  came to dispose of a curious mask, which Hunter had constructed
 to protect his face whilst making his observations on bees, the renowned auction-
 eer was completely non-plused.  At length, after  turning  it round and round,
 and surveying it on all sides, he said,  "This, ladies and gentlemen, is a cover-
ing for the face, used by the South Sea islanders when travelling, to protect them
against the snow storm.i.,,\ It would appear from a sale catalogue (in the pos-
session  of Mr.  Upcott), dated July 31, 1794, to which the prices are affixed,
that the produce of this sale could not have been considerable. 
98
THE LIFE OF JOHN HUNTER.
 it is to be regretted that amongst these were included his  library,"
 and a valuable  collection of crystallizations, both of regular  and
 irregular forms, which he was accustomed to use in his  lectures to
 exemplify the difference between the laws which regulate  the growth
 of organic and the increase of inorganic  bodies.   Whilst, however,
 we must  regret that these objects were irretrievably dispersed, we
 must entirely exempt his executors from  the  blame which  has been
 sometimes attached to them for  allowing this to take place.   Nei-
 ther of them  were in  circumstances to defray from  their  own
 resources  the expenses necessary for the  maintenance of his widow
 and children;  and  as there seemed little  prospect of soon disposing
 of his collection, they were obliged to have recourse to  the sale of
 objects which, under other circumstances, they would have gladly
 held sacred.f
   In  1796, all  the personal efforts of Hunter's  executors having
 failed to induce  the House of Commons to think  of purchasing the
 Museum, Lord Auckland kindly  undertook  to interest  himself in
 the affair,  and accordingly applied, in the following  letter  to Sir J.
 Banks, to know how far  he would  be  disposed to lend'his assistance
 in calling  public attention to the subject:

   * It has already been observed that Hunter found he could  employ his time
more profitably in studying nature than in reading books, whence it arose that
his library was small, and consisted principally of  presentation  copies.  Its
dispersion would not of itself have been a subject of regret, if it were not that
Mr. Hunter  was in the habit of annotating largely in the margins of those books
which he read.  He has made references to  Bcrelli, Hamberger, Goddard, Glis-
son, Swammerdam, &c, in his Croonian Lectures, which he would probably not
have done if he had not carefully consulted these authors.
  f These difficulties  were  entirely removed, after  some years,  through Dr.
Garthshore's kind interference.  He engaged Mrs.  Hunter, whose exemplary
conduct during her widowhood  had gained her the esteem of all parties, to reside
in  the house of two young ladies of large fortune, who were wards of his, where
she continued until her death in the receipt of a very handsome salary. Durinor
this time she published a volume of poems, which possess  considerable merit as
light compositions.  In 1804 she composed the following  Epitaph, with the
design of having it inscribed on a marble tablet to be placed over the remains of
her late husband in St. Martin's church ; a design, however, which it was inti-
mated to her by Dr.#Hamilton, the rector, was contrary to the rules of the church:

           " Here rests in awful silence, cold and still,
               One whom no common sparks of genius fired  ;
            Whose reach of thought Nature alone could fill,
               Whose deep research the love of Truth inspired.

           " Hunter ! if years of toil and watchful care,
               If the vast labours of a powerful mind
            To soothe the ills humanity must share,
               Deserve the grateful plaudits of mankind,__

           "Then be each human weakness buried here
               Envy would raise to dim a name so bright:
            Those specks which in the orb of day appear,
               Take nothing from his warm and welcome litrht.
" Anne Hunter." 
THE  LIFE  OF JOHN HUNTER.
99
                         " Eden Farm, near Bromley, Kent, Jan. 25, 1796.
    " My dear Sir,
  " I wish, in the fewest words possible, to engage your attention to a subject
interesting  both to friendship  and philosophy.   I  know that the pleadings of
two such advocates will be most congenial to your feelings.
  " Our late friend John Hunter  left nothing for the support of his widow and
children, after the payment of  his  debts, but his collection of comparative pre-
parations.   From  respect for his memory, and from regard for Mrs. Hunter,
whose conduct in such a position  has been highly becoming, I have concurred
with the Chief Baron during two  years in obtaining for her, through Mr. Pitt,
the aid of  His Majesty's bounty; and I have been of some use to her in other
respects.  But the Act of Parliament does not allow the King's bounty to be
given a  third year.  In the mean time the Trustees of the Collection (Mr. Home
and Dr. Baillie) have not been able to induce the House of Commons to purchase
it, or even to consider the subject.  In truth, the agitations of their minds amidst
the great scenes which are going forward, as well as a general  impression that
all avoidable expenses not essential to  the purposes of the war should be post-
poned, have combined to make it difficult to recommend the  purchase to the
public.  The delay is most distressing to the family, who have no other resource:
the mere expense of keeping the collection is an overwhelming  weight to those
who have nothing.
   "I do not pretend to be able to form any adequate  idea of the value and im-
portance of the collection to science ; it is quite out of my line of observation.
But I have always understood that you scientific  leaders concur in thinking it
highly curious, and well calculated to do service  in the school both of medicine
and of natural philosophy in general.
   " I trust that as the worthy President of the  Royal  Society, as  an  old and
respected friend of a distinguished person whose family is left destitute, and, in
short, as a man of science and" of benevolence,  you  will turn this subject in your
thoughts.  If the purchase could be properly and effectually recommended, with
 the King's approbation,  to the House of Commons and to the Minister at the
 head of the Treasury, it would be the best result.
   " If  you would like to have a  consultation at your house  of any  number of
 Mrs. Hunter's friends, and of persons of other descriptions, I shall be glad as an
 individual to attend your commands in Soho-square.  I propose to return to town
 about the middle of next week.
   " I wish you would re-settle  the seasons, which seem to be under a revolu-
tionary government.  I do not remember an instance of so long a prevalence of
southern gales in the depth  of winter.
                      " Believe me, my dear Sir, most sincerely yours,
                                                          " Auckland."

   In  his reply to  this  application Sir J.  Banks, as  will  be  seen,
 expresses his willingness to take part in endeavouring to bring about
 the desired purchase of the Museum ; but at the same time seems to
intimate that the College of Surgeons had been backward in interest-
 ing themselves on  the subject, although they were the  parties to
 whom it would prove flhost serviceable.

     " My dear Lord,
   "Had  I thought my friend John Hunter's collection an object  of importance
 to the general study of natural history, or indeed to any branch of science except
 to that of medicine, I hope that two years would not have elapsed  without my
 having taken an active part in recommending to  the public the  measure of pur-
 chasing it.  I was consulted in  the first instance by the gentlemen concerned,
 who, if I rightly understood them, agreed with me in thinking that  the history
 of diseases was the only interesting and valuable  part, and  the natural history
 was not of consequence sufficient to be brought  forward as an  object of public
 purchase. 
100
THE LIFE OF JOHN HUNTER.
    " Concluding that the history of diseases arranged  itself naturally under the
  protection of the College of Surgeons, and knowing that the corporate mansion
  of that learned bodv was roomy enough to receive the collection; being well
  aware that the matters of abstract medicine did not come within the province o!
  the Royal Society, knowing that the apartments of that body are scarce able to
  contain the property they already possess, and thinking the museum, to which,
  from the nature  of its institution, students could not  have a convenient access,
  an improper deposit, I declined with the full approbation, as I thought,  ot the
  parties concerned, taking any lead  in the matter.
    " Regard  for my deceased friend, however, has  always made me desirous ot
  doing all I could do, without interfering too much in a business evidently out of
  my province; I offered, therefore, at that time all the secondary assistance in my
  power.  I shall be happy, therefore, whenever your Lordship or the Chief Baron,
  who have hitherto taken the lead in this business, do me the honour to think 1
  can be of use, to obey either of your summons, and meet you when and when-
  ever either of you shall choose to appoint."......

    Soon after this the question was at  length  properly brought be-
  fore the House, when a Committee was appointed to take the peti-
  tion of Dr. Baillie and Mr. Home  into consideration, and to inquire
  into the value  and probable expense  of keeping  up the  Museum.
-  Several of the most eminent  physicians and surgeons,  as well as
  other scientific men, were examined, who strongly recommended
  the purchase of the collection, which they estimated  at a much
  higher value than 15,000/., the  sum named for it.  The Committee
  having satisfied themselves on this point, and made a report to the
  House, the above sum was voted  by  Parliament on the  13th  June
  1796.  Instead, however, of  being immediately transferred  to the
  Corporation of Surgeons, it is reported that an offer of the collectio'n
  was first made to the College of Physicians,* who, foreseeing the
  expense of maintaining  so large a number of preparations, demurred
  to accept  it, unless accompanied with such additional grants  of
  money and lands as should be adequate to  its support.   The disin-
  clination which was thus  manifested by the College of  Physicians
  to become the guardians of this noble collection, and to incur those
  public and private liabilities which were necessarily incident to the
  charge, might equally have been justified  on.',the part of the Sur-
  geons.  The funds of the Corporation of  Surgeons  at this  period
  were  in an extremely low state; nor were  the fame and public
  reputation of this body  in a much more flourishing condition.   It is
  therefore greatly to the credit of the  Council  of this Body that they
  came to  the  unanimous  vote,  on Dec.  23, 1799,  to accept  the
  Museum on the  terms  proposed by the  Government, especially
  when we  reflect that the costs  for maintaining and augmenting the
  Collection, up to August 1833, amounted to not less than 36,000/.
  It would  manifestly, however, have been in  the hio-hest decree
  improvident in  the  Surgeons  to  have  acceded to °the offer  of
  Government, with the conditions annexed,  if they  had not foreseen
  some method of replenishing  their finances.  This method consisted
    *  It would appear also, from a letter addressed by Dr. Baillie  and Mr  Home
  (Nov. 1799) to the Lords of the Treasury that thoughts were afterwards enter-
  tained of making it a part of the British Museum. 
THE LIFE OF JOHN HUNTER.
101
 in obtaining a new charter from the Crown, which should entitle
 them a Royal College, with permission to examine for diplomas;
 and in this hope they were not disappointed.  In the course of the
 ensuing year a charter was obtained; and although the  applicants
 for diplomas during the first two years did not amount to more than
 300, yet this number had increased to 770 in the two years ending
 August 1833 ; and the average receipts to the College derived from
 this source alone, during this  latter period, did not amount to less
 than 11,116/. per annum.   This increase of public reputation, and
 consequent wealth, must no doubt mainly be attributed to the cele-
 brity which necessarily accrued to the College from possessing a
 new charter, and from being appointed the public guardians of the
 Hunterian Collection.  It would be unjust, however, not to say that
 these circumstances alone would have  been insufficient to attain
 the objects in view, if they had not been strongly supported by the
 zeal and talents of several members of the Council, who more par-
 ticularly interested themselves in the management of the affairs of
 the College at that period.
  This valuable collection was not entrusted to the Corporation of
 Surgeons unfettered by conditions ; and that these conditions might
 be  duly performed, a Board  of Trustees was appointed, whose
 duty it was to supervise the general management of the collection.
  The principal of these conditions were,—
  "1.  It was incumbent on tne College to preserve the  collection
 in the best possible state at their own expense.
  " 2.  That the collection should be open to the inspection of the*
 Fellows of the College of Physicians and  the Iflfembers of the Com-
 pany of Surgeons, and persons  properly,introduced by them, four
 hours in the forenoon two days every week.
  "3.  That a catalogue should b^Vnade  of the preparations, and a
 person appointed whose business it should be to explain it to such
 persons as visited the cqlle^flon.
  "4.  That a  coursgp%f  twenty-four lectures on comparative
anatomy, &c, shodlrDe delivered annually at the College."
  The admirable manner in which the first and  last of these  con-
ditions have been complied  with will not be questioned by any one
 who has visited the Museum or attended the lectures.  As for the
second  and third, as it is impossible to offer praise, so it may be
more prudent to refrain from animadversion.  The parties who
were most to blame in this business have long since gone to another
tribunal, and any comment upon this subject would be useless.
11 
102
THE LIFE OF JOHN HUNTER.
                        CHAPTER VII.

                    THE HUNTERIAN MUSEUM.

   The museum of Hunter having been entrusted  by Government
 to the care of the  College of Surgeons, the Council, in July 1800,
 appointed from their body a Board of Curators, consisting of seven
 members, to whom was given the  charge  of superintending  the
 preparation of catalogues of the objects  in the collection, and of
 drawing up regulations for its management.
   During the first six years the collection remained in the gallery
 in Castle-street, which had been built by Hunter for its reception;
 but in  1806,  the  lease of the  premises  having  expired, it was
 resolved by the Board of Curators to deposit it temporarily in a
 house in Lincoln's-inn-fields, adjoining the College  of Surgeons, the
 Council having at the same time come to a resolution to erect an
 appropriate building for its reception, and  to apply to Parliament
 for assistance in accomplishing the work.    Plans were  accord-
 ingly drawn up,  and the expenses of the undertaking were esti-
 mated at 15,000/.   This sum was liberally granted by Parliament,
 and the building was commenced in the course of the following
 summer.  The work does not, however, appear to have proceeded
"very rapidly;  the  real cost of the structure, it  was found, would be
 treble that of the  estimated expense; and a second application to
 the legislature  was resolved on.  This elicited a second grant of
 12,500/., and the  remaining  deficiency (equal in amount  to  the
 sums voted by Parliament,) was made up out of the funds of the
 College.  At length, in the year 1813, the edifice being completed,
 and the necessary arrangements made, the museum was opened to
 the inspection of visitors.*
   In the year 1806, in compliance with the conditions of agreement
 under which the  Hunterian museum was entrusted to the College
 of Surgeons by Parliament,  the Council took the necessary steps
 for instituting two annual courses of lectures, the one on surgery,
 the other on anatomy.  These  were delivered for the first time in
 the spring of the following year, and have been continued annually
 ever since.  The  number of lectures in each course amounted to

   * During the time that the museum continued in Castle-street, it was open,
 under certain limitations, to the inspection of the public, and during the short
 peace was visited by many eminent scientific foreigners; amono-stwhom were
 MM. Du Fresne, Parmentier, Abbe Gregoire, Jean Baptiste Huzard, Dr. Gartner,
 Dr. Sioll, Professor Aldini, and Dr. Frank. The  first  of these gentlemen was
 highly delighted, and expressed his satisfaction in  a paper in the  first vo-
 lume of the Annates  du Museum.  In 1813 Cuvier visited England, and for
 the first time saw the Hunterian museum, to which he paid the greatest attention,
 and had thirty or forty drawings made of different preparations by a gentleman
 who accompanied him. 
THE LIFE  OF JOHN HUNTER.
103
fifteen; and as the chief object aimed at in  their institution was
the elucidation  of various  parts of the museum, it has been cus-
tomary to select from thence most  of  the  preparations introduced
by the Professors  in illustration of their doctrines.
  In  1813  Dr. Baillie and Sir Everard Home, the trustees of Mr.
Hunter, provided for the delivery of an annual oration on his birth-
day.  By this an opportunity has been yearly afforded of paying a
tribute of respect-to the memory of those  practitioners of  surgery
who have contributed during their lives to the advancement of our
profession.*                                                     ,
  To these lectures all the  Members of the College have of course
a right of entry;  and the senior pupils attending the London Hos-
pitals are by courtesy allowed to be present.
  From the  time when the  museum first became the property of
the College up to the  present  day, valuable  additions  have  been
continually made to its contents.  These have accrued chiefly from
two sources: on the  one hand,  from  the purchase  of appropriate
objects contained in other collections,  as the British Museum, the
Leverian Museum,  and the collection of the  late Mr. Brookes;  on
the other, and this has proved by far the most copious source, from
the  liberal  donations  of public bodies  and private individuals,
amongst which those presented  by some of the leading members of
the Council hold a conspicuous place.   Many, valuable preparations
have also  been added by the diligence of the Conservator and of
the  Assistant-Conservator.   The additions  from  these  and  other
sources amount at present to nearly one third of the whole collec-
tion.
   It is intended in the present chapter to  give some account of the
contents of  this noble monument of the genius of Hunter; a work
which stands unrivalled in its kind,f and the contemplation of which
must ever call forth the highest respect for the indefatigable industry
and extraordinary talents of its founder.
   The original design of Hunter, in the  formation of his museum,

  * It may be  worthy of consideration whether it would  not be better that these
orations should occur less frequently.   It is a hopeless task to seek for something
new every year on so limited a subject.  Mr. Lawrence's late  able oration might
seem  to contradict this remark; but it will  be observed that  he wisely quitted
the accustomed track, and sought for interesting matter in other countries and in
the collateral field of natural history.
  f This opinion is not only that of Englishmen, who have had an opportunity
of comparing the admirable manner in which the  preparations are displayed in
the Hunterian museum with that of some of the most  famous on the Continent,
and, amongst  others, of the Jardin des  Plantes, but of foreigners also.  Soon
after the conclusion of the late war, the Emperor of Russia sent a body of scien-
tific men to make the tour of Europe in pursuit of science.  Those who came to
England  had previously visited the collections on the Continent.  Their patience
was inexhaustible ; and of the many individuals who have visited the Hunterian
museum, none ever examined it with so much care, or brought a larger share of
previous information to  the work, than they did.   When they had  concluded
their  inquiries, they unhesitatingly declared  that this collection far excelled any
other in Europe. 
104
THE LIFE OF JOHN HUNTER.
  was to furnish an  ample illustration of the phenomena of life exhi-
  bited throughout the vast chain of organized beings, by a display ot
  the various structures in which the functions of life are carried on.
  His collection, therefore, at its commencement, was strictly physio-
  logical in its character; and though  in the course of time various
  other departments  were added to  the original one,  they were all in
  a manner subservient to this primary design.
   Amongst these accessory departments we may mention, first, the
  collections of dried preparations in  comparative anatomy, and the
  collection of comparative osteology,  as being both nearly allied to
  the subject of general physiology'   Next to these may be placed
 the collection of monsters and malformations, which is not less so.
 To the subject which the latter is designed to illustrate much atten-
 tion has of late  years  been deservedly directed, since the study of
 abnormal productions not only leads to a knowledge of the fact  that
 nature is subjected  to certain laws, even in her most striking devia-
 tions from the usual order of things, but also helps to throw much
 light on  the laws of normal or natural formation.
   In addition to the above, the museum contains a  large collection
 of specimens in  natural  history, of which the greater number are
 preserved in  spirits, and others are stuffed ; whilst those animals,
 or parts  of animals, which require no such preparation, as shells,
 zoophytes, and insects, form separate departments.   Nor did Hunter
 confine his attention to the animal  forms now in existence, but, not
 long before his death, collected a  large number  of  valuable fossils,
 illustrating the structure and form of animals of a former age. Another
 highly valuable portion  of the  museum illustrates the actions of
 living parls when in a state of disease.  This portion contains two
 large collections of pathological preparations, the  one  containing
 specimens of diseased  parts  preserved in spirits, the other speci-
 mens in a dry state ; and a collection  of the inorganic products of
 diseased  action, as  calculi, concretions, &c.  A numerous assort-
 ment of  valuable drawings, oil paintings, and casts, completes the
 whole; of these the former are  the most valuable,  since, from  the
 excellent style in which  most of them are executed, an  accurate
 notion is  afforded of the recent appearance of parts, when this has
been destroyed in the original subjects, either by  time or  by the
 action of the spirits  in which they are  preserved.
  In describing  more in detail the various parts of the museum,
 each  department will  be successively treated of in  the  order  in
which they have been mentioned above.  Before proceeding, how- '
 ever,  to  this  description, it will  be requisite to  say a few 'words
 respecting the work on  which Hunter was engaged at the time of
 his death, and which he designed as an exposition of  the  contents
 of his museum ;  and also to  make some remarks on the formation
of the Catalogues which  are  now in the course  of  publication  by
the Council of the College of Surgeons, and from which the sum-
 mary I am about to give will be principally derived.
  It would seem that for many years Hunter was accustomed  to 
THE LIFE OF JOHN HUNTER.              JQ5
trust chiefly to his own memory for  a history of the specimens
contained in his museum; but when his health and faculties began
to fail, under repeated attacks of disease, he  became  exceedingly
anxious to  complete the arrangement of its various parts, and to
commit to writing an exposition of the whole.  The  reflection that
he should probably die before this  labour was completed, and leave
his  collection, the sole provision he had made for his  family, in a
condition which would greatly detract  from its value, was a source
of painful anxiety during the last years of his life.
  It would  appear to have  been Hunter's intention, had he  lived,
not simply to form a catalogue of the  numerous preparations con-
tained  in his museum,  but  to record,  in one comprehensive work,
the results  of his labours and observations  in  each  department,
together with such general reflections a's he had been  able to deduce
from them.   In this  work would  have been included the anatomy
of the  whole animal kingdom, as far as he had investigated it, and
there is sufficient evidence that few forms of animated  nature had
escaped his  notice.   He would  have stated at large his views on
the nature of animal life, on the particular  uses of  the several
organs, and on their  relations to one  another.  The laws of ab-
normal formations, as far as he was acquainted with them, would
also have been unfolded; and from these various data  would have
been deduced a classification of animals according to their natural
affinities.  The fossil remains of past ages had also occupied much
of his  attention, and  his opinions respecting them would have filled
an important place in his purposed work.  It was his intention also
to have entered into a  full account  of the several sections  of his
museum  which are more directly connected with the  practice of
surgery,  those, namely, which  contain the pathological prepara-
tions ;  and it must ever be regretted that we have been deprived of
his exposition of these departments,  in which would have been
combined enlarged  and scientific views of the nature of disease,
with the  sound practical information  which his great experience
and acute observation would no doubt  have furnished.
  Such was  the work  in which Hunter designed to  embody the
knowledge acquired during five-and-forty years spent  in the diligent
investigation  of nature; and let it not be thought that the above
sketch  figures forth  an undertaking  which it  would have been
beyond the  power of any  single  man to complete; an immense
body of materials had already been prepared for different parts of
it, and  the regularity  and rapidity with  which he pursued his labours
would  almost certainly have insured  its completion within  a few
years.  Had he completed  it, " this work," to use the  language of
one who  has  had  ample means of knowing what were the inten-
tions of  Hunter,  and  of estimating  the extent  of his labours,*
" would have reflected equal honour on its author and on the  coun-
try and age in which he flourished."
* Mr. Owen.
   11* 
106              THE LIFE OF JOHN HUNTER.
  Hunter died, however, before this his  last undertaking could be
completed, but not before enough had been accomplished to fur-
nish us with  means from which  to form some judgment of what
the whole would have been.
  Of his labours in the  field of comparative  anatomy, which for
variety and extent have probably never been excelled, he kept accu-
rate and full minutes.   These alone extended to ten folio volumes
of MSS. ;* and besides  these there were catalogues of certain por-
tions of the' physiological  department,  with  interesting  general
observations of his own prefixed  to each series.   To the account
of the pathological  preparations  of the bones, Hunter had also
devoted  especial attention,  as  he proposed  (according to the late
Mr. Cline), to publish a work on the diseases of these parts,  and
had collected an immense number  of drawings in pursuance of this
intention.
  The whole of the above valuable documents passed into the hands
of the College along with the preparations to which they referred;
and it was the intention of the Council, with the  aid which  they
afforded, to  have  prepared a  descriptive catalogue of the whole
museum.  Before this  work was  far  advanced, however, the ten
volumes of minutes of dissections, along with many other valuable
papers, were taken from the museum by Sir Everard Home,f with-
out any previous permission from the Trustees, but with the alleged
intention ef employing  them  in preparing a catalogue, which  he
undertook to do gratuitously.   Time, however, passed on, and  no
catalogue was forthcoming; repeated applications were made by
the Council to have  the MSS. restored, but were as often evaded,
and  at length, to the astonishment  of all, it was ascertained that Sir
Everard Home had actually committed them to the flames !
  The announcement of such a proceeding of course drew upon
him the bitter reproaches of the Trustees and of the Council, against
which he defended himself by  maintaining  his legal right to the
papers, which he asserted  formed  no part of the museum, as  no
mention was made of them in Hunter's will;  and he added further,
that in burning the papers he had acted in accordance with the
directions of his late brother-in-law.  The first of these statements it
was of course not worth while legally to contest,  seeing that the
objects in dispute were now no longer in existence.  To^give cre-
dence to the latter was somewhat difficult for those who knew how
high a value Hunter had set on these papers.   To such it seemed

  * Nine of these were on animal, and one  on vegetable anatomy.  They were
written by Mr. Hunter's assistants, at his dictation, and contained the result of
his observations upon whatever  was new and interesting in the course of his
individual dissections.  It may be looked upon as a proof of the value which
Hunter set on these, that he had them introduced into his portrait by Sir Joshua
Reynolds.  His cases of surgery and dissections, of which the College possesses
four or five manuscript volumes, presented by Sir Everard Home, were recorded
with equal accuracy.
  f This was in 1812, when the collection was placed in the  new building. 
THE LIFE OF JOHN HUNTER.
107
incredible that he should have ever seriously meditated the sacri-
fice of these memorials of the labours of his life ;  and it was justly
urged, that if he had ever, in a moment of irritation, given expres-
sion to such a wish, Sir Everard Home  should  have  felt that he
would not only be justified in neglecting to  fulfil it, but was  bound
to do so, for  the honour of his  patron  and  preceptor, and for the
interests of science. Was it not also somewhat strange, it was asked,
if such a direction was given, that Sir  Everard Home should have
neglected to execute it during the time the  papers remained in his
hands previously  to the purchase of the collection by Parliament,
and  should have delayed its accomplishment until every one else
supposed  that these documents had, to  all intents and  purposes,
become the property of the College ?   Rumour, as usual, assigned
reasons for this act beyond  the  one alleged, and it was broadly
asserted, that if the MSS. could  be recovered, they would be found
to have furnished the substance of  many  of Sir Everard Home's
numerous papers in the Philosophical Transactions.*
   Whatever may have been the  cause of  this extraordinary pro-
ceeding, the effects are irreparable.  The  difficulties  experienced
in the formation  of a  catalogue were so much increased by the loss
of these papers, that  those whose duty it was  to superintend  the
work seem thenceforward to  have despaired of ever carrying it
into effect.  At least  such is the conclusion we must come to, when
 we recollect that nearly thirty years were  allowed to elapse from
 the  time the museum became" the property  of the College before the
 Council took effectual steps to supply such a catalogue.  Whether
 this  state of hopeless inactivity was excusable may well be doubted,
 when we see how satisfactorily the work will, in all  likelihood, be
 completed, now  that  it has been resolutely undertaken.  For though
 there can be no doubt  that the establishment of the Zoological
 Society, and the liberal  manner in which they  have granted the
 bodies of the animals dyinov in  their collection for the use of the
 College, have greatly facilitated the execution of some parts of the
 catalogue, it will yet scarcely be credited that the Council, had ihey
 been in earnest/could not have found  individuals long ago willing
 to undertake the task, and able  to have executed it, if not  as well
 as it will now be executed, yet in a  manner which would have
 greatly increased the value of  the  collection to the profession at
 large.   As it is, they will hardly free  themselves from the imputa-
 tion of want of zeal in discharge of their trust, and of having shown
 a culpable indifference to the honour of their great master and to
 the cause of science  in this country.
   Happily, the Council were at length induced to take active mea-
  sures for supplying the deficiency so long  and justly complained of,
  and two gentlemen were appointed to assist the conservator, Mr.
  Clift,  in  preparing  complete  catalogues  of the museum.  These

   *  Sir Everard Home  contributed more papers  to the Royal Society than any
  other single Member of that distinguished  Body since its foundation.
* 
108
THE LIFE OF JOHN HUNTER.
were the late Mr. Home Clift, the son of the conservator, and Mr.
Richard Owen,*  who is well known as one of the first comparative
anatomists in this country.   Certain departments were allotted  to
each of these gentlemen, of which they were directed to draw out
catalogues as speedily as might be  consistent with correctness.
The first  of these  was  published in   1830, since which time five
more numbers of the general catalogue, and two numbers of a des-
criptive catalogue, on a more extended scale, have appeared.   It
is understood that we are indebted to the respected conservator,
Mr. Clift,  for the  first and second parts of  the general catalogue,
containing an account of the pathological preparations in spirit and
in a dry state.  To Mr. Home Clift, his son, whose untimely death
was lamented by all who knew him, we owe the third, fifth, and
sixth parts, containing catalogues  of the human  and comparative
osteology, of monsters and malformations, and of the vascular and
miscellaneous preparations in  a dried state.  To Mr. Owen was allot-
ted the task of preparing the fourth part of the general catalogue, which
furnishes an account of the preparations of natural history in spirit,
and^the still more important and difficult duty of forming a descrip-
tive catalogue of the first two divisions of the physiological gallery.
The whole work, as far as it has* yet  appeared,  reflects credit on
the  Council, under whose auspices it  has  been published,  and by
whom the above appointments  were made,  and  on the gentlemen
to whom the business of preparing the  catalogues was intrusted, for
the  talent  displayed in the performance of the several parts.  It is,
however,  to be regretted that a fuller account of the pathological
preparations was not given, since the want of a history of the cases
often deprives them of more than half their value. It is understood,
however,  that the  Council  have it  in contemplation  to  publish
descriptive catalogues of the whole museum, which will probably
extend to  twenty volumes, and no doubt the present deficiency will
then be amply supplied-!   With  regard  to  that portion  of* the
descriptive catalogue which is already before the world, too much
praise cannot be given to Mr. Owen for the very able  manner  in
which he  has performed the difficult task of preparing it. When it
is recollected that a great many of the preparations in this depart-
ment had  not even a tittle attached to  them, and afforded no clue
beyond their situation in the collection, and their general appearance,
for  ascertaining what they really were or whence derived, and con-
sequently  that a search was to be instituted for their likeness in the
great book of nature, it will be readily granted that no  little talent
and diligence were required in overcoming this  first difficulty.
But, in addition to this, the object which Hunter had chiefly in view,

 *  Mr. Owen was appointed in 1827.
  |  The  conservator has long been engaged  in the preparation of such a cata-
logue, which at the  present time extends to five times the length of that pub-
lished by the Council.  The urgency of the demand for a catalogue on the part of
the  public and the Board of Trustees, was  the only reason why the Council
confined themselves to the fulfilment of their literal engagements. 
THE LIFE OF JOHN HUNTER.
109
in the formation of several of the series, was to be sought amongst
his  various  publications, or, where these did not furnish the requi-
site information, to be deduced from the writings of others, or from
the observations  of  Mr. Owen himself; and  from each of these
sources have been drawn  the  valuable  observations  prefixed to
several of the subdivisions.  That Mr. Owen has been successful
in overcoming these difficulties, the catalogue  itself affords suffi-
cient evidence, and the students of natural science will owe him a
debt of gratitude should he succeed in that portion of his work which
is yet unfinished as ably  as  he  has  done in the part which  has
already been published.                                      ,
  Having thus given a general  account of  the  museum  up to the
formation of the  catalogues, I  shall  now endeavour to furnish as
accurate an account of its contents as the means in my power and
the nature of the present work will admit.
  The first and  fundamental  department  of  the  museum, that,
namely, which is contained in the gallery of the present building,
is, as  has  been said,  devoted to  the illustration of the science ot life
itself.                                        .           .    ,
  '• It  consists of  dissections of plants and animals, in which the
structures subservient to the different functions are skilfully  and
intelligibly displayed.                                  .
  " These structures are taken from every class of organized mat-
ter, and  are arranged  in  series, according to the function, in the
order of their complexity, beginning with the  simplest form, and
exhibiting the successive gradations of organization  to the most
complex.
   " The series are disposed in two divisions : first, those illustrative
of the functions  which  minister to the necessities of the indivi-
dual ; and secondly, those which provide for the continuance of the
species.
  " The first division commences, with a few examples of the com-
ponent structures of organic bodies, and then  extends into a series
embracing the active and passive apparatus for progressive motion.
It is succeeded by analogous series,  illustrative of the  functions of
digestion,  nutrition, circulation, respiration, and  excretion,—or the
functions immediately connected with  the internal economy of an
organic being.   Then  follow the organs which bring the animal
into relation with the external world, viz.  the nervous system and
organs of sense, which are the  peculiar characteristics of  the ani-
mal kingdom.  After these come the parts which complete the sys-
tem of an animal body, such as the connecting and  adipose tissues,
and the  various  modifications of external covering; and lastly,
those instruments which, not being  immediately related to any of
the vital and animal  functions, constitute peculiarities  in the  eco-
nomy of particular species.
   The second division commences with a  series ot the generative
organs of plants and animals  in  the  passive  and  unimpregnated
state: first, of such  as complete the  function of generation by the 
 110              THE LIFE OF JOHN HUNTER.

 simplest kind of hermaphroditism;  second, of those in which  a
 necessity for reciprocal impregnation co-exists with the possession
 of both the sexual systems in the  same  body; and lastly, of the
 male and female organs, as they are exhibited separately in distinct
 individuals.
  " The next subdivision contains the female organs in a state of
 fructification or impregnation ; it exhibits the generated organism
 in its different stages  towards mature development, together with
 the various temporary structures destined  for its support during
 foetal existence; and lastly, the organs in  the  parent which supply
 the young with food, or afford it  shelter during the helpless period
 of its existence."*
  Such is a brief summary of the contents of this part of the museum
 which consists  of 3745 anatomical specimens, of great delicacy and
 beauty, and for the most part in an'admirable state of preservation.


         FIRST DIVISION  OF  THE GALLERY,

 ILLUSTRATIVE OF THE FUNCTIONS WHICH MINISTER TO THE  NECESSITIES
                       OF THE INDIVIDUAL.

  That portion of the descriptive catalogue which has been pub-
 lished  furnishes an account of 841  of these preparations, which
 form the two first subdivisions of the first division, and are designed
 to illustrate the functions of locomotion and digestion.


                    THE FIRST SUBDIVISION

               ILLUSTRATES THE SUBJECT OF LOCOMOTION.

  To the elucidation of this subject  thirteen series are  devoted, of
 which the  first exhibits the  component parts of vegetables and
 animals, as barkj  wood, blood, tendon, elastic  ligament, cartilage,
 bone, &c,  &c.
  To tljese succeed examples  of different kinds of sap and blood,
the former  arranged according to their degree of vitality, as shown
by their tendency to coagulate: from these we ascend to the colour-
less blood of crustaceous animals, the cold blood  of reptiles and
 fishes, and  lastly, the warm blood of the mammalia.
  With the third series, we enter on those parts of vegetables and
 animals  which  possess  evident motion.   Motion  in  vegetables
 Hunter considered to depend on a property analogous to irritability
 in animals : it may be caused either  by the irritability being excited,
 as in the mimosa and other sensitive plants; or by the cessation of
  * Introduction to the Descriptive and Illustrated Catalogue of
gical Series: 1833.  By Mr. Owen. 
THE LIFE OF JOHN HUNTER.
Ill
irritation allowing an antagonist force to take effect, as in the sleep
of plants.
  The fourth series  contains preparations of the  muscular fibre,
which, says Hunter,  " is  one of the simplest forms of an active
solid."  The various  modes in which these  fibres are arranged in
various muscles are shown; and to these succeed several prepara-
tions  illustrative of the application  of muscles, and the manner in
which certain parts of the body, as  we ascend in the scale of ani-
mals, come  to be  specially devoted  to the production  of motion,
either actively, as in  the case of muscles, or  passively, as in that of
the skin of worms and of the larvae of insects;  of  the hard cover-
ing of  crustaceous animals; of  this combined with  an internal
skeleton in the testudines; or of the latter alone in fishes, birds, and
mammalia.
  The application of elastic powers in  the  animal frame is next
illustrated.  These act either in  opposition  to  muscular force, as
in the hinge of bivalves, or in aid of it, as in the ligamentum nuchas
of various mammalia.
  The  five  succeeding series illustrate the particular properties of
the organs  of passive  motion.   These organs, as  is here shown,
may  be formed either of membrane, horn, cartilage,  calcareous
earth, or of various combinations of these.   The growfh and com-
position of shells are next illustrated, for though shells for the most
part serve as organs of defence,  " they are  in many cases used as
levers for the muscles to  act on."  Most of  the preparations  illus-
trating this  subject have been added of late years, and the varieties
they exhibit in chemical composition, &c, are explained in the
Catalogue, by extracts from Mr. Hatchett's papers on the composi-
tion of bone and  shells.   The structure and  growth of bone is next
unfolded.  The differences which bones exhibit in  consistence and
composition in different  classes  of animals, the  mode in which
ossification  commences,  and the superior vascularity  of growing
bone, are amply developed.  Next follow twenty-four preparations,
exhibiting the growth, perfection, and casting of the horns of deer.
And lastly, the increase of size in bones  is shown to take place, not
by the insertion  of  new particles  amongst the old, as Duhamel
supposed, but by the addition of new parts to  the  extremities and
circumference of bones,  whilst the form  of  the bone is preserved
by the  removal  of superabundant parts by the absorbents.  The
former fact is  shown  by preparations  of the  leg-bones of fowls,
into which  shot had been inserted at given distances from each
other whilst the bones were growing, which distances were found
not to have varied when the bones had much  increased in length.
A  fuller illustration of both facts is  afforded by feeding young ani-
mals on madder, which tinges all fresh  deposits of bone, and thus
points out exactly where and to what extent these have been laid
down.   There are several preparations which originally exhibited
these points very clearly, but as the spirit has destroyed the colour,
the assistance of Mr. Bell's drawings is required for their explana- 
112
THE LIFE OF JOHN HUNTER.
 tion, and engravings of these have  been accordingly given  in  the
 Catalogue.  After the growth  of bone, are displayed the various
 positions of the skeleton  in various animals; and the  last  of the
 five series illustrates  the  composition  of the skeleton.  This may
 be formed of one piece, as in the cuttle-fish; of several unattached
 pieces, as in the pennatula and  other zoophytes ;  or the several
 pieces may be connected by elastic joints, as in the spine of cartila-
 ginous fishes; by ligamentous fibres attached to the whole articu-
 lating  surface, as in  the lower jaw of the whale; by capsular
 ligaments; by capsular and inter-articular ligaments, as  in the  hip-
joint or with inter-articular cartilages, as in the joint of the  lower
jaw; or by the three combined, as in the human knee-joint.
   The various  mechanical  contrivances  by which the  power of
muscles is augmented, so as to combine neatness, which, as Hunter
observes, " is often a principal object in the formation of a limb,"
with the  requisite degree of power, form the twelfth series.
   The thirteenth and last series of this  subdivision  shows the form
and arrangement of parts  in the various organs adapted for pro-
gressive  motion; for swimming; for flying; for creeping, as ser-
pents, in  which animals the progressive motion is effected by means
of the  ribs,  which have  strong muscles  attached, and are moved
much in the same way as the centipede moves its legs; for bur-
rowing ;  for  climbing; for leaping;  for walking or running; and
lastly, for tearing the prey of the animal.
                  THE SECOND SUBDIVISION

              ILLUSTRATES THE FUNCTION OF DIGESTION.

  Teeth.—Of the organs which minister to this  function the teeth
are first  treated of.  The series in which the nature and offices of
these organs are shown consists of 170 preparations, derived from
all parts of the animal kingdom, the account of  which  in the Cata-
logue is preceded by some general observations  by Mr. Hunter on
their nature;  on their analogy to the beaks  of  birds ; and on the
varieties  they exhibit in number,  form,  structure, and situation,
according to the food of the animal; as also  on  the mode  of their
formation and growth ; on the manner in which the place of those
which  are lost  is supplied ; and on their  relation to the stomach.
These  several points are illustrated in a  number of subseries, of
which  the  three first exhibit  the structure and growth of parts
analogous to teeth in various tribes of animals,  as  the  calcareous
teeth of some mollusca, the bills of birds, and the whalebone in
whales.   The fourth subseries exhibits the  mode of growth of
various teeth.    1st,  Of such as are limited in their growth and
which, when  lost, require to  have their places supplied  by'new
teeth;  and this is effected in a variety of  ways.  2d  Of  such as
are continuous in their growth, as the incisors of rodentia  and the 
THE LIFE OF JOHN HUNTER.              H3
tusks of boars.  The amount of animal matter contained in various
descriptions of teeth is shown in a set of preparations, in which the
calcareous part has been removed by the use  of dilute acids.   The
mariner in which the teeth are shed, and their places supplied by
new ones, in different orders of animals, is  next  shown.   In some
the teeth are shed but once, and those of the new set are formed on
distinct pulps, as in most  mammalia;  in others, as  in  the shark,
teeth are successively  formed  at the back  part  of the mouth, and
brought forward by the absorption of the fore part of the jaw.  In
the crocodile there  is a constant  succession  of new teeth, which
are formed  on the same  conical projecting pulp which the former
occupied:  in many kinds of fish the new ones are formed in rows
of distinct pulps, and these may be situated  either within or without
the rows in use, but in either  case are  brought into  action by the
absorption of the opposite side of the jaw.
   The last subseries displays the  varieties  in the  situation of the
teeth, which may be  placed either on the jaws,  the tongue, the
palate, or in the stomach.
   We next come to  the principal organ of digestion.
  Stomach.—This organ Hunter considers  to be the  essential  part
of every animal.   In its simplest form  it is a mere bag, secreting a
liquid capable of dissolving and animalizing its contents, and  pos-
sessing the power of absorbing the nutritious parts of the food,  and
rejecting that which is indigestible.  In many  cases such a  bag
constitutes the'whole animal, as in the hydatid; but in most animals
other parts are superadded to  assist in the  process of digestion.
These parts vary exceedingly in different tribes, and "would serve
as a ground for the  classification of them."   A copious illustration
of the above facts is  furnished by a number of preparations selected
from  the various orders of animals, commencing with the most
simple, in which the stomach has but one orifice  for the reception
aqd rejection of foreign matter; and ascending through the radia-
ted animals, where two orifices are found, and the digestive cavity
is divided into stomach and intestines;  to the insect  tribe, where,
in  addition, a crop is sometimes found,  for  retaining  the food  pre-
viously to its  undergoing digestion; or, in  the case  of the bee, to
its being deposited in the hive.  To  these succeed the stomachs of
mollusca, ascending  from the ascidians, or soft-shelled mollusks* as
Hunter aptly called them, through  the  acephalous tribe to the gas-
teropoda and cephalopoda of Cuvier.
  The stomach of fishes is next displayed,  which is for the most
part  a simple capacious bag, between  which and the large  and
muscular oesophagus there is  often scarcely any distinguishable
separation.  In some fishes, as in the Gillaroo trout and mullet, the

  * Hunter had paid great attention to the anatomy of these animals, as also to
that of the cirripeds, on both of which Cuvier has also published memoirs.  The
beautiful engravings attached to this, portion of the  Catalogue show how accu-
rately and fully Hunter had unfolded the structure  of the various organs, and
how eorrectly, for the most part, he had made out their several offices.
                               12 
114
THE LIFE OF JOHN HUNTER.
 stomach is a strong muscular organ, fitted in the former for break-
 ing the shells of testaceous animals, on which  it feeds;  and in the
 latter, to grind down with sand the vegetable substances of which
 its nutriment consists.
   In reptiles we find great diversities in the form of the stomach.
 In the ophidians, both this and the oesophagus  are capable of great
 distension, for the reception of bulky animals, on which they prey.
 In the chelonians it is broad and flat, like the body; whilst  in  the
 crocodile it is divided into two cavities, a cardiac and a pyloric,
 much as we find it in some of the carnivorous  birds.
   Birds are furnished with a  proventriculus, or glandular cavity.
 which receives the food before it  passes  into the stomach, or giz-
 zard ; and in the crane tribe we find a pyloric cavity between the
 gizzard and duodenum, as in the  crocodile.  The  gizzard varies
 much in the strength of its muscular coat: this in carnivorous birds
 is much weaker than in granivorous ; but if a  bird of  the former
 kind be fed on grain, the gizzard will become  gradually more de-
 veloped, as is shown by the preparation of a gull's stomach which
 had been so fed.
   To the stomachs of birds succeed those of mammalia.   In many
 of these the stomach consists of a simple cavity, which in the orni-
 thorhynchus takes the general form of a  gizzard, the cardiac and
 pyloric orifices being close to each other, as in birds.
   In  the porcupine,  the  stomach is  partially  divided  into  three
 cavities; in the peccary the division  becomes  more  complete, the
 oesophagus opening into the middle  one, whilst the  cavity of the
 fundus takes a bifurcated  form.  In ruminating animals, however,
 a still greater  degree of complexity exists: in these we find four
 cavities, the first two of which receive the food prior to rumination;
 but after rumination  the food is prevented by a  peculiar sensibility
 of the sphincter, which closes their orifices, from re-entering them,
 and is passed on by a sort of canal to the psalterium, or third'cavity,
 and from thence to the abomasus, or fourth cavitv.
   In the llama and camel the muscular fibres of the first two  cavi-
 ties are disposed relicularly, and the mucous membrane forms sac-
 cuh between the meshes: into the sacculi of the second cavity water
 is received and is preserved there for a long time in a  pure state.
 In the whale tribe  we find the stomach assuming a loculated form
 and consisting of from four to  seven  cells, disposed in  a row one
 after the other.
   In this series are also deposited  several preparations illustrative
 of the d.gest.on of the coats of the stomach  after death; a fact
 which Hunter first pointed out and explained
  Intestines.-The: Third Series displays the structure of the intes-
tines in  various tribes of animals, arranged in the same  order as  is
adopted for the stomachs.
   Glands.-The Fourth Series exhibits the varieties which exist  in

digest."   C°mp0Sltl0n °f the Slands which ^d in the process  of 
THE LIFE OF JOHN HUNTER.
115
  First, of the salivary glands: these in many mollusks are found
in the form of tubes, blind at one end, and opening by the other into
the buccal cavity, or oesophagus, and gradually as we rise in the
scale assume the form of conglomerate glands.
  Next, of the pancreas; which in like manner is  first seen under
the form of caecal tubes, opening into the upper part of the intes-
tine.                                          '
  The same  may be said of the liver at  its first appearance as a
separate organ.   It soon, however, as in the mollusks, assumes the
form of a conglomerate gland, and is in these of a large size.  In
the lower animals the bile is secreted from arterial blood.
  After the liver, the gall bladder and ducts are exhibited. In many
of the lower animals, and in  some  of the higher, there is no gall
bladder.   In  the squalus maximus, for  example,  twelve ducts con-
vey the bile from  the huge liver to a receptacle six  feet distant, and
lying in contact wilh the duodenum, into which  it  opens.  This,
however,  is not supposed to be  analogous  to the gall bladder, as a
similar receptacle is found in the elephant, which possesses a gall
bladder.
  Next follow preparations of the spleen, and other appendages of
the alimentary canal, and these complete the division devoted to the
function of digestion.
  Absorption.—The function of absorption is the one which is next
illustrated.  In  vegetables this function is shown to  be  performed
by  simple tubes commencing  in the roots, of an equal diameter
throughout, and without branches.
  The first traces of the absorbent system in the animal tribes are
found in certain of the medusas, as the rhysostome, on which vessels
are found opening on the fringe, like appendages of the stem.  These
take up nourishment  from the  water,  and coalescing into  larger
trunks, empty their  contents into the  digestive cavity.
  In the aphrodita the absorbents consist of small capillary vessels,
arising from the caecal appendages of the intestine, where they take
up the chyle, and convey it to various  parts of the body, without
the  intervention of a heart.
  The next step is to the lacteals of the higher animals, which ter-
minate in  the venous system.  But the absorbents are employed not
only in taking up  nutriment for  the supply of the body, but in con-
veying away the  effete  particles; and these are  termed excretory
absorbents.   Amongst preparations  illustrative of this function is
one on which Mr. Hunter set a high value, as affording demonstra-
tive evidence that the absorbents perform the above office.   This is
a preparation from the  head of a spermaceti  whale, where the
lymphatics are seen filled with this animal oil, which they were in
the act of taking up.
  Circulation.—The organs of  the circulation are next exhibited,
in an ascending order.   First, in those  animals in  which there ap-
pears to be no heart, as the leech, where we find two sinuous ventral
vessels and a small dorsal vessel, each giving off lateral branches.
In the amphinome, which has external branchiae on each ring, small 
116
THE LIFE OF JOHN HUNTER.
vessels convcv the aerated blood from them to the dorsal artery:
this gives off other branches, and. amongst others, one which courses
along the upper side of the intestine, whilst the corresponding vein
to which ils branches pass runs along the under side, and with the
other veins enters the ventral vessel,Yrom whence lateral branches
are sent off to the branchiae.
   The situation of the heart  in different animals  is next  shown.
This, as Hunter observed, depends on the  situation of the organs
of respiration, which it always follows.
   In insects the heart  is a long tube, placed in the back, and ex-
tending from head to tail.
   In the lobster and other crustaceae it consists  of  a single cavity,
also seated in  the back, and of about the  same  extent as the roots
of the branchiae.   In bivalve mollusks it is seated  in the centre of
the back.   In  the gasteropods, in various parts of the body, follow-
ing the branchia\   In fishes, just at the lower angle  of the gills, vfcc.
   Its composition becomes more complicated as we ascend in the
scale of organization, beginning with the dorsal vessel of insects,
which receives the blood through valvular openings in the sides of
the vessel, from  the irregular venous sinuses  which permeate the
adipose tissue, and distributes it to the body through lateral branches,
as shown in the injected preparation of a large caterpillar.  In the
ascidians, or soft-shelled  mollusks, there  is a single long ventricle,'
which receives the blood at one extremity  and  distributes it from
the other end to the branchial  sac and body.  In bivalves we find
a single ventricle, sending the  blood to the branchiae, from which
it passes to the body, and is received back into two auricles, which
supply the  ventricle.   In the snail we have one ventricle and one
auricle.   In the cuttle-fish we find both  a systemic and  a bran-
chial ventricle, and the  latter  indeed  is divided into two portions,
one seated at   the  base of each of the  branchiae.  Two auricles
receive the blood from the branchiae, and empty themselves into the
systemic ventricle.
  In fishes we find a branchial ventricle and a single auricle.   In
some of the cartilaginous fishes the heart is largely supplied with
valves ;  in  the lophius europaeus,  for instance,  the veins  opening
into the auricle are seen to be guarded by valves: the  auriculo-
ventricular opening has  semilunar valves,  and the openino- from
the ventricle into the bulb at  the  root of  the main arteryls sur-
rounded with  valves.   In the sturgeon there are no less than three
rows of valves in the bulb.
  In reptiles we  find two  auricles, one receiving  blood  from the
lungs, the  other from  the  body, and a single ventricle supplying
both.  The  ventricle, which in frogs  and  other batrachians is a
simple cavity with one aorta, in the ophidians/chelonians, and saurians
becomes more and more  divided into different  cells  by imperfect
septa, the general effect of which is to prevent the aerated blood
from mixing equally with the whole mass of circulation- fluid and
to direct it rather towards certain parts, as the head°and upper
extremities.                                                vv 
THE LIFE OF JOHN HUNTER.
117
   In birds we  attain the  most perfect form of heart, consisting of
 two ventricles and  two auricles, as  exhibited in the hearts of the
 ostrich, emu, &c.
   The same form of heart prevails in  mammalia;  and under this
 head we find preparations of the huge  heart of the elephant with
 its three  venae cavae, and of the far  more enormous heart of the
 whale.
   To the foregoing preparations succeed others, in which the struc-
 ture of the blood-vessels is exhibited : the nature and form of  their
 valves;  the several coats of which they consist; and the varieties
 in these displayed in .different animals.   The  outer  of  these coats
 may be deficient when the vessel  passes through  cartilage, as is
 shown in the cervical vertebrae of the squalus  maximus.
   Respiration.—The organs in which  the aeration of the blood is
 effected are exhibited in the succeeding series.  This process  may
 be effected,
   First,—by exposure to  the air contained in water.
   The simplest form of the organ is where a certain portion of the
 general mass is especially devoted  to this  object, as the thin edge
 of the disk in  some kinds  of medusae.   In some of the annulose ani-
 mals, as  the amphinome, the  organ  consists  of a bunch  of  rays
 seated on either side of each ring.   In others, as the amphitrite, the
 branchiae are  collected on the rings  of the neck.   In  the lobster
 and  other crustaceae, the  branchiae  are  attached to the legs, and
 are  covered by a lateral extension of the dorsal shell.   In bivalves
 they form foliated appendages on either side of the body, between
 it and  the mantle.   In  the gasteropod and  other mollusks  the
 branchiae assume very various and  often elegant forms, and are
 variously placed on the body.
   In the  myxena, lamprey,  and other cartilaginous fishes, the  gills
 consist of a row  of saccoli, varying in number, and placed on either
 side of the neck, each sac having an external orifice and an opening
 into   the oesophagus, and its  internal membrane being variously
 laminated, to afford larger surface for the aeration of the blood. In
 the bony fishes the gills are supported on bony arches, and covered
 by an operculum  ; these arches differ in  form, and in some instances
 assume a very elegant appearance,  as shown in preparations of the
 branchiostegal bones from the devil fish of the Antilles  and others,
  Secondly,—-For the exposure of the  blood to the air in  water, and
 to the atmosphere.
  The foetus of the squalus alopeceus is shown  to be furnished with
 external branchiae when first born, as well as with gills;  the former
 drop off after a time.   \n the siren  and  proteus there are external
branchiae  and  lungs, and both are persistent.
  Thirdly,—-For the exposure of the blood to the atmosphere.
  Amongst the reptile tribes, we find that snakes are  furnished with
 a single lung, consisting of a long bag, the  upper part of which has
 vesicular parietes, whilst the lower  serves  as a reservoir of air, to
 be employed during the time in which the animal is swallowing its
                              12* 
118              THE  LIFE OF JOHN HUNTER.
prey  and its trachea is obstructed.  In frogs the lungs appear like
a conglomeration of transparent sacculi.  In the turtle these sacculi
are much smaller, and more numerous, so as to give the lungs more
the appearance of those of the mammalia, which  are  last shown.
The series is completed by twenty preparations of the tracheae and
organs of voice in birds and mammalia.
  Kidneys.—The organs for the depuration of the blood, or the kid-
neys,  are next exhibited, and some of their most remarkable differ-
ences in  situation, number, form, and  structure  in the vertebrated
animals are shown.
  Brain.—To this succeeds a series, containing about ninety prepa-
rations, in which the development of the  brain and spinal marrow,
from the knotted cord of  insects and Crustacea, with a small gan-
glion  above the oesophagus ; representing the brain upwards through
fishes, reptiles, and birds,  to the perfect brain and spinal  cord of
the  mammalia.   This series  is perhaps one of the least complete,
and this has arisen from the small degree of importance which these
organs obtained in Hunter's physiology compared with that attached
to them in the present day.


                   ORGANS OF THE SENSES.

  To the series illustrative of the central portions  of the  nervous
system succeeds one consisting of not less than four  hundred pre-
parations of the several organs of the senses.
  Of Feeling  and Touch,—Exhibiting the cutis increasing in vascu-
larity in proportion as its sensibility increases ; the varieties in
compactness,  density, &c,  which  the cutis exhibits in different
animals ;  the  slowness with which it decays  under  certain circum-
stances, as illustrated by a preparation of the right hand of a body,
said to be that of John of  Gaunt, in which  the  cutis  is perfect;
lastly, its retention of marks made in it, as in the tattooed skins of
South-Sea Islanders or British sailors.
  Of Taste.—Exhibiting the tongues of animals, arranged according
to their secondary uses ;  to which succeed fifteen  preparations of
some  of the principal varieties of the mouths and fauces of different
animals.
  Of Smell.—-In  fishes the organ of smell  assumes the  form of
laminae, arranged in various  order  around  the nasal  cavity   In
reptiles the cavity is divided by folds of the olfactory membrane, as
in the higher  animals; but these do not contain bonv plates between
their  layers :  the organ is exhibited in the turtle and other  animals
of this class.   In birds the extension  of the  nasal  cavity becomes
greater, especially  in birds of prey, and canals  leading  from  it
communicate with the air-cells of the head, as shown in the swan
and eagle. In mammalia it becomes still more complicated.
   Of Hearing-In this collection are contained several good  pre-
parations of the  ear in fishes, to which Hunter had paid much at- 
THE LIFE OF JOHN HUNTER.
119
tion, showing the semicircular canals, the sac  in which they ter-
minate, and its ossicles, varying in number from one to  three.  In
most fishes the ear has no external communication ; but in the ray,
the squalus, and other cartilaginous fishes, a  canal  leads from the
sac to the surface of the head, where its orifice is closed by a mem-
brane.  In reptiles, birds, and mammalia the organ becomes gra-
dually more complicated by the  development  of the  concha  and
addition of the tympanum and external ear.
   Of Sight.—The structure of the eye and its appendages is deve-
loped in a hundred and fifty preparations.  The peculiarity in the
eye of the cuttle, which  Cuvier has since pointed out, namely, that
the choroid coat is placed in  front  of the  retina, had attracted
Hunter's notice,  and is shown in several preparations.   The struc-
ture of the eye in fishes, fitting them for seeing in a medium of high
refractive power, is shown ; as  also the peculiar fulcrum on which
the eye revolves in cartilaginous fishes.  The plicated arrangement
of the retina in birds, enabling them to see at vast distances; the
tapetum lucidum, the membrana nictitans, and the various forms of
the pupil in several mammalia, adapted to their habits of life; and
lastly, the structure of the eye  in man, are all exhibited  in this
series.
   Cellular Tissue.—To  the organs of the senses succeeds  a series
in which the various forms which the cellular tissue  assumes are
well shown, as also the varieties of oil and fatty matter contained
within its cells in different animals.
   External Coverings.—The external covering alone remains to
complete  the list of parts fitted for providing for the necessities of
the individual, and the various forms which this assumes constitute
the subject of the next series.  We  commence as  usual with the
vegetable tribes, of which the texture and appearance of the cuticle
is first shown, and next  of the animal tribes.  The colour  of the
skin in the latter is seen to depend on  the rete mucosum, and this in
the dark  varieties  of mankind  assumes  more of a membranous
character, than in the lighter varieties.   The arrangement of the
external  covering, in the form  of hair,  bristles, feathers,  &c,  is
exhibited, and  the mode  in which the  latter are formed is developed
in several excellent preparations.  Several other specimens exhibit
the cuticular lining of the oesophagus and stomach in various ani-
mals.  In others the  external cuticle is shown to become thicker
where parts are  exposed much to the  action of external bodies, or
to assume the  form of scales, nails, hoofs, and spines, or of beaks,
horns, or spurs, according as defensive  or offensive weapons  may
be required.
   Individual Peculiarities.—This division of the Museum  is com-
pleted by a series of about one hundred and eighty preparations of
some of  the most distinguishing peculiarities of individual species
or of classes  of animals in the vegetable and animal kingdoms.
Amongst the former may be noticed the elegant natural ewer of the
pitcher plant, and the apparatus at the joints of the leaflets, subpe- 
120              THE LIFE OF JOHN HUNTER.
 tioles, and petioles of the sensitive mimosa, causing these parts to
 collapse on the slightest touch.  As examples  of the  peculiarities
 amongst animals are exhibited the casting off and  regeneration ot
 the external covering and cuticular lining of the stomach in crusta-
 ceous  animals;  and of the  cuticular covering  in  serpents.  Ihe
 regeneration of  entire members in Crustacea, newts,  &c.  ine
 green bones of the gar pike, or belone vulgaris ot Cuvier.   1 he dark
 periosteum of  the  African fowl.   Peculiarities  in  the  intestines
 arterial system  and urinary  bladder  in  various animals.   Local
 deposits of fat for specific purposes.  The tentacula of  the cuttle
 tribe, with the  suckers which enable  them to  secure their prey.
 The termination  Of the elephant's proboscis.   The  substitution of
 whalebone for teeth in the whale.   The ornamental  appendages of
 the male in some species of birds.   The peculiar glands of animals
 whether for internal uses or opening externally, as the oil-bags of
 birds, the odoriferous glands of the peccary, &c.  The air-bladder
 of  fishes.  Feet  in mammalia  adapted for swimming.   Fins  in
 fishes for flying.  Coralline formations.  The stings of insects, and
 poison-teeth of serpents.  The electric organs of the  torpedo and
 electric eel, &c.

      THE SECOND DIVISION  OF THE  GALLERY,

           ILLUSTRATIVE OF THE FUSCTION OF  RE-PRODUCTION,

Contains about fifteen  hundred  preparations, admirable  alike for
their delicacy and beauty as works of art, and for the  accurate
and extensive information they afford on this interesting department
of physiology.
  They are arranged, according to the Synopsis of the  Museum,
in ten series.
  The first series, which contains preparations of the sexual organs
in hermaphrodite plants and animals,  commences with an elegant
selection of subjects, exhibiting some of the most striking varieties
in the form and arrangement of  these parts in hermaphrodite flow-
ers.   To these succeed preparations of the organs  in  self-impreg-
nating animals, as the asteriae, the cirripeds ; and lastly, of herma-
phrodite  animals, which perform a double  coitus, as the snail, slug,
and other gasteropod mollusks.
  The second series of this division exhibits the form and  structure
of the male organs, commencing with  the  stamina of plants;  then
ascending to the animal kingdom, and exhibiting,  first, the  testes
 and  penis in insects, as the  bee,  the scorpion, &c;  then  in fishes
 amongst which we find two distinct forms:  in osseous fishes the tes-
tis,  or  milt, is a  cellular sac, varying greatly  in size at different
seasons, which opens by a common orifice with the kidney, imme-
 diately behind the anus.   In  the ray  and squalus it is a granular
 mass, having more of the form of the  testis in  the higher animals,
 and opens into the cloaca.  Several preparations exhibit the testicie 
THE LIFE OF JOHN HUNTER.
121
in the toad, increasing in size in the season of coupling, and attend-
ed with an increase in the size of the tubercle of the thumb, which
is emploved  in retaining the female.  The testis and penis of snakes
and lizards are next shown, the latter of which organs  is seen to be
double.  In  the crocodile and turtle it is single, and  assumes the
general form which it exhibits  in mammalia; but the urethra, in-
stead of forming a canal,  consists of a groove only, in the dorsum
penis.   In birds the size of the testis varies very much at different
seasons; this fact is  shown  in  the  sparrow.  The  urethra  is a
groove, as it is in reptiles, but the form of the penis  varies much.
In the ostrich it is straight and large; in the goose,  duck, &c, it
assumes a spiral form when thrust out from the sheath. The struc-
ture of these organs in mammalia, is shown in several injected pre-
parations, and in  others where the seminal tubes have been unra-
velled to show their great length; and  the series is completed by
several specimens, which exhibit the form and structure of the acces-
sory   glands, as  the  vesiculae  seminales, prostate, and  Cowper's
glands, in different animals.
   The third series consists of preparations of the female organs in
plants and animals.  A few specimens of  the  pistils of plants head    •
the series ;  and these are followed by the ovaries and  ducts in  mol-
luscous animals;  in insects;  in fishes, whether bony or cartilagin-
ous ;  in reptiles; in birds,  where  only one ovary is developed ; and
in the ornithorhynchus.    Next follow the ovaries and  uterus in ani-
mals, amongst which the latter organ is  simple, or divided  into two
cavities, or furnished with horns. In the marsupial animals  the horns
 are seen opening into a central or third cavity, which does not com-
 municate directly with  the vagina, but intermediately, by  means of
 two lateral curved canals.   The last eighteen preparations of this
 series exhibit the form of the clitoris in mammalia, and  the occa-
 sional appearance of a hymen in them.
   The coitus in some of  the lower animals  is exhibited in the ten
 succeeding preparations.
   The development of the ovum forms the subject of the three fol-
 lowing series.  First, in plants which have no evident seeds;  next,
 in gemmiparous animals, as the hydatid ; next, in cryptogamous and
 phanerogamous plants; and lastly, in hermaphrodite  animals,  whe-
 ther  self-impregnating, as the asleria, the barnacle; or  mutually
 impregnating, as snails, slugs, and other gasterapods.
   The sixth series of this division contains about four hundred and
 fifty preparations, illustrating the various conditions in which the
 eggs of oviparous animals are placed for the purpose of being hatched,
 and  of the changes which take  place  in the young  animal during
 the foetal state.    The ova of some animals, as certain of the uni-
 valve mollusks, are deposited previously enclosed in a membranous
 nest.  In others the eggs are retained in clusters, as is the case with
 the sepia, the ova of which resemble a bunch of grapes ; or with the
 roes of osseous fishes. In the insect tribes the young undergo certain
 metamorphoses  before they attain the perfect state :  these changes 
122              THE LIFE OF JOHN HUNTER.
 are exemplified in about ninety preparations of the larva and chry-
 salis state of different insects, and in about the same number, forming
 a regular series of the  changes in  the silk-moth.  The caterpillar
 state of several other insects is shown, and these are followed by
 preparations of the  nidus which many insects prepare to receive
 the egg and contain it during its transformation.  The ova of some
 animals are carried  in the arms of the mother until hatched ; in the
 Crustacea they are fixed to the scales beneath the tail.  In osseous
 fishes they  are clustered in masses; in the ray the eggs are depo-
 sited singly % each, as it passes through a gandular enlargement of
 the oviduct,  having a horny shell secreted on its surface; this is
 shown  in several very elegant preparations : in the  shark the ova
 are hatched before they leave the oviducts.   In Batrachian reptiles
 the young are furnished with  gills,  which  are  cast, off when they
 leave the tadpole  state.  Of snakes and lizards, some are seen to
 have the eggs hatched  in  the body, and  others  externally.  The
 turtle and crocodile deposit their eggs  on the ground, where they
 are hatched by the warmth of the sun.  In birds they are hatched
 under the mother.   The formation of the egg in birds is next shown;
 and the series is completed by about forty  preparations, exhibiting
 the progress of incubation in the egg. These, which were originally
 beautiful preparations, have, from  their delicacy,  been somewhat
 injured  by time; but happily  the deficiency is more  than  compen-
 sated by a series  of  exquisite drawings, made under  Mr.  Hunter's
 eye by Mr. Bell.   These will be published along with the descrip-
 tive catalogue of  this part of the museum ; and if the engravings
 should be executed, as there is every reason to  hope they will be,
 in a manner worthy of  the originals, they cannot fail to excite a
 very high opinion of Mr. Bell's talents as an artist, as well as serve
 to show with what masterly skill Hunter prosecuted his researches
 in this branch of physiology.
   The seventh series illustrates the  development of the ovum and
 its contents in Mammalia.  The changes  which  the ovary under-
 goes subsequently to  impregnation are first  shown, in various ani-
 mals.  Then the changes going on in the uterus ;  first, in such uteri
 as have horns, where the several ova are seen to occupy  separate
 compartments;  next, in  uteri without horns, under which  head are
 arranged a number of preparations of the uterus in woman, at dif-
 ferent stages of pregnancy ; and these are followed by others, show-
 ing the changes which the uterus undergoes subsequently to parturi-
 tion.  The series is completed  by a number of preparations  designed
 to elucidate  the structure of the placenta, and  its connexion with
 the uterus, a point which has given rise to so  much  discussion of
 late.
   The eighth series shows  the principal peculiarities  of structure
in the young animal  during the  foetal state, such as the yolk-bag,
and its  connexion with the foetus; the fcetal circulation'in birds;
the horny knob on the beak used in breaking the shell; the recep-
 tion of the yolk into the stomach ; the umbilical cord in Mammalia; 
THE LIFE OF JOHN HUNTER.
123
the open foramen ovale; the ventricles of the heart of equal thick-
ness ; the  situatibn and descent of the testes;  the membrana pupil-
laris, and the large thymus gland.
  The ninth series illustrates the growth of the young, whether in
plants or animals.
  The tenth  and last series shows some of the various modes  in
which food and protection are furnished for the young animal; as,
for instance, the glandular structure in the crop of pigeons, which
secretes a kind of milk;  the lactiferous glands of Mammalia; the
young  lodged in temporary cells on the back of the mother, as m
the pipa frog; or carried in a pouch, as in the marsupial animals; or
preserved  in nests, as in birds, insects, &c.
   Having  entered into  so full an account  of the Physiological
Gallery, the remaining departments of the  Museum must be treated
of but  briefly.

                      DRY PREPARATIONS.

   That which comes next to be noticed is  the collection of objects
in Comparative Anatomy preserved in a  dry state.   This depart-
ment contains 745 specimens, of whch 617 belonged to the original
Museum as left by Hunter.  These are arranged in eleven series,
which successivelv exhibit preparations of  the heart  and blood-
vessels ; of the absorbents ; of the respiratory  organs;  of the diges-
tive organs;  of the male urino-genital organs ; of the same organs,
with the lactiferous apparatus, in the female;  of the nervous system;
of the  organs of vision ; and of the  cutis.  The tenth series contains
models, casts, &c.;  and the eleventh, several mummies.   Various
interesting and  curious  preparations are comprised  under these
several heads : the first affords a pretty full illustration of the various
modes in  which the  aorta and  its  first branches arise in  different
animals;  the sixth consists of the admirable preparations of the
nerves which accompanied Mr. Swan's prize essay on this subject;
in the  tenth series are three wax models by the celebrated Clementi
Susini; and  amongst the mummies the most  remarkable is that of
Martin Van Buchell's wife, which was prepared by  Cruikshank
according to Dr. Hunter's  directions, and given many years after-
wards to  the College by her son.
   The Catalogue  of this department forms  the fourth part of the
 General Catalogue in the course of publication.

                          OSTEOLOGY.

   The department of Human and Comparative Osteology is that
 which I shall next briefly notice.  To the specimens here contained,
 very large and valuable additions have been made since Mr. Hunter's
 death.  The original collection consisted of 963 preparations, to
 which 973 have  since been  added. The  sources whence  these
 have been derived are very various ; the most abundant has been 
124
THE LIFE OF JOHN HUNTER.
that of donations, but many of ihe rarest and most valuable skeletons
were purchased  by  the  College  at the sale of  Mr. Brookes's
Museum.   Only a fifth part of the valuable specimens contained in
this department has vet been displayed, from a want of room in the
present building; and upwards of 400 boxes, containing either  the
whole or a portion of the  skeleton of various animals prepared by
Mr. Hunter, remain shut up from public view.  Of these,  a manu-
script catalogue is in the course of publication.   The arrangement
adopted for this  department  is that of Cuvier in his Regne Animal.
At  the head  of  the collection  stands  the  skeleton of  Charles
Byrne, who measured eight feet four inches in height at  his death;
and as a contrast to his gigantic remains, we find here the  skeleton
of Mdlle. Crachami, an Italian dwarf, who, at the age of  nine, when
she  died, measured only twenty inches in height.  The  order
Bimana is further illustrated by a large collection of skulls, exhibit-
ing the characters of the five great varieties of the human race,
the  Caucasian,  Mongolian,  American,  ^Ethiopian, and   Malay.
The preparations from which the engravings in Hunter's work  on
the teeth were made are also deposited in this collection.   Under the
order Quadrumana we find the  skeleton  of the adult  pongo, the
chimpanze,and ournng-outang, and a few specimens from the family
of lemurs.
  The large order Carnivora also contains many valuable skeletons,
principally from animals of the true carnivorous tribes, as the Plan-
tigrada, Digitigrada, and Amphibia.  The Cheiropterus and Insec-
tivorous genera are but scantily illustrated.
  The order  Rodentia  contains about  a dozen  skeletons, with
several skulls of some of the  rarer species.
  In the order Edentata we find a few valuable skeletons, amongst
others one of the Rufous Ornithorhynchus.  There  are also several
specimens of the Marsupiata.
  The order Pachydermata exhibits various specimens of the tusks,
teeth, and skulls of elephants, as also the skeleton of Chuni, the
large male elephant, whose violence necessitated  his destruction
some  years since at Exeter 'Change; a  skeleton of the hippopo-
tamus, of the  single-horned rhinoceros,  and  of  the  two-horned
rhinoceros; as also the tapir, and of several of the  smaller Pachy-
dermata.
  The order Ruminantia is rich in  skulls and horns of the antelope
tribes, and of other genera, but contains few skeletons.
 ^ There is no  adult skeleton of any of the  larger  species of the
Cetaceous  tribes  except one of  a  young whalebone-whale, and
about half a dozen skeletons  of the smaller animals  of this race.
  The class Aves, though  illustrated by several  valuable skeletons
and a large collection of skulls, affords ample room for  the dona-
tions of liberally disposed individuals.
  The same remark holds good of the class Reptilia.
  The class Pisces is very meagrely supplied with skeletons, which 
THE LIFE OF JOHN HUNTER.
125
 no doubt chiefly arises from the difficulty experienced in preparing
 and preserving in place the bones of these animals.
   The Catalogue of this department forms the third part of the
 General Catalogue.

                            MONSTERS.

   The department which next claims our attention is that contain-
 ing preparations of monsters and malformations.   These are dis-
 posed in two divisions, according as the preparations are preserved
 in spirit or in a dry state, and each division comprises four series,
 as arranged by Hunter.
   The first series contains examples of the preternatural situation
 of parts.   The second, of the addition of parts.  The third, of the
 deficiency of parts.   The  fourth, of hermaphroditism.  Several
 curious and  valuable  preparations are contained in this collection;
 many have been added since Hunter's death.  Amongst  the latter
 are to be numbered two in  the first series, which  exhibit curious
 instances of one foetus becoming inclosed in the belly of another.
 The first is that which occurred  to Mr. Highmore, of Sherborne;
 in which  the foetus was encysted in the  belly of a young man of
 seventeen.  In the second,  which occurred to Mr. G. Young, the
 containing child was  six months old when it died.  The  histories
 of both have been published.
   Under the second head we find various  examples of double parts
 in animals;  amongst  others,, of  a double uterus and vagina in a
 woman, and one of the uteri containing a foetus of seven months.
   The  case of deficiency of parts is exemplified by preparations of
 the heads of pigs and  lambs,  in the former of which animals mal-
 formations appear to  be very common.  In several  of  these the
 whole of the face which lies anterior to  the ears  is  wanting; in
 others there  is but one eye, in the centre of the forehead, with a
 proboscis from the forehead.  Pigs so constructed go under the
 name of elephant pigs.
   The fourth series contains preparations from  the  hermaphrodite
 cow, or free-martin,  on the generative organs of which Hunter
 wrote a paper in the  Philosophical Transactions;  as  also of the
 organs  of generation  in  hermaphrodite  sheep and dogs.   The
 organs of the hen pheasant, which has taken on the plumage of the
 cock, are also here exhibited.
   Amongst the series  of dry preparations  the most curious is that
 of a double skull, which belonged to a child of six years of age.
 The  skulls are united by their vertices;  the  upper one  was sup-
plied by blood-vessels passing through the united  portions; and
from the  account given by  eye-witnesses, the upper  head seems
during  life to have experienced sensations, and to have exhibited
mental operations, distinct from those of the lower head.
  These preparations are described in the fifth part of the General
Catalogue.
                              13 
126
THE LIFE OF JOHN HUNTER.
                        NATURAL HISTORY.
   1.  In spirit.—The  next department of the Museum contains
2098 specimens of natural history preserved in spirit, of which 1743
belonged to the Hunterian collection.   As yet only a catalogue of
the invertebrate animals has been published, which amount to 614
in number.  " This division," says Mr. Owen, who prepared  the
catalogue, " originated in the preservation of natural objects trans-
mitted  to  Mr.  Hunter for dissection, which accumulating as  the
reputation of the illustrious founder increased and extended, and as
the  requisite leisure  for  their examination  became  abridged, at
length  enabled him to exhibit in a  series the most remarkable dif-
ferences in the outward forms of the animal kingdom.  They were
arranged by him in the ascending order; this order has therefore
been adhered to. and best accords with the position of the several
classes of animals whose structures are shown in the Physiological
Gallery. With a few exceptions, the classes and orders of Cuvier and
 Lamarck  have been adopted.  The invertebrate animals  are ar-
 ranged in two series, one ascending through the inarticulate,  the
 other through the  articulate classes."
   The  Tunicata are arranged according to Mr. MacLeay's method.
The  Entozoa,  after Rudolphi.   The Cirripeds, after Dr.  Leach.
 His genera have also been adopted for the Crustacea ; but the fami-
 lies and  the orders are arranged according to Latrcille's method
 in  Cuvier's Regne Animal.  After the latter also the Insecta  are
 arranged.
f   2. Stuffed.—In  addition to the specimens of natural history pre-
 served  in the foregoing department, the Museum contains a small
 collection  of stuffed animals," and about 1000  dry specimens of
 insects, shells,  zoophytes, &c, of which no catalogue has yet been
 published.
   3. Fossils.—The collection of fossils contains  1415 specimens,
 of  which  two hundred  have been  added  since the  death of
 Hunter.   There exists a manuscript  catalogue of  this department,
 with introductory remarks  by Hunter, but this  has not vet been
 published.

                           PATHOLOGY.
    Having thus taken a rapid sketch  of the natural history  depart-
 ments  of the Museum, a brief notice must now  be  given  of the
 department of pathological anatomy.  The preparations here con-
 tained are arranged  under three heads.  The first contains speci-
 mens of deceased parts preserved in spirit.   The second, patholo-
 gical preparations in a dry state.  The third, the inorganic products
 of disease, as  calculi, concretions, &c.
    1. In Spirit.—Under the first head are arranged 1392 specimens,
    * An application is at present before the Privy Council for leave to dispose of
 the larger stuffed animals, which take up disproportionately the room of the
 Museum, while they only indirectly subserve the primary object of its formation. 
THE LIFE OF JOHN HUNTER.
127
of which 1084 constituted the collection as left by Hunter.  They
are disposed in  three  divisions, of which  the  first  illustrates the
actions of restoration and of disease in the various structures of the
body.  Examples of union by the first intention are first exhibited;
to these succeed specimens of adhesive inflammation; of suppura-
tion, under  various circumstances; of ulceration, in its different
forms; of granulation, as seen on different tissues ; of cicatrization;
of the union  of fractured bones.  These are followed by a series illus-
trative of the effects of inflammation in bone, of diseases in joints,
and of dislocation of bones.   Diseases  arising from pressure are
next exemplified ; then the collection of fluids in cavities ; diseases
of the circulating system;  tumours  not encysted; and finally,
encysted tumours.
   In the  second  division the effects of specific or peculiar diseases
are shown, as  of scrofula, cancer, fungated  ulcer, small-pox, gout,
syphilis, gonorrhoea, hydrophobia.
   The third division contains specimens of disease, arranged ac-
cording to their  locality,  beginning with diseases of the oesophagus,
and proceeding to those of the stomach, intestines, and anus ; of the
liver and gall-bladder;  of the spleen, kidney, and urinary bladder;
of the uterus and its appendages, in the impregnated and unimpreg-
nated state; of the brain and  its membranes; of the spinal  cord
and nerves ; of the eye;  of the gums and teeth ; and lastly, of the
air-passages and lungs.
   2. Dry—Under the second head we find a large collection of dry
preparations, illustrative of the actions of disease and restoration in
bones, on which subject Hunter was preparing a work for publica-
tion at the time of his death.   He bestowed great pains on the
arrangement of  these  specimens, and left  behind him very  com-
plete  explanatory documents relating  to  them; but  these, it is
supposed, were  committed to the flames by Sir  Everard  Home,
along with  the  manuscripts which have been mentioned  before.
Besides the above specimens, we find under this head specimens of
diseases occurring in teeth ;  of diseases in the blood-vessels, lungs,
intestines, and  urinary organs ; besides,a variety of casts, and other
miscellaneous objects.
   3. Calculi.—The collection of calculi and concretion contains
1781 specimens, of which more  than two thirds have been added
since the death of Hunter.   A manuscript  catalogue of the whole
has been  completed, but the  chemical composition of several of the
specimens remains yet to be ascertained.
  I have endeavoured  in the  above outline  to furnish  a general
conception of the character and contents of the Museum of Hunter.
That it conveys  but a faint  idea of the  real  merits  of  this noble
monument of his genius I am well aware.  The brevity with which
I  have been  compelled  to speak of the several parts has necessarily
prevented my entering into those details which would have given
interest to the account, and  under any circumstances  a written
description could furnish but an inadequate notion of the merits of this 
128              THE LIFE OF JOHN HUNTER.
work.  He that would fully appreciate these must not only see the
collection, but must examine each part with minute  attention; for
in this way alone can a correct idea  be acquired of the skill dis-
played in the execution of the several parts, and of the comprehen-
sive genius and  indefatigable  industry, the  combination  of which
alone could have enabled him to plan and to  execute so great an
undertaking.
   Without doubt it is by this  work, above all others, that  Hunter
has immortalized his name.   In his writings  we occasionally find
an obscurity in the expression of his  thoughts, a want  of logical
accuracy in his  reasonings, and an incorrectness in  his language,
resulting from a deficient education.  In this work no such failings
are apparent; Nature is here  made to be her own  expositor, and
the treasures she has poured forth come fresh to the mind from the
fountains of knowledge, unimpaired by passing through the imper-
fect medium of language, and unimpeachablv proclaiming the genius
of him by whose labours they were brought to light.  That Hunter
should have still left this work incomplete, after  so many years
devoted to its construction, will  not surprise those who reflect that
the stores of Nature are in truth inexhaustible.  He  has raised a
noble edifice, the magnitude and beauty of which  all must  admire
who consider that it was the work  of one mind ; but there is still
ample room for  the labours of others in adding to or  completing its
various parts; and those to whose care this invaluable collection
has been committed could not have better forwarded the interests
of science than by devoting, as they have done, some of the ample
funds at their disposal to judiciously increasing its treasures, and to
making those treasures more extensively useful by publications, such
as those by which they are now illustrating  them.
   It has long been a subject of just regret that the building in which
the Museum is  at present contained, does not afford  room for the
display of more than one half of the whole collection.  The Coun-
cil have therefore determined on increasing  the accommodation, by
the incorporation  of the  two adjoining houses, so as to form one
uniform building, in which particular attention has been paid to en-
sure the  complete illumination of every part,  a point in regard to
which the present premises are remarkably  defective.*
   This  building is now rapidly advancing,  and will probably be
completed in about a twelvemonth,  by which time also the remain-
ing parts of the  General  Catalogue  will be far advanced.   In  addi-
tion to this the College has provided, at an expense of upwards of

  * It is perhaps to be regretted that the  Council of the College should have
come to the resolution of building upon their present site, where they  are con-
fessedly so much cramped for room.  The accumulated and  yearly funds of the
College, amounting in 1832  to upwards  of 66,000/. in hand, and 11 000/ per
annum, might justly have warranted a more enlarged  plan, commensurate with
the trust reposed in their hands, and with the expectation of further  increase
which they have a right to entertain.  The building, however,  which is now in
progress will form a noble object in  the metropolis, and be a great improvement
upon the former one.                                       r 
                 THE LIFE  OF JOHN HUNTER.              129

10,000/., a magnificent library, to which valuable additions are now
being made; so that when these and the before-mentioned arrange-
ments are completed, the surgical profession in England will  have
reason to boast of possessing one of the noblest scientific establish-
ments which the world can exhibit.
13* 
APPENDIX.
         Chronological List of Mr. Hunter's Writings.

1762.  1. On the Descent of the Testis—Medical  Commentaries,
           by  Dr.  Wm. Hunter.  Part I.  p. 75;  and Animal
           (Economy.
----   2. On Absorption by Veins—Med. Comm. p. 42.
1766.  3. An account of an amphibious  Bipes, by J. Ellis, with
           supplement by J. Hunter—Phil. Trans.
1771.  4. Treatise on the Natural History of the Human Teeth,
           Part I.
1772.  5. On the Digestion  of  the Stomach after  death—Phil.
           Trans.,  and Animal (Economy.
1773.  6. Anatomical Observations on the Torpedo—Phil. Trans.
1774.  7. An account of certain receptacles for air in Birds, which
           communicate with  the lungs  and Eustachian  tubes,
           &c.—Phil. Trans., and Animal (Economy.
----   8. Observations on the Gillaroo Trout, commonly called in
           Ireland  the Gizzard Trout—Phil. Trans., and Animal
           (^Economy.
1775.  9. An account of the Gymnotus electricus—Phil. Trans.
---- 10. Experiments  on Animals and Vegetables, with  respect
            to  the power of producing  heat—Phil.  Trans., and
            Animal GSconomy.
1776. 11. Proposals for the recovery of people apparently drowned
            —Phil.  Trans., and Animal  CEconomy.

       12. Croonian Lectures on Muscular Motion (never printed).

      13. On the Heat of Animals, &c.—Phil. Trans., and Animal
            (Economy.
1778. 14. Treatise on the Natural Historv of the Human  Teeth,
            Part II.
1779. 15. An account of the Free Martin—Phil. Trans., and Ani-
            mal (^Economy.
1780.  16. Account  of  a Woman who had the  smallpox  during
            pregnancy, and who seemed  to  have communicated
            the same disease to the foetus—Phil. Trans.
 
APPENDIX.
131
 1780. 17. An account of an extraordinary Pheasant—Phil. Trans.
            and Animal (Economy.
 1782. 18. Account of  the Organ of  Hearing  in  Fishes—Phil.
            Trans., and Animal (Economy.
 1784. 19. Observations  on the inflammation of the internal coats
            of veins—Transactions of a Society for the Improve-
            ment of Medical and Chirurgical Knowledge, vol. i.
 1785. 20. Description of a new Marine Animal, in  a  letter  from
            Mr. Everard Home to J. Hunter, F.R.S., with a  post-
            script by Mr. Hunter, containing  anatomical remarks
            upon the same—Phil. Trans.
 1786. 21. Treatise on the Venereal Disease.
 ---- 22. Observations  on certain parts of the Animal  (Economy,
            being  a republication  of certain papers above men-
            tioned, in the Phil. Trans., to which were added the
            nine following:
      23. A description  of the situation of the  Testis in the Foetus,
            with its descent into the scrotum.
      24. Observations on the glands situated between  the rectum
            and the bladder, called vesiculae seminales.
      25. On the Structure of the Placenta.
      26. Some observations on Digestion (almost an entirely new
            paper).
      27. On a secretion in the  crop of breeding Pigeons for the
            nourishment of their young.
      28. On the  colour of  the Pigmentum  nigrum in different
            animals.
      29. The use  of the oblique Muscles.
      30. A description  of the Nerves which supply the Organ of
            Smelling.
      31. A  description of some branches of  the  fifth pair of
            Nerves.
 1787. 32. Observations tending to show that the Wolf, Jackall, and
            Dog are  all of the  same species—Phil. Trans,  and
            Animal (Economy, 2d Edit.
----  33. An experiment to determine the effect of extirpating one
            ovarium upon the number of young produced.—Phil.
            Trans., and  Animal (Economy, 2d Edit.
----  34. Observations on the Structure and (Economy  of Whales.
            —Phil. Trans.
 1789. 35. Supplement to the paper on the Wolf, Jackal, and Dog.
            —Phil. Trans., and  Animal (Economy, 2d Edit.
----  36. On Introsusception.—Transactions  of  a  Society,  &c,
            vol. i.
----  37. An account of Mr.  Hunter's  method of performing the
            operation for the  cure of Popliteal  Aneurism, by Ever-
            ard Home,  Esq., from materials furnished by  Mr.
            Hunter.—Transactions of a Society, &c, vol. i. and ii. 
132
THE LIFE OF JOHN HUNTER.
>
Journal of a Voyage
   to  New  South
   Wales, by John
   White, Esq.
 1790. 38. A case of Paralysis of the Muscles of Deglutition cured
             by an artificial"mode of conveying food and medicines
             into the  stomach.—Transactions of a Society, &c,
             vol. i.
 ----  39. Some observations  on the loose cartilages found in joints,
             and most commonly met with in that of the knee, by
             Everard  Home, Esq., from materials furnished by Mr.
             Hunter.—Transactions of a Society, &c, vol. i.
 ----  40. General observations on the mode of collecting and send-
             ing home animals, and on the  nomenclature and clas-
             sification of animals.—Journal of a Voyage to New
             South Wales, by  John White,  Esq.
 ----  41. Description of the Kangaroo.
 ----  42.----------------Wha Tapoau
             Roo.
 ----  43.----------------Dingo, or Wild
            Dog of Australia.
 ----  44.----------------■  Tapoa Tafa or
            Tapha.
 ---- 45.----------------Poto  Roo, or
            Kangaroo Rat.
 ---- 46.----------------Hepoona Roo. J
 1791. 47. Observations on  certain  horny  excrescences  of  the
            human body, by Everard Home, F. R. S., from mate-
            rials furnished by Mr. Hunter.—Phil. Trans.
 1792. 48. Observations on Bees.—Phil. Trans.
 1793. 49. Some facts  relative  to the late Mr. J. Hunter's prepara-
            tion for the  Croonian Lectures, by E. Home, Esq.—
            Phil. Trans.                                  ^
 1794. 50. Observations on the  Fossil Bones presented to the Royal
            Society, by the Margrave of Anspach,  by the late Mr.
            J. Hunter.—Phil.  Trans.
 1794. 51. Treatise on the  Blood* Inflammation, and  Gun-shot
            Wounds.
 ----  52. The case of a young Woman who poisoned herself in the
            first month of pregnancy, by Thomas Ogle; to which
            is added an  account  of the  appearances after  death,
            by the late J. Hunter.—Transactions of a Society, &c,
            vol. ii.                                     J
 ----  53. Mr. Hunter's  opinion concerning  the Anatomy  of the
            Camel's Stomach.—Natural History  of  Aleppo, by
            Alexander Russel, Esq., 2d Edit. vol. ii. p. 419.
----  54. Notes on the Anatomy of the Jerboa, by Mr. Hunter —
            Ibid., vol.  ii. p. 419.
 1798. 55. Experiments and observations on  the growth of Bones,
            from the papers of the late Mr. Hunter, by Everard
            Home, b. K. S.—Transactions of a Society, &c, vol. ii. 
APPENDIX.
133
  Some  account of the Editions of Mr.  Hunter's  Works.

TREATISE ON THE  NATURAL  HISTORY  OF  THE HUMAN TEETH.

        Parti. 4to. 1771.
1st Edit,  i part n 4tQ> 1?78
           On the occasion  of the publication of Part II.  a new
         title-page was added to  Part I., and the two (being bound
         together) were sold as the second Edition.
2d Edit.    1778.—The circumstances of this Edition are explained
         above.
3d Edit. 4to.  1803.                  /
           A few unimportant alterations in the disposition of the
         prefatory parts  of the  work are made in this edition.—
         No pains seem, however, to have been taken to rectify any
         of the errors of the former editions.
           The drawings from  which the engravings were made
         having been marked by  Mr. Hunter with the initial capital
         letters A, B, C, &c, instead of by the Roman numerals I.
         II. III., &c, the engraver mistook the I for the J, <fcc, and
         thus  innumerable  errors in the references arose,  which
         rendered the explanations to several  of the plates  abso-
         lutely unintelligible in all  the former editions.
              TREATISE ON  THE  VENEREAL DISEASE.
1st Edit. 1786. 4to.
2d Edit.  1788. 4to.
         The alterations in the Second Edition were mostly verbal.
       Both the First and Second Editions were printed and pub-
       lished at Mr. Hunter's own  residence.
3d Edit.  4to. with Notes by Sir  Everard Home.
         This was printed by some mistake from the First, instead
       of from the  Second Edition, and is therefore chargeable
       with all  those errors which  Mr. Hunter was at so much
       pains to correct.  The Editor has not only added notes at
       the foot of the page,  but has incorporated his  own remarks
       in the body of the text, without the insertion  of any marks
       by which they may be distinguished.  He has also omitted
       whole paragraphs, or parts of paragraphs, in several parts
       of the work, without  any  apparent authority for so doing.
       The work is illustrated by the original plates.
4th Edit. 1810.  1 vol. 8vo.  with  Notes by Dr. Joseph Adams.
         This is a pretty correct reprint from the Second Edition.
       Dr. Adams, however, was  too enthusiastic an admirer of
       Hunter to admit of his seeing  any defects in  the works of
       his favourite  author;  and  consequently his  notes  rarely
       apply  themselves to  the  real difficulties or defects of the
       work, but rather manifest  a  determination  to  uphold  the
       opinions of his friend at all events.  The plates which illus-
       trate this  edition are reduced from the  4to plates, and can-
       not  be commended. 
134
THE LIFE OF JOHN HUNTER.
 5th Edit,  j J®0**' j 4to. with Notes by Sir Everard Home, Bart.

         Being the Second Edition by this Editor, in which, how-
       ever, few deviations from the First are observable.   A sup-
       posititious title-page, purporting to  be the Third  Edition,
       seems to have been added in 1810, in order to increase the
       sale.

      OBSERVATIONS ON CERTAIN PARTS OF THE  ANIMAL 02CONOMY.
 1st Edit. 1786. 4to.
 2d Edit.  1792. 4to.
         Both these Editions were printed and sold at Mr. Hunter's
       own residence.   The  Second Edition contains two addi-
       tional papers, as well as some additional  plates  illustrative
       of the papers contained in the  First  Edition.   The altera-
       tions are exceedingly numerous in every part  of the work,
       and, upon the whole, considerable  additions are made.

   TREATISE ON THE BLOOD, INFLAMMATION, AND GUNSHOT WOUNDS.
 1st Edit.  1794. 4to.
        Was about one third through the press when Mr. Hunter
       died.  It possesses  no  index.  Its punctuation is extremely
       erroneous, the language often obscure, and the printing very
       inaccurate.   These defects must be ascribed to the circum-
       stance of Mr. Hunter's  death, and the neglect which  the
       work afterwards suffered.  A Life, by Sir Everard Home,
       is prefixed.
2d Edit. 1812. 2 vols. Svo.
3d Edit. 1818. 2 vols.'8vo.
4th Edit.  1828. 1 vol. 8vo.
        These are merely reprints of the errors as well as of  the
       other matters contained jn the first 4to Edition.  The plates
       are  reduced  from the 4to plates, and  cannot be  praised as
       specimens of the art of engraving.  None  of these  Editions
       contain any Index, or Life of the author.
Mr. Hunter's Evidence on the Trial of John Donellan, Esq  for
  the wilful Murder, by poison, of Sir Theodosius  Edward Alles-
  ley Bougiitox,  Bart, at the  Assizes at  Warwick, on  Friday,
  March 20, 1781.*                                          *'

           (Taken in Short Hand by J. Gurney, Esq.)
     Mr. John Huxter sworn: Examined by Mr. Newnham.
  Q.  Have you heard the evidence that has been given by these
gentlemen ?—A.  I have been present the whole time?
* See Life, p. 62. 
APPENDIX.
135
  Q. Did  you hear Lady Boughton's evidence ?—A. I heard  the
whole.
  Q. Did  you attend to the symptoms Her Ladyship described, as
appearing  upon Sir Theodosius Boughton, after the  medicine was
given him  ?—A. I did.                                •   ,   .
  Q. Can  any certain inference, upon physical or chirurgical prin-
ciples, be  drawn from those symptoms, or  from the appearances
externally  or internally of the body, to enable you, in your judg-
ment, to decide that the  death  was occasioned by poison 1—A.  I
was in  London then; a gentleman who is in Court waited upon me
with a  copy of the examination of Mr. Powell and  Lady Bough-
ton, and an account of the dissection, and the physical gentlemen's
opinion upon that  dissection.
  Q. I don't wish you to  go into that; I put my question in a gene-
ral way.—J. The "whole appearances upon  the dissection explain
nothing but putrefaction.
  Q. You have been long in the habit of dissecting human subjects.
I presume you have dissected more than any man in Europe'?—A.
I have dissected some thousands during these thirty-three years.
  Q. Are those appearances  you have  heard described such, in
your judgment, as are the result of putrefaction in dead subjects?—
A. Entirely.
  Q Are the symptoms  that appeared  after the  medicine was
given such as necessarily conclude that the  person  had taken  poi-
son ?—A.  Certainly not.
   Q. If an apoplexy had  come on, would not the symptoms have
been nearly or somewhat similar ?—A.  Very much the same.
   Q. Have you ever known or heard of a young subject dying of
an apoplectic or epileptic fit?—A. Certainly; but with regard to the
apoplexy, not so  frequent; young subjects will  perhaps die more
frequently of epilepsies than  old ones;  children are dying every
day from  teething, which  is a species of epilepsy arising  from an
irritation.
   Q. Did you ever, in  your practice, know an instance of laurel-
water  being given to a human subject?—A.  No, never.
   Q. Is any certain analogy  to be drawn from the effects of any
given species of poison upon an animal of the brute creation,  to
that it may have  upon a human subject?—A. As far as my experi-
ence goes,'which is not a very confined one, because I have poisoned
 some thousands of animals, they are very nearly the same ; opium,
 for instance, will  poison a dog similar to a man; arsenic will have
very near the same effect upon a dog as it would have, I take it for
granted, upon a man.  I   know something of ihe effects  of them,
and I believe their operations will be nearly similar.
   Q. Are there not many things which will kill animals almost in-
 stantaneously, that will have no detrimental or noxious effect upon
 a human  subject; spirits, for instance, occur to me ?—A. I apprehend
 a great deal depends  upon the mode of  experiment; no man is  fit
 to make one but those who have made many, and paid considerable
 attention  to all the circumstances that relate to experiments.  It is 
136
THE LIFE OF JOHN HUNTER.
 a common experiment, which  I  believe seldom fails, and is in the
 mouth of everybody, that a little brandy will kill a cat: I have made
 the experiment and have killed several cats, but it is a false experi-
 ment ; in all those cases  where it kills the cat, it kills the cat by get-
 ting into her lungs, not into her stomach; because if you convey the
 same quantity of brandy, or three times as much, into the stomach,
 in such a way as  the lungs shall not be affected, the cat wilf  not
 die.   Now in those experiments that are made by forcing an animal
 to drink, there are two operations going on; one is,  a refusing the
 liquor  by the  animal, its kicking  and working with  its throat to
 refuse it;  the other is, the forcing the liquor upon the animal:  and
 there are  very few operations  of that kind but some of the liquor
 gets into the lungs ; I have known it from experience.
   Q.  If you  had been called  upon to dissect a body suspected to
 have died of poison, should you or not have thought it necessary to
 have pursued your search through the guts ?—A.  Certainly.
   Q. Do you not  apprehend that you would have been more likely
 to receive information from thence than any other part of the frame?—
 A. That is the track of the poison, and I should certainly have fol-
 lowed  that track through.
   Q. You  have  heard  of the froth issuing from Sir Theodosius's
 mouth a minute or two before he died : is that peculiar to a man
 dying  of poison,  or is  it  not very common in  many other com-
 plaints ?—A. • I fancy it is a general effect of people dying in what
 you  may call health,  in an apoplexy, or epilepsy,  in  all sudden
 deaths, where the  person was a moment before that in perfect
 health.
   Q. Have you  ever  had an opportunity of seeing such appear-
 ances upon such subjects?—A. Hundreds of times.
   Q. Should you  consider yourself bound, by such an appearance,
 to impute the death of the subject to poison ?—A. No, certainly not;
 I should rather suspect an apoplexy; and I wish in  this case the
 head had been opened, to remove all doubts.
   Q. If the  head  had been  opened, do you apprehend all doubts
would  have been  removed ?—A. It would have  been  still further
 removed, because although the body was  putrid,  so that one could
 not  tell whether it was  a recent  inflammation, yet  an  apoplexy
 arises from  an extravasation of blood in the brain, which would
have laid  in a coagulum.  I  apprehend, although the body was
putrid, that would have been much more visible than the effect  any
poison  could have had upon the stomach or intestines.
   Q. Then in your judgment, upon the appearances the gentlemen
have described, no inference can be  drawn from thence  that Sir
 Theodosius Boughton died of poison?—A. Certainly not; it does not
 give the least suspicion.


       Mr. John Hunter, cross-examined by Mr.  Howorth.

   Q. Having heard the account to-day that Sir Theodosius Boughton, 
APPENDIX.
137
apparently in perfect health, had swallowed a draught which had
produced the symptoms described, I ask  you whether any reason-
able man can entertain a doubt that that draught, whatever it was,
produced those appearances 1—A. 1 don't know well what answer
to make to that question.
  Q. Having heard the  account given of the health of this young
gentleman on that morning, previous to taking the draught, and the
symptoms that were produced immediately upon taking the draught,
I ask your opinion, as a man of judgment, whether you don't think
that draught was the occasion of his death 1—A. With regard to his
being in  health, that  explains nothing;  we  frequently, and *ndeed
generally, see the healthiest people  die suddenly, therefore I shall
lay little  stress upon that:  as to the circumstances of  the draught,
I own they are suspicious:  every man  is just  as good  a judge as
I am.                                                     .
  Court.—You are to give  your opinion upon the symptoms only,
not upon any other evidence given.
  Mr.  Howorlh.—-Upon the symptoms immediately produced, after
the swallowing of that draught, I ask whether, in your judgment
and opinion, that draught did  not occasion his death?—A.  I can
only say, that it is a circumstance in favour of such an opinion.
   Court.—That the draught was the occasion of his death?—A. No :
because  the symptoms afterwards are those of a man dying, who
was in perfect health; a man dying of epilepsy or apoplexy, the
symptoms would give one those general ideas.
   Court.—It is the general idea you are asked about now, from the
symptoms which appeared  upon Sir Theodosius Boughton  imme-
diately after he took the  draught, followed by his death so very
soon after ;  whether, upon that part of the case, you are of opinion
that the  draught was the occasion of his death 1—A.  If I knew the
draught  was poison I should say, most probably, that the symptoms
 arose  from that; but, when I don't know  that  the  draught  was
poison, when I consider that a number of other things might occa-
 sion his  death, I cannot answer positively to it.
   Court.—You recollect the circumstance that was mentioned of a
violent heaving in the  stomach 1—A. All that is  the  effect  of the
 voluntary action being lost, and nothing going on but the  involun-
 tary-                                .         • •         *u
   Mr. Howorth.—Then you decline giving any opinion upon  the
 subject?—.#. I don't form any opinion  to myself; I cannot form
 an opinion,  because I can conceive if he had taken a  draught  of
 poison, it arose from that:  I can conceive it might arise from other
 causes.
    Q. If you are not at all acquainted with the effects and operations
 of distilled laurel-water, whether the having swallowed a draught
 of that would not have produced the symptoms  described?—^. 1
 should suppose it would ; I can only say this  of the  experiments 1
 have made of laurel-water upon animals, it has not been  near  so
 quick.   I have injected laurel-water directly into the blood of dogs,
                               14 
138
THE LIFE OF JOHN HUNTER.
and they have not died ;  I have thrown laurel-water, with a  pre-
caution, into the stomach, and it never produced so quick an effect
with me, as described  by those gentlemen.
  Q.  But  you  admit that laurel-water would  have  produced
symptoms such as  have  been described ?—A. I can conceive it
might.
  Mr. JVewham.—Would not an apoplexy or an epilepsy, if it had
seized Sir Theodosius Boughton at this time, though he had taken
no physic at all, have  "produced  similar symptoms too ?—A.  Cer-
tainly.
   Q.  Where a father has died of an apoplexy, is not that under-
stood, in some measure, to be  constitutional?—A. There  is no
disease whatever that becomes constitutional but what can be given
to a child.  There  is no disease which is acquired that can be given
to a child ;  but whatever is constitutional in the father, the father
has a power  of giving that to the  children;  by which  means it
becomes what is called hereditary.  There is no such thing as an
hereditary  disease, but there  is  an hereditary  disposition  for a
disease.
  Mr. Howorth.—Do  you call  apoplexy constitutional ?—A.   We
see most diseases are constitutional: the small-pox is constitutional,
though it requires an immediate cause to produce the effects.   The
venereal disease is hereditary.  I conceive apoplexy  as much con-
stitutional as  any disease whatever.
   Q.  Is apoplexy likely to attack a thin young man who had been
in a course of taking cooling medicines before  ?—A.  Not so likely,
surely, as another man;  but I have,  in my account  of dissections,
two young women dying of apoplexies.
   Q.  But in such a habit  of body, particularly attended with the
circumstance  of  having taken  cooling  medicines,  it was   very
unlikely to happen ?—A. I do not know the nature of medicine so well
as to know that it  would hinder an apoplexy taking effect.
   Court.—Give me your opinion in the best  manner  you can, one
way or the other,  whether, upon the whole of the symptoms des-
cribed, the death proceeded from that medicine or any other cause?
—A. I do not mean to equivocate ;  but when I tell  the  sentiments
of my own mind, what I  feel  at the  time, I can give  nothing  deci-
sive.
          Extract from Mr. Justice  Buller's Charge.

  " For the prisoner you have  had one gentleman called, who  is
likewise of the faculty, and a very able  man.  I can  hardly say
what  his opinion is, for  he does not seem to have formed any
opinion at all of the matter.  He, at first, said  he  could not form
an opinion whether the death was, or was not, occasioned  by the
poison, because he could conceive that it might be ascribed to other 
APPENDIX.
139
causes.  I wished very much  to have got a direct  answer from
Mr. Hunter if I could, what, upon  the whole, was now the result
of his attention and application to the subject, and what was his
present opinion ; but he says he can say nothing decisive.   So that,
upon this point, if  you are to  determine  upon the evidence of the
gentlemen  who are skilled in the  faculty only, you  have the very
positive opinion of four or five gentlemen of the faculty that the
deceased did  die  of poison.  On the other side, you have what I
really cannot  myself call more than the doubt of another; for it is
agreed by Mr. Hunter, that the laurel-water would produce  the
symptoms  which are described.  He says, an epilepsy or apoplexy
would produce the same  symptoms;  but, as to an apoplexy, it is
not likely to attack so  young and so thin a man as Sir Theodosius
was ; and, as  to an epilepsy, the other witnesses tell you, they don't
think the*symptoms which have been  spoken of  do show that  Sir
Theodosius had any epilepsy at  the time.
THE END. 
 
LECTURES
PRINCIPLES   OF   SURGERY
BY
JOHN  HUNTER,  F.R.S.
WITH NOTES
            JA~MES F. PALMER,
SENIOR SURGEON TO THE ST. GEORGe's AND ST. JAMF.s's D1SFENSART, FELLOW
    OF THK ROTAL MEDICAL AND CHIRURGICAL 90CIETT OF LONDON,
                    ETC., ETC.
HASWELL, BARRINGTON, AND HASWELL,
         293 MARKET STREET.
               1841. 
 
PREFACE.
   The  following Lectures  are printed from a very full
and  accurate copy, taken in short-hand by Mr.  Henry
Rumsey of Chesham, to wThom I am indebted for the per-
mission to make them  public.   They were delivered  in
the years 1788 and 1787, after which period I have not
found any copy, excepting a very short and imperfect one
in the  Museum of the Royal College of Surgeons, dated
1791, by Mr. James Pearce.  There  are also in the Col-
lege Museum five  other  copies, which are respectively
attributed to Mr. Twigge,  Mr. Hopkinson, Mr. Parkinson,
and Mr. R. Keate; the fifth being only a partial transcript
of a copy by Dr. Joseph Adams, Mr. Hunter's biographer.
Of all these,  Mr. Parkinson's is by far the most full and
accurate, although in these respects it falls very far short
of the accuracy and fullness of  Mr. Rumsey's copy, from
which the ensuing lectures are printed.  Indeed, from the
fullness of the latter, one  might almost  suppose that the
writer  had had access to the Hunterian manuscript; for,
besides being generally more full, it never omits examples
and illustrations in  proof  of opinions, which the former
ones frequently do.  The style also  is  characteristically
Hunterian.
   I am also indebted to Sir. Benjamin Brodie, to Professor
Macartney, and to  Mr.  Frederick Tyrrel, for the  use  of
copies in their possession,  the first of which is ascribed to
Mr. Howison, the second was taken by the Professor him-
self, and the third by Mr. Robert Lees.  The last of these
(bearing date  1785 and 1786) is the most valuable, being
not only the most full, but abounding with interlineations,
which there is every reason to believe were added during 
4
PREFACE.
an attendance upon a second course of the same Lectures.
These last-mentioned  copies,  as well as Mr. Parkinson's,
have been had recourse to whenever occasion required, but
in general, and with very few exceptions, the printing has
been conducted from Mr. Rumsey's.   Occasionally it has
been found necessary to retrench redundancies and repeti-
tions, and to substitute one  word for another having a
synonymous signification.
  The value of these Lectures,  I  suppose,  will not  be
questioned, nor the interest which attaches to them denied.
Besides the  luminous  general views  on Physiology and
Pathology which they contain, they also abound in useful
facts and the  most valuable practical  suggestions.    In
some respects they  may be regarded  as  amplifications
of his published opinions, but in other respects they enter
upon entirely new subjects of the greatest interest to the
Surgeon.
  The notes which accompany these Lectures are not nu-
merous ;  for as many of the subjects treated of will again
come under consideration in the course of the Treatises, it
seemed  more convenient  to  refer any  observations that
might be required, to those parts of the work, in which
the Author  has expressed his  opinions in his own un-
doubted  language.  In the few  observations which the
Editor has deemed it necessary to make, he has sometimes
had  recourse to authorities,  which he  has  not always
thought  it necessary to mention  particularly.  He trusts,
however, that this general acknowledgment will obviate
the suspicion of his wishing to  appropriate unjustly the
labours of other men.

                             JAMES F.  PALMER.
  38 Golden Square, April,  1835. 
CONTENTS.
Chap. I. Introductory Remarks on  the  Study of Physiology, and  on
               Physical and Vital Laws.
      II. Of Life.
     III. Of the Blood.
     IV. General Views of Organization and Action,
      V. Of the Functions of Nutrition and Absorption.
     VI. Of the Brain and Nerves, and of Sleep.
     VII. Of Susceptibility of Impressions ; of Stimuli; of Dispositions
               of the Body  ; of Habit and Custom.
    VIII. Of the Heat of Animals.
     IX. General Principles of Disease.
      X. Of Sympathy.
     XL Of Local and Constitutional Diseases.
     XII. General Principles of Inflammation,  and of Ecchymoses.
    XIII. Of Adhesive Inflammation.
    XIV. Of Suppurative and  Ulcerative Inflammation;  Granulation;
               Skinning; Hectic Fever, and Dissolution.
     XV. Practical  illustrations of  the  preceding  subjects;   Hernia ;
               Ruptured Tendons ; Phlebitis, &c. &c.
    XVI. Of Hydrocele; Diseased Testicle, &c.
   XVII. Of Gunshot Wounds and Injuries of the Head.
  XVIII. Of Diseases of the  Bones and Joints ; Fractures ; Dislocations,
               &c. &c.
    XIX. Of Hemorrhages and Aneurism.
     XX. Of Specific Diseases ; Varicose Veins ; Tumours;   Hydatids,
               &c. &c.
    XXL Of Scrofula; Lumbar Abscess; Scrofula  of the Testicle  and
               Breast, &c.  &c.
   XXII. Of Mortification and  Carbuncle.
  XXIII. Of Poisons ; Itch ;  Cancer; Fungated Ulcers, &c. &c.
1* 
 
                 LECTURES

                          ON THE


PRINCIPLES   OF   SURGERY.
                        CHAPTER   I.


                           INTRODUCTION.


 Introductory remarks.—These lectures to contain the results of Mr. Hunter's own
  observation;—intended to explain the general  principles of the art;—these the
  necessary guides to  practice.—Mr. Hunter's  opinion of operations;—motives
  for lecturing.—To commence with some account of physiology.—Preliminary
  observations on matter;—.its  general properties;—rour  perception of matter: —
  attraction;—repulsion;—properties added  to constitute organized matter.—Of
  animal and vegetable matter;—its origin in, and return to, common matter;—
  but distinguished from it by peculiar properties;—growth;—propagation of
  the species:—existence under two states, the living and the dead;—three
  modes in which it may be considered:  1st,  Living; 3d, Chemically when
  dead; 3d,  In a state of decay, and  return to common  matter.—.-Errors of for-
  mer physiologists, in explaining vital actions  by mechanical or chemical ope-
  rations;—this error  to be corrected.—Consideration of animal matter  in par-
  ticular ;—and especially of the human body;—but information to be drawn
  from other animals and vegetables {^•also from diseases and malformations,

Mr. Hunter  used  generally to  commence by stating that it was
his intention, in these lectures, to  give only the results  of his own
observations and  experience, because the opinions of others might
be found  in their  works.  I do  not mean, said  he, that all I say in
this course  will be entirely new, and  that none  of the opinions and
observations which I shall deliver are to be found in any publica-
tions, for  there are many facts too obvious to have been overlooked
in the most ignorant days of physic.  I intend in this course  to in*
elude some of the most interesting parts of surgery, principally those
subjects on which I have  had opportunities of making many new,
and I hope  useful observations, so as to put our art, in many re-
spects, in a new point of view.   Many of my  ideas, and the ar-
rangement  of my subject,  are  new, and consequently my terms
become in part new, for two ideas cannot be expressed  in the  same
terms.  I am led to suppose my  ideas are just, because they  have 
8             HUNTER'S PRINCIPLES OF SURGERY.
  in some measure stood the  test of time;  and what is the most in-
  contestible proof of their correctness is, that they have been adopted
  by others; and I hope my terms  will be  found expressive  of the
  things meant,  and that  they are so  appears  evident, from their
  having been employed in several late publications  on surgery.
    I do not intend to give my lectures as a regular course, but rather
  to explain what appear to me to be the principles of the  art, so as
  thereby to fit my pupils to act as occasion may require, from com-
  paring and  reasoning  on known  principles.  I shall  suppose you
^ already acquainted with  the structure of the parts of the human
  frame, and must observe, that a knowledge of  the  healthy and
  diseased actions, or, in other  words the  principles of our art, are
  not less necessary  to  be understood than the  principles of  other
  sciences;  unless, indeed,  the surgeon  should wish  to  resemble the
  Chinese philosopher, whose knowledge consisted only in facts.  In
 . that  case  the  science must remain unimproved until fresh facts
  arise.  In  Europe  philosophers  reason from principles, and thus
 "account for facts before they arise.  Too much attention cannot be
 l paid  to facts;  yet too many  facts crowd  the memory without ad-
  vantage, any further than that they lead  us to establish principles.
  By an acquaintance with principles we learn the causes of diseases.
  Without this knowledge  a man cannot be  a  surgeon.   Surgeons
v  have been too much satisfied with considering the effects only; but
  in studying diseases we ought not  only to understand the effect, as
■  inflammation,  suppuration, &c, but also  the .cause of that effect;
  for without this knowledge our practice must be very confined, and
  often applied too late,  as  in many cases it will be necessary to pre-
  vent the effect.   In  the bite of a  mad dog, for instance, the disease
  will be prevented by removing the part; in the venereal disease, in
  the case of chancre, we must not only know  how to cure the chan-
  cre, but also to prevent its effects on the constitution, which is done
  by giving mercury internally.  On the other hand,  it would be often
  proper to increase  the  effect,  which can  only  be  done when  we
  know the  cause.*   In  many cases,  where the  effect  could not be

   * [By the " law of nature" is meant the invariableness or uniform constancy
  of certain results following certain given conditions,  the agents (which for the
  most part are unknown and invisible), being denominated the cause, the resulting
  phenomena the effect, and the conditions under which that effect is produced, the
  law.  Thus, all bodies  fall to the earth, and all bodies also suffer an expansion
  of their particles by the application of  heat.   Here the principles of  gravitation
  and heat  are the  causes, the descent and expansion of the  bodies, the  effects,
  and the rates according to which these effects take place, the laws of Gravitation
  and heat.  Causation is attributed merely in  consequence of the invariableness
  of the phenomena, and not  in consequence of  any knowledge which we possess
  of the intimate relation of causes  and effects.
   It is not in general difficult to deduce the laws of physical  agents, in conse-
  quence of the power which we possess  of simplifying and  varyinc the  condi-
  tions  of our experiments, so as in the first  instance  to separate  all  extraneous
  influences or disturbing causes, and in the second place to verify the results thus
  obtained by every possible combination of opposing circumstances.   Such cer-
  tainty, however, is rarely attainable in regard to organised bodies in consequence 
INTRODUCTION.                         9
prevented, or afterwards either removed, diminished, or increased
with advantage, it will be proper to change it to some other more
in our power to  remove, as, for instance, by converting  the vene-
real into common inflammation.  If the  disease is already formed,
we ought to know the modes of action in the bodtf and in parts, in
their  endeavour  to  relieve  themselves;  the  powers  they have of
restoring themselves, and the means of assisting those powers.   Or,
if these  prove insufficient, we  judge, by all the  attending circum-
stances, how far excision may be necessary, and what condition of
the constitution is most favourable for an  operation.  To determine
on this  last point is exceedingly difficult,  and in some  instances
exceeds our present knowledge.  I lately saw a patient die in a few
hours, of no other  operation than the excision of a small tumour
from the arm ; another, by the  removal of one from the abdomen;
a third,  by  castration;  and  within these two days I assisted at an
operation for fistula in perinaeo, sixteen hours after which the  pa-
tient died. Now  all these patients seemed previously in good health,
and perhaps  the cause of death, and the particular circumstances  .
of the constitution which render operations thus hazardous, will
never be understood.
   This last part  of  surgery, namely, operations, is a reflection on  .
the healing art ; it is a tacit acknowledgment of the insufficiency
of surgery.  It is like an armed savage who attempts to get that
by force which  a civilized man would get by stratagem.   No sur-


of tbe reaction of the parts of which they consist upon one another, and the
consequent impossibility of observing the effects of organic agencies  In their
simple state.  The conditions under which  any given class, of phenomena are
observed are continually varying, and a variety of extraneous  causes are mixed
up in almost every case, so that, from the most careful experiments, it is still
extremely possible to mistake the  conclusion,  and  to deduce laws which are
expressive only of a part of the facts.  These circumstances  afford no just
ground for under-valuing physiological principles, although they are calculated
to inspire a wary caution in arguing  with too much  positiveness from principles
of this kind.  We would say, " Est quodam prodire tenus si non datur ultra."
   It is scarcely necessary to observe that causes differ greatly among themselves.
It would be  absurd to confound the  principle of heat, the  expansion of steam,
and the machinery by which the power thus generated acts, as causes of the same
kind.  The remote and  the proximate cause  in such a case have no immediate
relation, but  are connected together  by a number of intermediate circumstances
 which, like the steps of an argument, unite the conclusion to the premises.  It is
 very necessary to bear this in mind in physiological reasoning, in consequence of
 our almost total ignorance of these intermediate links in the chain of causation.
 In the instance above adduced  by the author, we have no knowledge of  the mode
 in which the poison of a rabid animal, or the poison of syphilis, produce their
effects on the animal body ; nor how mercury and other medicines should tend to
eradicate the latter from the  constitution.  We are unable in  these  cases  to
 advance a step further than to perceive the necessity of absorption of the poison,
after which all is conjecture.   A full perception  of the whole sequence of effects
would doubtless at once discover the precise nature of the remedy, as well as
the proper cases in which it should be administered.
   These few observations have been made in consequence of the indefinite and
 not very philosophical  manner in which Mr. Hunter sometimes employs the
 word cause.  The  final and efficient causes are frequently confounded.] 
10
HUNTER'S PRINCIPLES OF SURGERY.
 geon should approach the victim of his operation without a sacred
 dread and reluctance, and should  be superior  to that popular eclat
 generally attending painful operations, often only because they are
 so, or because they are expensive to the patient.
   Mr. Hunter next mentioned his  motives for lecturing; showing
 that he did not do this with  a view to pecuniary gain, since the
 time thus expended might be employed more profitably in extending
 his connexions and  enlarging his practice.  I have  seen, said he,
 as  much practice, and made a larger collection of diseased prepar-
 ations than perhaps any man in Europe,  all of which I  find to cor-
 respond with the opinions I have formed  of the nature of the re-
 spective diseases.  In the years 1761 and 1762, having been already
 engaged ten years in the  profession, I attended the army, without
 which I should have  been unable to give my  opinion  concerning
 gunshot wounds, which rarely occur in civil practice.   In the year
 1768 I was called upon to be a teacher of anatomy, but I congra-
 tulate myself that I did not become so, as it  could not  have failed
 of engaging my attention  too  much to admit that general attention
 I have  been able to pay to surgery;  and  the necessity I  should
 have been  under  to read might have occupied me too much, and
 prevented  my forming habits or established  modes of  thinking.—
 In the years 1772,  1773, and 1774, I had frequent opportunities of
 giving my opinion in private, and had generally the  satisfaction to
 be heard with candour.   Since I have lectured, I have scarcely
 found a pamphlet without some of my  opinions, and often my very
 language,  as adhesive  and  suppurative inflammation,  &c.  But
 what more than all induced me to lecture, was the great advantage
 every one finds by putting his thoughts into  writing.  A man can
 never tell how much he knows till he arranges his knowledge, and
 then he can tell how defective it is; hence it is that almost all the
 authors of any consideration in physic have been public  teachers.
  In the present lectures it is my intention to begin with the physi-    *
 ology of the animal economy in its natural or healthy  state ; and
 then to  come to pathology, or the physiology of disease,  which
 may be called the perversion of the natural  actions of  the animal
 economy.   Amongst the latter I shall treat  first of accidents the
 most simple or natural, or diseases spontaneously arising; next, of
 the means of restoration, on which I shall be particularly full,—of
these the first is  adhesive inflammation, commonly called healing
 by the first intention;  then of inflammations tending to suppura-
tion, granulation, and cicatrization : after these I shall consider the
specific diseases, as locked jaw, scrofula, &c.: the poisons next,  as
the venereal disease, cancer, &c.
Of Matter;  and first of the Distinction between Animate and In-
                       animate Matter.

  I must now beg the close attention of the gentlemen present, as 
INTRODUCTION.
11
 I shall be a little abstruse in the present lecture, which I  intend as
 an introduction to all animal matter.
   Before we endeavour to give an idea of an animal, it is neces- t
 sary to understand the properties of that matter of which an  ani-
 mal is composed; but the better to understand animal matter, it is
 necessary to understand the properties of common matter;  else
 we shall be often applying our ideas of common matter, which are
 familiar to us, to animal matter, an error hitherto too common, but
 which we should carefully avoid.
   By our senses alone is  matter demonstrable.   If a man did not
 see, he would have no conception  that there was such a thing as
 liaht; if he was deaf,  he could have no idea of sound; if he  had
 no touch, no taste, no smell, in short if he had no sensation at all,
 (which  is easily conceivable), he  would not know that there is
 such a thing existing  as  matter.   On the other hand, it is  from
 matter alone that we come  to a knowledge of our senses ; so that
 the only proof of the existence of either is by their  reciprocal
 effects.
   An animal, then, must  be composed in such a manner as  to be
 susceptible of impression, which impression consists of an  alteration
 in the part impressed ; and matter must make the impression on us
 before we can become sensible of its existence.   Matter is in itself,
 however, only an abstract idea, and it is not the matter itself but
 some  of its  properties which make the impression,  as  sourness,
 heat, &c. When we see a man, it is not the man himself or the
 matter of the man that makes the impression, but the light which
 he reflects, and which our eye has the power of collecting to one
 point, so as  to  give a determinate shape on the  organ of  sight.
 Now the act of seeing is that impression made on our eye which
 gives us an idea of a body exterior to  us,  exactly similar to touch;
 it is an impression made of a given figure.   Every man might be
 able to see simply with every part  of the  body as well as with the
 eye; for if you were  to place before my skin a refracting glass, so
 that the image should be thrown on my body of the same shape as
 that which is exterior, if my feeling was so very delicate as to dis-
 tinguish this shape, it would give me the  same idea as seeing.  A
 drum has no sound  in itself, but it has the power of putting the
t matter of the air into  action, which produces the idea of sound  by
 its impression on the  organ of hearing.  The sense of touch would
 appear most to contradict the above statement; but touch only
 arises  from  the resistance  of matter, which resistance  alters the
 form of the  part touching,  and the alteration causes feeling.   If it
 was the matter itself which caused the sensation, we ought to have
 as many kinds of matter as we have  of sensation ; but our sensa-
 tions  correspond with the  different properties of matter, not with
 the different kinds.
    But to return to my subject: by matter we mean all  that  com-
 poses  this globe of the earth on which we live, and which is pro-
 bably  formed of only a  few substances  differing  in specific pro- 
12           HUNTER'S PRINCIPLES OF SURGERY.
  perties from each other, but which  when compounded  produce a
  very great variety, and of course these  cause a great variety of
  sensations in  us.   Matter, thus compounded, appears to us in one
  of the three following states, a state of solidity, fluidity, or vapour.
    The first, or solidity, appears to be the natural state of matter;
  the other two seem to involve a kind of force, especially vapour.
    The first of the various properties of matter  is attraction: of
  this there  are many kinds, of which I shall first  mention elective
  attraction, which  is a disposition  in all matter to unite with some
  particular kinds of matter  rather than with others, forming with
  them a compound, which at the same time  that it is a compound,
  seems homogeneous.  Elective attraction can only take place when
  bodies are in a fluid state or in vapour; it would  appear to be a
  kind of choice, and it is one of the most refined properties of com-
  mon matter, producing new compounds by a species of generation,
  but annihilating the old by the same action.  This property is given
  to matter for the purpose of forming various  regular solids  and
  fluids of which the world  is composed, and it is this that gives us
  such variety.
    Secondly.   By  a particular attraction,  or by an increase of the
  same attraction, these parts are brought into closer approximation:
- this we call the attraction of cohesion, by means of which attraction
  bodies are kept in one mass.   When bodies are  so subdivided as
  to be reduced to their constituent particles, still each particle has
  its centre of gravity on which it may be said to  move, from whence
  arises fluidity.   So that a fluid would appear to be a body reduced
  to its  original parts; the attraction of cohesion  is destroyed, but
v  each particle  has  its centre of attraction or gravitation.  As the
  centre of the  globe attracts every particle of matter that  is in it,
  so every mass of  matter, simply as matter, has an attraction in its
  centre, by which it can bring bodies to it or keep them in contact
  with it.   If we were to let drop some quicksilver, and it met with
  no resistance, it would  assume a globular form : this is not from
  the  attraction of cohesion, but from the  attraction of gravitation.
  It must be observed, however, that  where  the  attraction of cohe-
  sion is but slight,  as in fluids, this will not take place, unless there
  is some  affinity, as  between  acids and water, spirits of wine and
  water, &c. Water and oil will not unite by this  species  of attrac-
  tion when in a fluid state.
    There are other general properties which arise out of the attrac-
  tion of cohesion, such as figure, magnitude, &c.  These properties
  are  those which make bodies fit  subjects for mechanics, but they
  are  not the only ones necessary.   A clock may be made  correctly,
  but  yet it will not go until we bring in some active power, such as
  gravitation, the raising of water into steam, &c.  Thus we find
  something like  the life of mechanics, which is not matter,  but a
  property belonging to it; what is simply mechanical, that is made
  of inert matter, must have, as it were, a soul to put and continue it
  in motion. 
INTRODUCTION.
13
  When all these properties have their full effect they produce va-
rious other effects, and become the regulators of the whole mass,
confining its motion, space, &c.
  These are some of the properties of common matter.   How far
repulsion is a  universal principle I am not able to  determine;  I
should much suspect that it is not so general as the others.  That
there is such a principle in nature is evident, because neither flui-
dity nor vapour could take  place without it; perhaps heat is the
great repulsive  property,  at  least  it  counteracts attraction  and
produces repulsion amongst the particles of matter when diffused
through it.
  Thus the matter of the globe is in general so regulated, by pro-
perties  stamped  on it  at first, that in its common actions it cannot
err.  But we find that matter has  been carried  much further in
some other properties than in those just mentioned; it has under-
gone changes  not in the least connected with or arising out of them,
and its properties are of course  entirely  different;  seeming, as it
were,  a monstrosity in the combination of matter.   Its mode of
continuance, by preparing within itself matter similar to itself,  is
entirely different.
   These changes produce  the animal and vegetable or organic
portion of the  world.


            Of the Matter of Animals and  Vegetables.

   Animal  and  vegetable  matter has certainly arisen out of the
 matter of the  globe, for we find it returning to it  again.  Both are
 subject to the laws mentioned above as regulating common matter,
 but they  are  so different, from their peculiar modification, as  to
 appear at first like originally distinct species of  matter ; but  they
 will be found, on investigation, to be only a new modification of
 matter.
   This change  in the  original principles  of matter seems to be
 equally distinct  both in animal and vegetable matter, and  the first
 principle of action of those two substances seems  to be in great
 measure the  same ; however, there are marks by which they can
 be distinguished. The  connexion of these two  modifications of
 matter with common matter  has never yet been traced,  nor has
 the gradual transition from one to the other been imagined ; and if
 those substances had not  reverted into common matter  by  their
 decomposition, it never could have been suspected that they were
 originally composed of the same materials.  For these reasons they
 have been ranked by themselves.
    Animal and vegetable substances differ from common matter  in
 having a power superadded, totally different from any other known
 property of matter, out of which arise various new properties.
    Animals and vegetables have a power  of action within them-
 selves, are capable of increasing their own magnitude, and possess
                                2 
14
HUNTER'S PRINCIPLES OF SURGERY.
the power, as it were, of working themselves into form and a highei
state of existence.  This power of action and capability of increase
requires a supply of, materials, as well  for the  increase as for the
waste arising from  action.   This supply appears not to be wholly
the same in both, though perhaps it may be.   The idea of a supply
always  supposes a resource distinct from the thing supplied, and no
waste parts can ever perfectly revert into the  thing itself without
first going through all the changes which first  brought it  into a fit
state.
  This  supply is furnished  by the materials of the globe.  Vege-
tables alone appear to have a power  of immediately converting
common matter into their own kind.   Animals probably  have not
that power, therefore are removed  further from  common matter;
so that  a vegetable  seems an  intermediate step between  common
matter  and  animal matter.  But observation will show that vege-
tables can readily convert  both animal and vegetable matter into
their own substance, as in the case of dung, which increases  the
natural growth of plants.*
  Both have a power in propagating their kinds by a production out
of themselves, by which means the stock is replenished.
   Both are capable of being in two states: one of these is the living
state, which wre have been  considering, the other is the dead state.
   Hence both animals  and vegetables are capable of being  con-
sidered  in  three ways.  1st,  In their  power of continuance  and
production,  when  possessed of their natural powers  of action or
life.  2d, In their nature chemically as matter, which can only be
considered when they are  dead.  3d,  In their decay,  or sponta-
neous  reduction to  common  matter, when life is  gone.f  In all
these operations they are  totally different from  common matter.

  * [It is highly probable that the different proximate elements of vegetable and
animal substances hold different ranks in the scale of organised substances, in
the same manner that one animal ranks higher in the scale of organised beings
than another.  Thus, starch, sugar, and woody fibre among vegetable substances,
and gelatin, albumen, and fibrin  among animal substances, are raised, as it were,
from one to the other by successive processes in the animal or vegetable econo-
my ; so  that fibrin  may be regarded as the substance most hiorhly animalized, or
as possessing the distinctive properties of an animal substance in the highest
possible degree.   In this view, vegetable life, which subsists almost exclusively
on carbonic acid gas, and graminivorous animals, which are able to extract nutri-
ment from vegetable substances, may be regarded as subservient processes,
intended to prepare the common elements of matter as nutriment for the more
perfect animals,—which, however, afterwards  undergoes a series of further pro-
cesses in the bodies of these animals, in order to fit it for all the purposes of the
economy.   Sennebier  and Saussure have satisfactorily shown that decayed
organic remains do not nourish plants by being absorbed  in their  unmodified
state, but by affording a  more abundant supply of carbonic acid gas, which, in
combination with water, forms  the principal  aliment  of vegetables. There is
no process in vegetables corresponding to  digestion in  animals, and hence the
food of plants is spontaneously evolved by the natural processes of fermentation
and putrefaction.]
   | [There are many  other distinctions between organised and inorganised
bodies, which, however, it is unnecessary to consider in this place.] 
INTRODUCTION.
15
The first  distinction, or  life, in which  consists the power of self-
preservation, is the antidote to the two last, since before either of
these can utke place the whole part must be deprived of the living
principle.   When in the first state, their actions are either natural,
the whole being in harmony, and every  part acting in concert with
the rest, which is  called health; or they are unnatural, which con-
stitutes  disease, the tendency of which is to destroy the whole.
   When chemically considered, both animal and vegetable matter
are found to be acted on by different substances, or are capable of
solution in other  bodies, as concentrated  acids, alkalies, &c, in
which respect they are  pretty similar to one  another.   Both  are
capable of being acted on by fire;  but in this process we find each
yielding some substances  peculiar to itself;—animal matter  when
distilled yields water,  volatile alkali, empyreumatic  oil, and cal-
careous earth;—besides these  there is a small proportion of iron,
which does  not appear, however,  to  be a constituent part of the
whole animal body, being chiefly procurable from the blood ; a small
proportion of their substances  may also  be  found in the blood.*
   In their decay, both animals and vegetables  go through a series
of regular spontaneous changes, the succeeding one arising entirely
out of the first, and  the next out of this, until  the  whole return to
common matter from whence they arose, for to the  earth they must
return from whence they came.  In  this natural process we find
animals and vegetables yield  many substances not to be found in
them before these changes, also not to be found in common matter.
This process I call fermentation, and it is peculiar, I  believe, to
vegetable and animal matter.
   The  processes carried on by chemistry and fermentation, which
can only take place when the parts are  dead, have been  intro-
duced by physiologists into the living animal  economy;  and, not
satisfied with this, they have brought in mechanics to account for
many of the operations of vegetables and animals.   But, for the
purpose of distinguishing  more accurately between mechanical,
chemical, and vital operations, and the circumstances under which
the two first are applied to the living body, let us consider them a
little further.
   The  actions and productions of actions, both in  vegetable  and
animal  bodies, have been hitherto  considered  so much under the
prepossessions of chemical  and mechanical philosophy, that phy-
siologists have entirely lost sight  of life;  and perhaps they have

   * [Vegetable substances are nearly all composed of oxygen, hydrogen, and
carbon,—carbon, for the most part, being the preponderating ingredient.  In
some few examples  nitrogen is likewise present.   The proximate principles of
vegetables, or those substances which exist  ready formed in plants, are exceed.
ingly numerous, as gum, starch, sugar, &c, amounting in the whole to not less
than forty-five or fifty substances, characterised by different properties.  Animal
substances, on the contrary, at least all the principal animal substances,  contain
nitrogen  as well as oxygen, hydrogen, and carbon, and the  proximate elements
are not so numerous as those of vegetables. The animal fats, which are consi-
dered by many as a natural store of nutriment, contain no nitrogen, and therefore
approximate to vegetable products.] 
 16            HUNTER'S  PRINCIPLES  OF SURGERY.

 been led to this  mode of reasoning because these  properties are
 much more familiar, more adapted to our understandings, and more
 demonstrable  than  the living properties of  organized beings.   But
 unless we consider  life as the immediate  cause of  all actions oc-
 curring either in  animals or vegetables, we can have no just con-
 ception of either  vegetable or  animal matter.  No wonder,  then,
 that the theories  of the older physiologists are ill  built and ill sup-
 ported,  their principles being false.   Many of the effects both in
 animals and vegetables might at first sight  appear to be chemical,
 or  the  consequence of fermentation.  The production of many
juices of plants, such as gums, acids, sugar, &c, would seem to be
of this kind ; but all arise  from natural  actions of the vegetable, and
do  not belong to  chemistry.  No chemist on earth can make out of
the earth a piece of sugar, but a vegetable  can  do  it.   Digestion,
the formation of the blood, and all the secretions of an animal, might
at first appear to be of this sort; but that they really are not chemi-
cal products I am clearly convinced.   If an ingenious man under-
took  to  account for every change  in matter by fermentation, there
is no change in nature that might not be  brought within his definition.
The living principle itself would be shown to arise from fermenta-
tion ;  brain, muscles, bones would grow from fermentation, since
they  are all formed from  the blood, and yet the blood is not found
in them.-—Of all things on the face of the earth definitions  are the
most cursed; for if you make a definition you may  bring together
under it a thousand things that have not  the least connexion  with
 it.*

  * [By the fermentation here  spoken of is not meant that process of sponta-
neous decomposition, occurring under the conditions of heat and moisture, to
which the appellation  is restricted by modern chemists, but a vague  chemical
disturbance, in the course  of  which a new and undefined  arrangement of the
elements was imagined to take place.
  Mr. Hunter, in  his zeal  for  the vital principle, has probably gone too far in
excluding the agency of chemical causes.  There is not the leasf reason for sup-
posing that the vital principle is able to confer new properties on matter, or to
transmute one matter into another, so as  indiscriminately to employ other sub-
stances thau those which it does for the repair of the body and its various secre-
tions ; on the contrary, there seems every reason for believing that the elementary
particles exert the same affinities  under the influence of vitality that they do in
the  laboratory of the chemist,  and  that if it were possible  to present these to
each other out of the body under precisely the same circumstances that they are
presented in  the body, and in the requisite  states  and proportions, the  same
combinations would take place, and the same  results would be produced.  The
vital principle may not perhaps improperly be  compared to the principles of heat
and electricity, which exert an influence over the  affinities of matter without
essentially altering its nature; but the great distinction between organic and
ordinary chemistry is not less in the nature of the agent than in the minute and
appropriate apparatus by which  that agent  operates.  All the processes of
organic life, referrible to this head, are executed, as it were  anatomically,  by an
arrangement  of parts infinitely small; by which   the affinities of the acting
bodies are brought together in modes which cannot artificially be imitated by the
chemist.  The following observations by the  reviewer of MM. Tiedemann and
Gmelin's Treatise on Digestion apply to the present question :__" Je  suis loin
de nier qu'il y ait dans les actes du corps vivans quelque ohose  de special, 
INTRODUCTION.
17
    What I call fermentation, only takes place in animal and vege-
 table matter when dead.   It is that  change which takes  place in
 the substances themselves out of their own spontaneity, without any
 external assistance.   Chemistry is a kind of force on things to de-
 compose them.   In  the process of fermentation, vegetable matter
 goes through intermediate stages, in  which it  is neither vegetable
 nor common matter; the same with animal matter during putrefac-
 tion.  But  in  all the productions of a living animal  or vegetable,
 the  substances  produced are  animal or vegetable matter.  The
 only substance produced in an animal which cannot be called ani-
 mal  matter is the earthy matter of bones, and of some diseased
 parts :*  it appears also that, in some of the secretions of animals,
 the products produced have none of  the  original properties of ani-
 mal matter, as the sugar of milk, the bitter principle in the  bile,
 these not having been found in  any of the natural solids or fluids
 by any process whatever.   But this does not come up to my notion
 of fermentation, for  no process  of fermentation of animal or ve-
 getable matter ever produced either one or the other ; and even in
 vegetables, where sugar seems to constitute part of the plant, it is
 formed by the action of the vegetable.  If ever any matter is formed
 in  any of the juices secreted in any  part of a vegetable  or animal
 body similar to what  arises from fermentation, we may depend on
 it it arose from  that  process, but we may also depend on it that
 there is a defect of the living principle in those cases.
   The conversion of water into vegetables, which is vegetation, or
 of vegetable and animal matter into animals, which is animalization,
 is not a change  taking  place  according to the nature of the sub-
 stance, but  is  effected by the actions of the vegetable or  animaj.
 The different juices formed  from the  blood, called secretions, differ
 not from  the nature of the blood as animal matter, all giving nearly
 the same substances  when  analysed, or subjected  to  fermentation.
 Nor can  the substances formed in a vegetable be  formed, by any
 process that we  know of,  from water.f   We might  suppose that
 fermentation would produce an animal from a vegetable, because
 in this change " a decomposition of matter and a new combination"
 is effected;  but fermentation never could bring back  dead animal
 or  vegetable matter to living, so that it does not correspond to the

 quelque chose qui reconnait d'autres lois que celles qui regissent les corps bruts ;
 mais ces dernieres interviennent, sans aucun doute, plus qu'on ne le pense gene-
 ralement dans les  functions de nutrition ;  et c'est mieux servir la science  de la
 vie de reconnaitre  cet intervention, et de l'etudier jusqu'a son  extreme limite que
 devoir partout de la vitalite sans attacher a ce mot un veritable sens."]
  * [It is a question with some geologists whether lime  is not essentially an
 animal product.]
  f [The refinements even of modern chemistry have not yet enabled us to form
any animal or vegetable principle  ab  origine from  any combination of the
ultimate elements.   The substance called oxalamide, obtained by  Professor Fara-
day from the oxalate of ammonia, approaches in character to an animal product,
although it is not actually  so. A few other examples of the same sort might be
mentioned.]
                               2* 
18
HUNTER'S PRINCIPLES OF  SURGERY.
above definition which has been given of it.  This  single  circum-
stance throws more light on the power of the stomach than we are
yet aware of, for dead matter subjected to it is not obliged to un-
dergo any change as matter, but goes through  that process which
produces life.*
  In treating of an animal body I shall always  consider its opera-
tions, or  the causes of all its effects, as arising from the principle
of life, and lay it down as a rule that no chemical  or mechanical
property can become the first cause of any of the effects in the ma-
chine.  But as all animals have form and motion, which motion is
directed by that form, these motions become mechanical, so that
every motion may  be truly  called mechanical.   Mechanics  are
therefore introduced into the machine  for  many purposes.   The
living principle, however, in  itself is not in the least  mechanical,
neither  does  it arise from, nor  is it  in the least connected with,
any  mechanical  principle.
  Having thus given a general idea  of these singular combinations
of matter, I shall now confine  myself to animal matter.   But before I
treat of the diseases of the animal body, which is the intention of
these lectures, it will be necessary to give such general ideas of the
subject, and  to  lay down  such  axioms and propositions, as will
enable you to follow  me through all the necessary descriptions of
preternatural actions of the machine. This matter we must consider
in two  points of view:  1st, in  its production; 2dly, in  its  con-
tinuance.  This leads me into a new field, and exhibits  properties
very different from all the other properties  of matter.  It will  be
necessary,.I  say, to have clear and distinct ideas of the difference
between animate and  inanimate matter, in order to know when and
where the animal principle acts, and when other principles are made
use of in an animal body in accomplishing all the different purposes
of life.   The human body is what I mean chiefly to treat of; but 1
shall often find it necessary to illustrate some  of the  propositions
which I shall lay down from  animals of an  inferior order, in whom
the principles may be more distinct and less blended with others, or
where the parts are differently constructed, in order to show from

  * [There are grounds, I think, for believing that the first rudiments of life, or
the revivication of dead animal matter, actually commences in the stomach.—
Digestion, however, is a complicated chemical process, and not  of that simple
kind that might be inferred from Mr. Hunter's  language.  (See Tiedemann and
Gmelin, and Prout.)  The transformation or passage of common matter under
the empire of physical laws to living matter which exists in defiance of those
laws, is a mystery which will perhaps never be completely understood.  So fat
as observation has gone, the steps of this transformation are gradual and compli-
cated; the products of each successive process always advancing from a lower
to a higher degree of animalization.  If therefore  we regard life as a super-
added principle, we cannot but observe that it is communicated to common matter
only in proportion as this  matter is animalized.  In short, certain conditions of
the recipients of life seem necessary before  it can be communicated, and  the
higher the manifestations of life the higher are these conditions.  The manifes-
tation of intellect in proportion to the development of  the brain presents an
example very analogous.] 
ON THE VITAL PRINCIPLE.
19
many varieties of structure, and from many different considerations,
what are the uses of the same parts  in man; or at least to show
that they are not for the uses which have been commonly  assigned
to them; and as  man  is the most  complicated part of  the  whole
animal  creation, it will be proper in the first  place  to point  out
general principles common to all this  species of matter, that  I may
be better understood when 1 come to the more complicated machine,
namely, the human.  Besides having recourse to many of the inferior
orders of animals for the elucidation of some of the phenomena of
the more complicated  orders, we  are also obliged to Disease  for
many of our hints on the animal economy, or for explaining the  ac-
tions of parts, for the wrong action of a part often points out what
the natural action was, and itself  gives an idea of life.   Disease
often corrects our imagination and opinions, and shows us that such
and such parts cannot have the uses commonly attributed to them,
and therefore brings us a step towards the  knowledge of the true
use.  Monstrosities contribute to rectify our opinions in the same if
not in a more intelligible manner.   A monster is either from  a defi-
ciency of parts which cajj^be produced from art (and often is from
necessity, as in operations), or else from a modification  caused by
a wrong arrangement or construction of parts, which will produce
an unnatural action, by which means the natural  action may be
known.
                        CHAPTER II.

                     ON THE VITAL PRINCIPLE.

 Difficulty of conceiving of this principle ;—complex in its effects, but simple in
  it3 essence; not the result of any perceptible arrangement of matter;—may
  result from a peculiar arrangement of the  ultimate particles, giving rise to a
  principle of preservation;—this  the simplest idea of life;—illustrated  by
  magnetism  in iron.—Erroneous comparison of life to mechanical powers.—
  Action not an  essential property of life.—Life without action;—vitality of
  an egg;—experiments;—but action promotes the continuance of life.—Seem-
  ing exceptions to the preservative power of life;—peculiar form of putrefac-
  tion in certain bodies; death of a part of the body previously to general death.

 Animal matter is endowed with a principle called, in common lan-
 guage, life.   This  principle is,  perhaps, conceived  of with more
 difficulty than any other in nature, which arises from its being more
 complex in  its effects than any other;  and it is therefore no wonder
 that it is the least understood.   But although life may appear  very
 compounded in its  effects in a  complicated animal like  man, it is as
 simple in him as in the most simple animal, and  is reducible to one
 simple property in  every animal.*

  * [It is considered by many, and perhaps truly, that we are not yet prepared
for a generalization of so high a kind, or at least that  it would be more conve-
 nient for the analysis of vital phenomena to consider life as made up of several
principles differing in their nature.] 
20
HUNTER'S PRINCIPLES OF SURGERY.
   I have observed that animal matter may be in two states; in one
it is endowed with the living principle, in the  other it is deprived of
it.  From this it appears that the principle called life cannot arise
from  the peculiar modification of matter, because the same modifi-
cation exists where this  principle  is no more.   The matter ab-
stracted from life appears  at all times to be the same, as far as our
senses and experiments carry us.  If life arose out of this  peculiar
modification, it would not be destroyed until the modification was
destroyed, either by spontaneous changes, as  fermentation, or by
some  chemical processes ; and were it destroyed by the last, it
might sometimes be restored again by another process.  Life, then,
appears to be something superadded to this peculiar modification of
matter; or this modification of matter is so arranged that the prin-
ciple  of life arises out of the arrangement, and this peculiar dispo-
sition of parts may be destroyed, and still the modification, from
which it is called animal matter, remain the same.  If the latter be
the true  explanation, this arrangement of  parts,  on  which  life
should depend, would not be that position of parts necessary to the
formation of a  whole part  or organ, for  that is probably a me-
chanical, or  at least  organical, arrangement, but  just a peculiar
arrangement of the most simple particles, giving rise to a principle
of preservation; so that matter so arranged could not undergo any
destructive change till this arrangement were  destroyed, which is
death.  This simple principle  of life can with difficulty be con-
ceived ; but to show that matter may take on new properties without
being altered in itself as to the species of matter, it  may be not im-
proper to illustrate this idea by such  acquirements in other matter.
Perhaps magnetism affords us the best illustration we can give of
this.  Iron appears at all times the same, whether endued with this
property or  not;  magnetism does  not seem to  depend on the for-
mation of any of its parts.   A bar of iron  without magnetism may
be considered like animal  matter without life;  set it upright and it
acquires a new property, of attraction and repulsion, at its different
ends.  Now is this any substance added; or is it a  certain change
which takes place in the arrangement of the particles of iron giving
it this property ?  If we take a piece of glass, it is transparent; we
break it into a thousand pieces and  it becomes white.   Whiteness
is not a new matter added to it, but a property arising from its being
composed of a number of small pieces.
   It was not sufficient that animal matter should be endowed with
this first  principle, the principle of preservation, it  was necessary
that it should have action or motion within itself.   This does not
necessarily arise out of the arrangement for  preservation; on  the
other  hand, the arrangement for preservation, which is life, becomes
the principle of action, not the power of action, for  the  power of
action is one step further.   The power of action must arise from a
particular position of those living parts, for before action can take
place  the matter must be arranged with this view.  This is o-enerally
effected by the union of two or more living parts, so united as to 
ON THE VITAL PRINCIPLE,
21
allow of motion on each other, Which motion the principle of action
is capable of effecting when so disposed.  A number of these sim-
ple  acting parts, united, make a muscular fibre; when a number of
these are put together they form a muscle, which, joined with other
kinds of animal matter, as tendon, ligament, composes what may be
called an organ.  Thus, too,  by the arrangement of the living par-
ticles, the other organs of the body  are formed, their  various dis-
positions and actions depending on the nature of the arrangement,
for  action is not  confined to muscle, the nerves also have action
arising from the arrangement of their living particles.*
  The principle of life has been compared to the spring of a watch,
or the moving powers of other machinery; but its  mode of exis-
tence is entirely different.  In a machine  the  power  is  only the
cause of the  first  action or movement, and thereby becomes the
remote  cause of the second, third, &c.; but  this  is not the case
with an animal;  animal  matter has a principle of  action  in every
part, independent of the others, and whenever the action of one part
(which  is always the effect of the living  principle,) becomes the
cause of an action in  another, it is by stimulating the living prin-
ciple of that other part, the action in the second part being as much
the effect of the living principle of that part  as the action of the first
was of  the living principle in it.   The  living principle, then, is the
immediate cause of action in every part; it is therefore essential to
every part,  and is as much the property of it as gravity is of every
particle of matter composing the whole.  Every individual particle
of  the animal matter, then, is possessed of  life, and  the least ima-
ginable part which we can separate is as much alive as the whole.
   The  first, and  most simple idea  of life, I have observed, is its
being the  principle  of self-preservation, preventing matter from
falling  into dissolution,—for  dissolution immediately  takes place
when matter is deprived  of it; and the  second is its being the prin-
ciple of action.  These  are  two very different properties, though
arising  from  the same principle,  the first being capable of existing
independently of the second; for it may be observed, that it is not
necessary for the preservation of animal matter that there should
be  action in all parts, for many parts of an animal appear  to have

  *  [This opinion concerning the unity of the principle of life has already been
shortly adverted to.  It may perhaps be illustrated by referring to the powers
of common matter, which are not one, but many.  There seems good reason for
considering the different kinds of attraction as modifications of a higher principle,
and the  best reason for believing that magnetism, common electricity, and
galvanism proceed from the same source, or  at least are essentially identical;
the same is  highly probable in regard to the powers of life; in  analysing
physical phenomena, however, it is found far more convenient to consider the
powers above mentioned separately, and it cannot be doubted that physiologists
would derive equal  advantage from pursuing a similar method.  According to
the author's representation, the modifications  of life result simply from differ-
ences in  the organised apparatus, through which it manifests its effects, nearly in
the same way as mechanical force may be made to produce the  most different
effects, according to the kind of machinery which is employed.] 
22
HUNTER'S PRINCIPLES OF SURGERY.
little action, yet  they are as much endued with life as the more
active parts; such, for instance, as tendons, elastic ligaments, &c.
  A fresh egg is a body which, it must be allowed, has  no vital
action;  yet an egg is  as  much alive as an animal, which I shall
endeavour to illustrate by observation and experiment.  I was led
to this opinion in the  year 1757, when I was making drawings of
the  growth of the  chick in the process of incubation.   I then ob-
served, that whenever an egg was hatched, the yolk, which is not
diminished in the term of incubation, remains sweet to the last, and
that part of the albumen which was not employed in the growth of
the  chick was perfectly  sweet some days before  the  hatching,
though both had  been kept at  a temperature of 103° in a hen's nest
for  three weeks.   But if the egg did not  hatch, I observed that  it
became putrid nearly in the  same  time that  other dead animal
matter  does.
  To determine how far eggs  would stand other tests  of the pre-
sence of the living principle, I made the following experiments: I
put  an egg into a freezing mixture about zero, and froze it, and then
allowed it to thaw.   From this process I conceived that the pre-
serving power of the egg must be lost, which proved the  case.  I
then put the egg into a freezing mixture at 15°, and with it a new-
laid one, to make the comparison on that  which I should call alive,
and the difference  in the time of freezing was seven minutes and a
half, the second one taking so much longer to freeze.  2d. I put a
new-laid egg into a cold between 17° and 15°; it took about half an
hour to freeze:  when  thawed I put it into an  atmosphere only at
25°; it  froze in  half the time, which  it should not have done, nor
even in half an hour, if had not been killed by the first experiment,
for  the atmosphere now was not so cold as in the first experiment
by  nine degrees.  These experiments  show that the  egg, when
living, has a power of resisting cold, which, when killed by freezing,
it has not.
  To determine the comparative heat of a living and  dead egg,
and to determine whether a living egg be subject to the same laws
with the more imperfect animals, I made the following experiment.
  I took a fresh  egg, and one which had been frozen, and put them
into a  cold  mixture  at 15°.   The thawed one soon came down
to 32°, began to  swell and congeal: the fresh  one sunk to 29£°, as
happens to living animals, and in twenty-five minutes after the dead
one froze.  Another reason for supposing it dead was, that  before
freezing took  place it rose to 32°, as other  fluids do  which are
brought below their freezing point.
  From these observations and experiments, it must appear that a
fresh egg has a power of resisting heat, cold, and putrefaction; and
similar  results are come to by similar experiments on some of the
more imperfect animals, which we  shall  have occasion to  notice
hereafter.
  It would appear, then, that life is hot action, but it is continued or
supported by it when it takes place.   Action creates a necessity of 
ON THE VITAL PRINCIPLE.
23
support, and furnishes it.   It  is not necessary that action should
continue in all parts ;  in some it is only necessary that the principle
and power of action should be continued, but in others it is necessary
that action should take place even for the preservation of the prin-
ciple of action.  Action  is  necessary  for the various purposes for
which the animal is intended, and if one species of action takes
place, it brings the whole into action, as all the  parts and actions of
an animal body are dependent upon one another.  If the heart acts,
the lungs must fulfil their part; the stomach must digest, the other
parts subservient to this organ must be  put in motion, and the secre-
tory organs, nerves, and voluntary muscles.   The whole is thus set
in motion to produce some ultimate effect, which appears to be the
propagation of the species, for preservation (of the individual) can-
not be called the ultimate effect.
  I have asserted that life  simply is the principle of preservation in
the animal preserving it from  putrefaction; but there is a curious
circumstance  attending life which would appear to be contradic-
tory to itself.  Life is the  preserver of the body from putrefaction,
and when  life is gone putrefaction would  appear soon to begin.
But this is not uniform ; it is sooner  in some cases than in others;
therefore there must be some other cause than  the simple depriva-
tion of life to account for  this  difference  of  time.  In the most
striking instances of  rapid  putrefaction  after  death, it  does  not
appear to arise from  the  process of putrefaction having gone to
some  length before total death took  place, for in those  who die of
putrid fever  the  smell becomes less offensive before  death, and
when life is gone they do not go into putrefaction as soon as might
have been expected, and  not nearly  so fast  as  many who had not
the least tendency this way before death.  The tendency to putre-
faction in those whilst living would appear to be part of the disease,
but does not become putrefaction, and on dying they appear to lose
that tendency, and to become like other bodies.  However, it  is
disputed whether, in putrid fever, there is really any putrid matter
formed.*
   But  there is a process or  an action in life which  predisposes the
body  for many diseases, and  which  becomes the remote cause of
them ; and there is an action in life which disposes the body for a
species of putrefaction (or decomposition) when dead, and very
probably death is the  effect  of this action  in these cases.   In these
cases the body immediately after death becomes emphysematous;
this emphysema, though  it  does  not occur during life, would yet
appear to be an  effect of life, for it depends on disease as the body
is dying.  It is not genuine putrefaction;  for, when the  process  is
ended, the body keeps nearly as long  as if  no such process had
taken  place.   It occurs immediately after death, or perhaps in the
act of dying.  The process  itself seems to continue when the body
  * [The offensive exhalations here alluded to may  probably, in great part,  be
referred to the excretions, which show a great tendency to run into rapid decom-
position.] 
24           HUNTER'S PRINCIPLES OF SURGERY.

is  warm;  after a time  it  stops, and the body remains  stationary,
until it  sets out, as it were, for a second  time to become putrid.
What diseases this is to be classed with I do not know.   To ascer-
tain the causes of it with precision, it would be necessary to know
the persons when alive, the  disease of which they died, and the
time when the putrefaction occurred after death.  I  have myself
seen several very remarkable instances  of its occurrence. The first
was that of a young lady about four months gone with  child,  who
in March or April, about two or three  in the afternoon, was  sud-
denly taken  ill  with a fit, of which she shortly died.   She  was
opened  the next  morning at  seven o'clock, when the  body  was
found swelled with air  extravasated in the cellular membrane; the
mesentery, intestines, liver, and  heart  were loaded  with air, the
blood worked out of the larger vessels mixed with air, and the  body
had become very offensive.
   Another case of the  kind occurred at St. George's Hospital, in a
man who had an encysted tumour in the  upper belly of the  right
rectus muscle, which  contained a fluid: it was opened on Friday,
and on the  Monday  following, in the evening, he became ill, and
died at one o'clock.  He was opened seventeen  hours after death,
and was found emphysematous, just as  in the former case.
   This appears to be similar to what is commonly termed sphacelus,
being a species of mortification occurring before death, or in the
 act of dying.
   That the mode of dying  assists the process of putrefaction is
 evident in common mortification, which will  be noticed when on
 that  subject, and I may  illustrate  it further by relating what took
 place in a case of operation  for aneurism.
   A man  at St. George's Hospital had the operation for popliteal
 aneurism  performed.  The  artery  was  tied just where it passes
 through the tendon of the triceps muscle.  The case went on well
 till the sixth day, when  ulceration took place in some  part of the
 artery which was not united: considerable  bleeding  took  place,
 and  recurred  several times  afterwards, by which so much  blood
 was lost as to become in  the end the cause of death.   Immediately
 after the first bleeding, I  observed the foot and  leg of  the diseased
 side to become cold as high as  the middle of the calf, while it was
 warm about the knee, ham, and upper part of the leg.   The  lower
 part of this leg ever  after remained cold, and did not  in  the least
 change in appearance, from which I conjectured that  it was dead,
 not mortified (for there is a material difference).  I suspected  it was
 dead as in common death.   He became wreaker and weaker every
 day, and  died  about  four  days after.  Before he died, the upper
 parts of the leg,  which  had  gone on with life a little longer, were
 mortified, that is, they  showed evident signs of such a change
 taking place;  a vesication formed, discharging a bloody serum, and
  they became darker,  as if blood was diffused in the  cellular mem-
  brane, and  oedematous, or,  rather, emphysematous.  A very short
  time after death these parts became putrid, while the lower part of 
ON THE VITAL PRINCIPLE.
25
the leg and  foot  remained unaltered as in common death.  Here
was a part which just died for want of circulation,  therefore no
action took place in that part;  but above, where there was action,
a very different change  took  place, producing a tendency to putre-
faction after total  death had taken  place.  The part which died
naturally without any action did not become putrid, while the part
in which that peculiar  action took place  became putrid directly,
though it died later.  I  took off the two feet, to see which of them
would become putrid first;  for some  time it was difficult to perceive
any difference, but about sixteen days after, the foot on  the sound
side began to turn  green, and went on to putrefy much faster than
the other.
  The whole of this part of the case is extremely curious.  First,
that part  of  the  leg  which  retained life  longest became putrid
immediately  after  death, because during  life  it  took on actions
which were productive  of putrefaction.  The foot of the diseased
side, which died early, was not  allowed  time to take on any actions
while living, excepting perhaps  that resulting from the stimulus of
death, and did not  become putrid so soon as the foot on the sound
side, which may be said to have died a natural death, and w7hich
died later.  This I  think may be accounted for by supposing  that
the latter, from surviving some  time  longer, took on some of those
actions which gave the  tendency to putrefaction.   It may be neces-
sary to explain what I mean by the stimulus of death.  Death itself
produces an action in all the  muscular parts when there  is nothing
to prevent it.  If a man's head be cut off,  he becomes stiff;  he  is
not stiff while there is real life: for  there is a difference between
visible life  and real life.   A part may be living though not in action;
but whenever death takes place it excites an  action in every part
that is muscular: they contract, and this is the action of death. To
cease breathing is not the action of death, though certainly it is the
first step towards it, and gives  rise  to  the other.  The   action of
real death is that which takes place in the stiffening of  the body,
and till then it is not  dead  (except when killed in a peculiar man-
ner—killed universally before the stimulus of death can be given,—
and then it remains lax).
  I suppose,  then, that  this foot, which  died first  from the loss of
blood, became stiff; that is, took  an action resulting from the stimulus
of death, all the muscular parts  contracting;—that in the  other foot
the stimulus  of death was in some measure lost,  from the longer
continuance of the  diseased state, and  the consequent action was
less strong.  What would be the consequence of this 1   I take  a
man  in perfect health,  and cut off both his legs;  to one I give  a
stroke of electricity sufficient  to kill the part before it contracts, and
no  contraction takes place; the other I leave to itself and let the
stimulus of death produce contraction:  this latter shall not become
putrid so rapidly as the  former.
3 
26
HUNTER'S PRINCIPLES OF SURGERY.
                        CHAPTER  III.

                           THE BLOOD.

Reasons  for its fluidity;—erroneous views respecting its nature.—Animaliza-
  tion and vivification two distinct steps in the conversion of foreign matter into
  part of a living body.—Blood not merely fluid animal matter;—has also
  become vivified;—arguments for this opinion.—Coagulation of blood;—its
  importance in determining the nature of blood;—varieties in the process.—
  Case proving the life of the blood.—Death of the blood preventing coagula-
  tion.

What I have had hitherto principally in view has been the solid
animal  matter,  its formation,  and its arrangement by which it is
endued with life, composing,  as it were,  the whole visible body.
The fluid part of the compound now remains to be taken notice of.
  Blood is the material out of which the whole body is formed and
out of which it  is supported.*   It is fluid that it may be capable of
moving to the very minutest part of the solid with  ease, and may
with less difficulty be  divided  for the  increase  and repairs  of  the
different parts of the machine; easy of division and  separation, to
form various  secretions, and also  to bring back what was supera-
bundant, and to carry off the  parts which were useless.
   This part of the body has been considered as a passive, inanimate,
moving fluid, found everywhere in the body, deriving motion from
the heart for the various purposes of the whole, then returning to
the heart to be  sent out again.   Those who have formed this idea
of the blood have no adequate notion  of the manner in which it is
capable of performing those great uses above mentioned.  Some,
in  considering  this fluid,  have been in a great measure satisfied
with examining the spontaneous changes which it undergoes out of
the circulation.   This might have led them to draw some natural
conclusions, since all  natural phenomena  are  facts,  and  teach
enough of a thing to enable us  to draw sound conclusions.   Others
have attended to the chemical  analysis, which teaches nothing with
respect to its use in the living body;  for  blood  gives no analysis
excepting that of common animal matter.t  Some inquirers have
laid great stress on its appearance when viewed with a microscope,
as if forms of parts would explain first principles: this they cannot
do  unless in operations that  are mechanical.   This inquiry could
   * [The expression of Bordeu is peculiarly elegant: " Lt sang est de la  chair
 coulante.,,'\
   ■j- [This observations no longer true.  Some important additions to physiology
 have of late years been obtained from chemical  investigation of the blood with
 the present improved means of analysis; and <with further  improvements we
 may expect still  more light to be thrown on the  subject. The subject will be
 more fully considered when the 'Treatise on the Blood,' &c, comes before us.] 
THE BLOOD.
27
be carried no further than to investigate such parts of the blood as
have form and opacity, if there are such, and that which appears
to have both is called  red blood:  in  a great number of animals,
therefore, the knowledge of the operations of the blood in the animal
body rests nearly in the same state that it did some  centuries ago.
The two  last points of investigation, namely, the chemical analysis
of the blood and the form of the blood globules, though very proper
to be made by physiologists, have  hitherto explained  nothing in the
animal economy.
   Before I explain my opinion of the  blood, it may not be improper
first to state some facts from which I draw my conclusions.
   I have endeavoured to show that animal matter differs from
common  matter  in many circumstances ; that this animal matter
has a principle peculiar to itself,  which I call life, and this life is
the second step or  process of  animal  matter.  Animalization is the
first;  vivification the second.    To prove this, I observed that an
animal is increased and supported by  many substances, which pre-
viously had not the properties of animal matter, and of course  not
the principle called animal life;  I observed, too, that it was also
supported by substances which were  of animal  origin, but  which
had not then the living principle;  in other wrords, an  animal can be
supported on dead  vegetable and animal matter.   In  the next place
it  was remarked that these substances, before they can increase or
support the animal, must all be converted into animal matter; and
lastly, that the substances must be so prepared,  or animalized,  as
to become part of the body,  and of  course  to be endued with the
living principle.
   It is now necessary to  trace  these changes in  the food till it
becomes part of our  solids, rand observe as we go along when it
is most probable that life begins.
   Blood is not simply fluid animal matter, it is animal matter parti-
cularly arranged, for it differs in  every respect from fluid animal
matter produced by art.  The first change that takes place with
vegetable matter before it is rendered blood is its conversion into
animal matter.   This change I call  animalization.   With animal
matter it might be supposed that no change wras  necessary to pro-
duce animalization ; but we find the change, whatever it  may be,
the same in both; and  the process in both is probably similar, for
the produce from the digestion of animal matter is as different from
common  animal matter as anything can be: were it  not so, animal
substances rendered  fluid by  chemical operations, as jellies, &c,
would  answer the  same purpose as blood.   But the necessity for a
total and similar change in both is evident, for out of this change
life is to  arise, digestion being the  first step towards vivification.  It
may be supposed that the first step in the digestion of vegetables is
that of animalizing them, and that they go  through the  next of
chylification with animal matter;  but this we cannot allow,  for it
would  be supposing two different actions going  on in the stomach
St the same time, which I should very much doubt. 
   28            HUNTER'S PRINCIPLES OF SURGERY.

     The second process, vivification, must take place  somewhere
   before the blood becomes an active part of the machine.   We shall
   first premise that animalization may take place without vivification,
   —(how far this is the case is not easily determined,)—however, we
   may say  with certainty that vivification cannot be prior to anima-
   lization.  Let us first trace animalization.
     Animalization begins in the  stomach, and in common language
   is called digestion, the immediate produce of which is called chyle.
   In the  change of food into  chyle we do not see why it may not  have
   received the living principle, for the change is such as renders  it
   capable of becoming alive.   But it may be supposed that this process
   is reserved for the lungs, where the chyle is so  much exposed to the
   air : the air may be imagined to act on it like heat on an egg, or
  moisture and warmth  on seeds, giving a power of growth to  their
  particles.   In these cases,  however, it is  not  the principle of life
  which  they give ; they only give life its action.
    Again, blood may be supposed not to  become alive till it be made
  into a solid, when it becomes part of our body, and loses the property
  of blood, and there its  life  is indisputable; but  I am apt to believe
  that the living principle takes place sooner, which I imagine will
  appear in investigating the  properties of the blood,  with the many
  phenomena that attend it in the living body.
    I have already observed that the organization of animal matter
  is not necessary for life,^ only for  its actions ;  therefore fluidity is
  no objection to the blood being alive.   My reasons for supposing
  the blood to be alive in a fluid state are the following:  1st, It may
  be observed that it appears to carry life to every part of the body,
  for whenever the whole or  a part is deprived of fresh blood it very
  soon dies.  This blood, however, must be such as  has  undergone
  some change in the lungs;  for if the blood  did not undergo this
  change it would probably soon die, therefore would not be capable
  of keeping up the living principle in other parts.  This effect arising
  from the want of fresh blood is so evident that it needs no illus-
tration; I may  therefore conclude  that  it is the only  cause  and
| support of life, the nerves having no other  part in it but to produce
  some of the actions,—not life itself, for without  this support the
 nerves  themselves  die,  2dly, We  may observe  that whilst  cir-
 culating, or in useful motion, it is always found in a fluid state.—
 Hence I think I may be  allowed to say, as it  is never found  in a
 solid form in the cavity of the blood-vessels, that it has not the least
 tendency to become solid; that such a state is contrary to its nature.

   * [This has ever been a quxstio vexata with physiologists, and will  Dro-
 SJrFn.Tf'VrM S°a  T-\inStanCe °f thf eS-  which  has be*n already
 adduced,  and of the blood, which  now comes under consideration, were supposed
 by Mr. Hunter to demonstrate the existence of vitality independently of organi-
 zation. Although, however, the fact of the vitality of the blood and of the!w
 should be admitted, it yet remains to be proved that the globules of which thev
 both appear to consist do not present incipient traces of organization • hut the
 question is not one which can be  entered into here.]              «»«««» »«« 
THE BLOOD.
29
This  must arise  from some principle  which  is probably  both in
the blood and the vessel.  The want of disposition to coagulate
whilst moving in  the living vessel  does not arise from the motion,
for in many places where the motion is extremely slow the blood
remains fluid.  We  have instances of this in  the veins of the leg,
where the crural arterv has been tied, in which case the blood
only moves through a few small collateral  branches  below, and
back again by  the larger veins.   Now, a small quantity of blood
being sent into these larger vessels, the motion  in  them must be
next to stagnation;  yet, while there is  any degree of motion, the
irritation of imperfection is not given: there  is consciousness  of its
being an useful part; by which is meant that the  harmony between •
the solids and fluids  is kept up.   It is curious often to see the small ,
quantity of motion which shall keep up this  mutual harmony.  In
cases where  people  have been  days, or even weeks, in trances,
where there is not the least perceptible motion in the blood, it has
retained  its fluidity, because both  solids and fluids retained  their
life, though not their  actions.  The want of disposition to coagulate
in such situations does not arise from  any property in the blood
simply as  animal matter, for simply as animal matter (whose alter-
ations arise  out of its  composition, as fermentation,) it would not
va^ in its effects from circumstances that do not in the least  alter
the nature of the compound.
   Dead animal matter acts on the living body as  any other foreign
or extraneous matter ; therefore, the blood being in perfect harmony  ,
with the living principles  of  the  solids when  both are in perfect
health, is  a presumption that the blood is alive.  However, this
argument is not conclusive, for we find in the blood heterogeneous
parts which do  not destroy this harmony: most probably those
heterogeneous  bodies  are introduced simply as  stimulants  to the
living principle, as extraneous objects are to the sensitive.
   This harmony of the blood with  the solids  is more observable in
some parts than others.   The parts  with which  it is in the greatest "
harmony are the  vessels ; this is evident from its retaining its flui-
dity longer in contact with them  without motion  than in any other
part of the body, though equally inclosed in living parts.
   All the diseases which act on the  solids act on the blood, causing
it to effect those changes which  arise spontaneously from rest out i
of the .body;  so that blood is as capable of diseased actions as the
solids are.  If the blood did not change in the diseased states of the
solids, it would lose the natural harmony I have  been speaking of.
This change is according to  the  state  of the solids, which shows
the intimate connexion between the two; it is not primary diseased
alteration of the fluids, but a consent with  the  diseased disposition
of the solids.*

  * [How far the blood can originate an action within itself, for the purpose, as
it were, of bringing itself into harmony  with the changed condition of the  solids
is a aaestion which I think will generally be answered in the negative.   That
tie blood does harmonize with the solids  is an incontestible fact; but then the
                              3* 
30
HUNTER'S PRINCIPLES OF SURGERY.
   On the other hand, the solids are affected by diseases of the blood :
I even suspect death in the blood can take  place independently of
the solids; but the death  of the solids will soon follow.
   The blood  when at  rest has a disposition to separate into several
parts, viz. coagulable lymph, red particles, and serum; the red part
being retained in the coagulable matter, and the serum squeezed out
in the act of  coagulation.  This  disposition in one of the parts to
coagulate when at rest, from whence the above changes are  pro-
duced, is more or less strong, according to circumstances.
   This property of  the blood deserves particular  attention, as it
throws more  light on its  nature than any point of view in which it
can be considered, it being spontaneous and natural.  It is by this
change that the solids  are formed, and it seems to me so important
that I think  it almost  the only thing  necessary to be considered
more fully; indeed the power of coagulation in the blood throws so
much light on the  nature of  a  disease, so far as the blood is  con-
cerned, that it is almost the only part we have recourse to in the ex-
amination of the blood after bleeding, when we look to see whether
or not the blood is buffy, that is,  whether there has been a disposi-
tion for the red globules to sink faster in such blood; or rather, per-
haps, that from  such  blood  being longer in coagulating, the  red
globules have time to  sink to the bottom, and leave the coagultble
lymph atop free from  red globules, and  this causes the buff' of the
blood.*   It is by  this coagulation  also that we perceive whether
the blood is cupped  or not, that is, whether the coagulum  draws

cause  of this harmony is in the solids themselves, either directly by an impres-
sion communicated to the blood by the vessels, or indirectly from some defect in
the processes of nutrition  and sanguification; some retention or vitiation of the
secretions; some introduction of deleterious  matter, or some fault in some one
or mote of the vital actions.  According to Mr. Hunter's" own definition (p. 28),
action requires organization, and yet  the  great difficulty which he is even now
combating is, how the blood,  an unorganized  fluid, should possess life.  In
short,  there is  the  strictest kind of  reciprocity between the solids and fluids;
not, however, arising as  parallel effects, but as cause and effect; the  solids,
heing  altered, necessarily modify the blood, and  the blood, being-modified, as
certainly reacts upon the solids.  In  this  point of view, to employ the words of
Andral, " On ne trouve plus de sens aux disputes des solidists et des humoristes ;
l'economie ne  parait  plus qu'um  grand  tout, indivisible, dans l'etat de santc
oomme dans l'etat de maladie."]
  * [The buffy coat is undoubtedly mainly due  to the cause which Mr. Hunter
has assigned.  Dr. Davy,  however, has  remarked, and  I think the observation
will be borne out by the experience of every one, that this phenomena is some-
times  exhibited, even in a marked degree, although the coagulation shall have
taken place more rapidly than usual; nay, a bluish and transparent lymph may
often be observed to have separated from the  other parts within thirty seconds
after the blood is drawn, and consequently much sooner than under ordinary
circumstances.   There seems, therefore, reason for believing that the buffy coat
is refernble in some measure  to a greater relative  d fference in the specific gra-
vities of the coagulable lymph and red globules than natural, as well as to the
slowness of the coagulation.  Mr. Hunter partly also accounted for the appear-
ance of buffy blood, by  supposing  that " the blood has an increased disposition
to separate into Us component parts ;" a supposition which I eannot  but think is
borne  out by many facts.] 
THE BLOOD.
31
together and its edges rise; and then we say that the blood is not
only inflammatory, but highly so, showing great strength in the con-
stitution : if, on the other hand, it lies flat in the cup, and makes an
even uniform  surface, we know it  is rather loose  in  its texture
(although it may be still buffy), which shows  that the powers  of the
constitution are weak.
  The red globules abstracted, or the red blood abstracted from
the other parts, need  hardly be considered, as  they hardly explain
anything.
  The serum also explains but very little ; there  may be more or
less of it than common, but in itself it explains very little.
  The power of coagulating in  the blood is greater when  out of
the circulation and exposed to  common  air,  even more than when
extravasated in some cavities of the body, the necessity or  use of
which is evident, for by this it becomes more effectual in stopping
extravasation.  A striking instance  of this  kind  happened in the
crural artery of a boar.   I cut it through and  allowed  it to bleed ;
but before the animal became weak, or at least had the appearance
of weakness, the bleeding became less and less, till at last it stopped.
On examining the artery, it was found to have a quantity of coagu-
lated  blood opposing and surrounding its  cut  end like a mop,
through which the blood could not pass.
  This power of coagulation, especially when exposed, enables the
blood to unite  external wounds  more  readily, and  of  course pre-
serves the living principle better, and keeps the internal parts from
exposure in many wounds which otherwise would become external:
by this means they are united by the first intention.
  In all inflammatory dispositions in the solids,  whether universal
or local, the blood has an increased  disposition to separate into its
component parts, the red globules become less uniformly diffused,
and their attraction to one another becomes stronger, so that the blood
when out of the vessels soon becomes cloudy or muddy, and  dusky
in its colour, and when spread over any surface it appears mottled,
the red blood attracting itself and forming spots of red.   This is so
evident  in many cases that it is hardly necessary to wait till the
whole coagulates to form a judgment  of it.   I think  I can say
when the blood is coming from the vessel, by its  appearance in the
stream, whether it will be sizy or  not.  When  the  blood has not
an inflammatory disposition, the stream  has  a degree of uniformity
and transparency in  its appearance ; but it is  only an  eye  accus-
tomed  to  it that can make this distinction.
   If the  inflammatory-disposition of the  solids  arises  from fever,
this disposition in the blood  is universal.  If there is universal in-
flammatory disposition,  from  some local  irritation,  the  blood
is still  universally affected.  But  if the inflammation is local, and
the constitution is not  affected, the  disposition in the blood  is
not universal: how far there  is local  inflammatory disposition  of
the blood I do not know, but there is reason, however, to  suspect 
32
HUNTER'S PRINCIPLES  OF SURGERY.
it, from the ready union of parts under inflammation.   If the blood
does become inflamed  in passing through  an  inflamed part, we
must suppose  that  it immediately loses  that disposition when  it
meets with parts  in perfect health.*
   These properties, namely, increase  disposition to separate, and
a disposition to become a firmer solid, always  show increased dis-
position for action in the living principle,  and also, most probably,
increased power.   It is one of the signs of strength of the living
powers although the materials for action are weak.
  The use of this change in the blood is  evident,  since it is made
fitter for uniting parts by this means ; and it is from this disposition
that the blood retains its living principle sufficiently long till union
takes place.  Unless the stimulus of necessity for coagulation  is
given by the  solids, the extravasated blood  will not coagulate, it
will  only act as an extraneous body, which often happens where
union is unnecessary, improper, or hurtful, as in cases of contusion
where the blood remains fluid in the cellular membrane.
  This disposition to coagulate when  out of the vessels, or when
retained in them  without motion till  the  consciousness of the use
of motion, and of course of fluidity, is lost, in one of the effects of
the life of the blood.
  I have used the word consciousness because we have no language
existing answerable  to  all my views of the animal economy, and
to coin words would not answer the purpose, because then I  must
have a  dictionary of my own.  I have not  a word for expressing
the cause  of  those  actions which take place in the body, as if  it
was conscious that such and such things were going to  take place.
There are actions in the body which come the nearest to conscious-
ness of the mind  of anything that I can conceive, and therefore I
make use of this word; but it is commonly applied by philosophers
only to the mind.
  Coagulation is  a species of attraction  arising out of this irrita-
tion.t   It may be considered  as  a species of generation, for it  is

  * [That the blood  undergoes peculiar changes, losing its globular character,
its transparency, and the vividness  of its colour, as well  as its motion, in the
vessels of inflamed parts, it is evident from the observations of Levret, Kalten-
brunner, Dollinger, and others, who have microscopically investigated this subject.
These changes  are most likely due to  the influence of the  vessels upon their
contents; but to suppose that the blood itself can be the subject of inflammation,
is to suppose it endowed not only with  life and organization, but with life and
organization of a high degree, for from the best observations which have been
made it does not seem  probable that those animals which are lowest in the
zoological scale  are capable of inflammatory action.  Certainly we can form no
definite idea of inflammation, except as  connected with vascular and organised
parts, although,  from what i3 said further on, Hunter did not carry his Ideas of
the blood to that extent.]
  f [Hunter uses the term irritation in place of the exciting cause.  His meaning,
therefore, seems to be that the consciousness of necessity is  the exciting  cause of
coagulation, or that coagulation arises from the irritation of this  consciousness.
This is an instance of false  logic, or of reasoning from final causes which he 
THE BLOOD.
33
the first action or establishment of a power of action within itself,
so as to form  itself into  muscular  fibres, the  only powers  in  an
animal; these, again, with other parts, form  organs to act on the
materials from which they arose, for their own support.
  I will relate a case in  proof of most of the  arguments which
I have employed respecting  the  life of  the blood.  It is one of
many.
  A man came to St. George's Hospital who had a hydrocele, for
which he was tapped with a lancet.  The water was clear serum:
when this was evacuated, the testicle to the feel was found to be
larger  than  natural.  About a month  after, the  tunica vaginalis
became as full  as before ; the radical cure was now determined on,
the tunica  vaginalis was slit up its whole length, and the  fluid,
which was now bloody, was  evacuated.   The  testicle, on  being
exposed, was found larger than natural,  and was  extracted.  On
the body of the testicle, and nearly in the direction of its long axis,
and opposite to the orifice in the sac made by the lancet when the
water was first evacuated, lay a coagulum of blood, dark in colour,
almost like a leech when that animal is shortened, about two inches
long, and of the thickness of  a common sized little finger.  In the
angles  between the epididymis and body of the testicle lay another
coagulum, adhering in some places to the epididymis, in other parts
loose to the body: it was  attached only at one end.   The adhesions
of the large coagulum to the body of the testicle were firm, although it
would  admit of separation.   This was made at one end, when fibres
were plainly seen running from the testicle to the coagulum.   The ad-
hesion of the small coagulum was in many parts still firmer.  All over
the tunica vaginalis there were a  great many vessels full of  blood,
and in many parts coagula of blood-like extravasation.   In this state
I had a drawing made  of it,  and a small part magnified,  to  show
the vessels and the dots  of extravasation as  they then appeared.
By being put into water all  these  vessels and  dots disappeared,
and the parts  became  white.   I then  injected the  testicle by the
spermatic  artery, which  succeeded  extremely  well.   On ex-
amining the part I observed the following appearances.  The sur-
face of the testicle and  tunica vaginalis had resumed the former
appearance, only  with  this  difference,  that  the  injection was
of a lighter  red than  the blood  to  the naked eye,  and  much
more  so to a  small magnifier.  The  vessels on the surface were
very distinct, and  the  dots, where the  extravasation  of  injection
was as if there had been  extravasation of blood.   The coagulum
on the tunica vaginalis  now  appeared vascular;  the surface of the
adhesion, for about one twentieth of an inch, was injected and ex-
tremely full of distinct vessels.  The smaller coagulum was injected

not unfrequently displayed:  he has described the objects to be attained  by
coagulation, and he here states that the necessity of affecting these objects is the
cause of the coagulation, which is much the same as to say it is so, because it is
so.  It is evidf nt that this does not in the least help us to discover the proximate
causes of ooagulation.] 
34
HUNTER'S PRINCIPLES OF SURGERY.
in many places through and  through its  whole  substance, in the
other only for a little way.
  If it should be asked, How came those coagula there 1 The answer
is the blood from the wound  made by  the  lancet in  the tunica
vaginalis passed into the cavity, and then coagulated on the testicle
directly opposite to the wound, and a  small quantity of the blood
which got down  to the  chink between the testis and epididymis
coagulated  there  also.   That  this is  the most  probable  way  of
accounting  for it  is, I think,  strengthened by  another case, where
the tunica vaginalis was  found adhering to the testicle, when  per-
forming the radical cure,  at the very part where he had before been
tapped.  In half a year probably this coagulum would have become
wholly vascular,  and  probably in a little longer time the whole
would have been taken away; because, being vascular,  it would
have  had absorbents, which  would  have taken  it all, as  a useless
part,  into the constitution.
  The tunica vaginalis filling again so rapidly in this case was per-
haps  the reason why it did not adhere to the coagulum on the other
side,  so as to produce a union between the two parts.
  Quaere, For what purpose did this coagulum become vascular 1*
for no visible purpose could be answered by  it,  as  absorption, we
may  suppose, might have taken place as easily in a coagulum as in
the cellular  membrane.   But  perhaps  absorption not going on
here  was the  cause  of  the collection of water;  and  adhesive
inflammation  evidently took place here  that it might be able to
absorb itself.
   Thus, then, the materials of which  the blood  is composed are
joined with the living principle: in consequence of which the blood,
if properly disposed, is capable, when extravasated, of forming itself
spontaneously into parts  fit for motion, and for  performing all the
offices of any part of the living whole, successively receiving the
stimulus of nature from the surrounding parts to form  itself into a
similar part, as bone, cartilage, &c.
   In many diseases not inflammatory,  namely, those called putrid,
where the solids have a tendency to fall into those changes natural
to animal matter  deprived of its preserving principle, the blood has
no  disposition to coagulate,  nor the  solids  any power of raising

  * [The opinion that coagulated blood can become vascular, and so afford the
common basis of union by the first intention, was firmly entertained by Mr.
Hunter; but the proofs which are here adduced in favour of such an  opinion are
by no means so conclusive as they should be to establish so important a doctrine.
For, not to mention the length of time which elapsed,  in the present cases,
between the injuries received and  the appearances observed, the situation and
definite form of the coagula would  rather favour the idea that they proceeded
from effused lymph, which became more or le3S intermixed with effused blood.
Such  an intermixture is generally  observed in cases of wounds and  operations,
but I  am not aware  of any unequivocal  example of pure coagula which have
been observed to become vascular, although it is scarcely possible that this should
have  escaped observation if it were at all frequent.  See Plates I.  and  II. for
the appearance alluded to in the text.] 
THE BLOOD.
35
inflammation, both having taken on the same disposition.  In such a
disease both the principle and power are diminished, so that life is
hardly able to preserve the matter  from  falling  into its  natural
changes, though it has still a disposition  to keep the vital parts  or
body moving.
  Many kinds of death as well as putrid diseases produce this effect
on the blood: an instance of which was  met with in a gentleman,
who being in perfect health, died instantaneously from passion, this
having been so violent as to produce death in every part at once,
and his blood did not coagulate.
  A healthy woman was taken in labour of her fourth child.   As
the child was coming into the world the woman died almost instantly.
On opening the body next day, there appeared no  cause for death
whatever, every part being natural and sound ;  but the blood was
in a fluid state, nor did it coagulate on  being exposed.
  A soldier, a healthy young man, confined for desertion, received
a blow on the pit of his  stomach from one of his comrades, from
which he dropped down, and died almost instantly.  On opening
the body, no preternatural appearance  was observed, but the blood
was in a perfectly fluid state, and did not coagulate when taken out
of the vessels and exposed a considerable time.
   In animals struck dead by lightning the blood does not coagulate
nor the muscles contract, both  being  killed at once.
   There are other instances.   Two deer were hunted to death, in
which case they acted until the very power of action ceased, and
of course  death ensued.  On  opening them the blood was fluid,
only a little thickened, and the muscles were not rigid, as we find
them, where they are  capable of acting, from the stimulus of death.
In both cases the life of the solids and  of the blood was  destroyed
at the same time and at once.*
   The observation that animals hunted to death are tenderer  than
those killed by other means, is not uncommon.
   There is a natural  action of the living body which destroys the
life of the blood in the act  of extravasation;  this is the  discharge
of the menses in women.  If that discharge is natural and healthy,
the blood  does not coagulate; but, on the  other hand, if the extra-
vasation is  not a  healthy one, the  blood  coagulates as  it is
extravasated, and comes away in clots.   This perhaps is best de-
monstrated in cases  where the  hymen is unperforated  and the
menses are accumulated.  This observation leads us to  understand

  * [The diversity of circumstances under which the blood remains fluid after
death at present renders any generalization  upon the subject impossible.  This
is so much the case that many able physiologists of the present day are disposed
to ascribe the incoagulability of the blood  to a cause the very reverse of that
assigned by Hunter, viz. to a greater residual vitality in the blood and vessels
than in ordinary death, by virtue of which the fluidity of the blood is preserved
until the disposition to coagulation is lost.  But this explanation, like the former,
explains only half of the  cases.  See Notes  to the Treatise on the Blood  and
Inflammation.] 
36
HUNTER'S PRINCIPLES OF SURGERY.
 something of the nature of the menses; for, depend on it, where a
 woman has her menses come away in clots, it is not a natural but
 a diseased  discharge.
   To prove that the blood and the  solids correspond very much in
s their actions of death, we  shall only generally observe, that when an
 animal dies in the common way, it is by the vital actions being first
 destroyed; but life still exists,  for the muscles contract and the
 blood coagulates.   But if we destroy life  instantaneously, or along
 with the vital actions, then the muscles will not act, and the blood
 will remain fluid.*
   These changes  in the blood, which appear spontaneous, are not
 really so ;  they arise  from irritation in  the blood itself as much as
 any actions in the solids.   This irritation excites the natural action
 of the blood, which produces these  effects and all the properties we
 see the blood possesses in either a healthy or diseased state.
   We cannot suppose the blood  has a power of communicating
 sensations, as it cannot have nerves; its  living powers  are there-
 fore those of simple life, and it is similar in that respect to the
 solids of many animals.
   As sensation is a principle superadded, and intended  to convey
 fixed intelligence,  it is necessary for a moving part to have it; but
 when it becomes a fixed and solid part it  opens a  communication
 with the mind.
   Thus far I have endeavored  to show that the blood  is as much
 endued  with life as the solids are ;  and the only difference between
 the two is  that  the solids have construction, called organization,
 producing  considerable visible effects, while the blood, not having
 this construction, does not produce these visible effects.  The truth
 of this theory will appear more  evident in treating of the diseases
 of the animal body.t

   * [In Bichat's language, the animal life  dies first, and after that the organic
 life.  The muscles stiffen by organic contractility.]
   f [The reader will form a better idea of the greater copiousness of the present
 copy of Lectures as compared  with Mr. Parkinson's " Reminiscences," when he
 is informed that the whole of the  preceding pages are comprised in less than
 seven pages of the latter.  The consideration of the blood is less fully entered
 into here than in the Treatise on the Blood and Inflammation; but the reader
 will not fail to observe that Mr. Hunter often speaks with less reserve on many
 points in the former  than in the latter;  although in  judging of his opinions,
 those contained in the Treatise  on the Blood should undoubtedly be  preferred, as
 being the result of his last and most deliberative judgment.] 
ORGANIZATION AND ACTION.
37
                       CHAPTER IV.

                   ORGANIZATION  AND ACTION.

General views of organization and action—Arrangement of matter into certain
  forms to answer the end required ;—these structures combine to form organs ;
  __organs arranged according to certain laws constitute animals.—Organization
  and life distinct from each other.—Action exists in every part of an animal;—
  depends on contractility.—Of two  kinds ;—common—and peculiar.—These
  are mutually dependant;—of  the first kind, all involuntary ;—of the second,
  nearly all so;—cessation of the latter in disease;—Mr. Hunter's own case.—
  Of the second, digestion, circulation, and respiration  are most closely con-
  nected with the first;—others, as motion of the limbs, more distantly.—Mo-
  tion may be caused by elastic forces reacting, as in ligaments.—Conclusion.

From what I  have  said above, it  must appear that original or
common matter has  been  first  so decomposed, and then again so
combined,  as to become animal matter.  This  animal matter next
became so arranged as to  become alive.  Now I shall observe that
these combinations and arrangements are differently modified, so
as to produce the various kinds of animal substances; some of which
have their parts so disposed as to have motion  among themselves,
as muscles; others to have sensation, as brain and nerves ;  and in
others the living parts are so disposed as to acquire other proper-
ties, as elasticity, rigidity,  &c.
   Solidity, in  a  certain degree,  is necessary for  self-motion; for
parts cannot  produce motion in one another without some resist-
ance or fixed  point of motion.  We therefore find the acting parts
of an animal composed of solids, or the parts which compose them
could not coalesce together by the attraction of cohesion ; and it is
necessary that it should be so, as without this no determined  action
could be produced.
   Now we have gone so far with the  materials of an animal, let us
next examine  how these materials are disposed so as to form an
animal.   These materials  may now be considered in a mechanical
point of view, like the component parts of a machine, each of which
has its destined use and own peculiarity of form.   These are united
with each  other to form parts, the whole forming organs of various
kinds  to produce the mechanical effects required.  These organs,
again, united  according to certain established  rules, form animals.
This compounding of animal matter is what should be understood
by organization.
   Now if this idea of organization is just, organization and  life are
two different  things; for,  according to this definition,  a dead body
is as much organized as a living one, for in the dead body the same
mechanism exists as in the living one.
   Organization, then, comes nearest our  ideas of the  mechanical
                                4 
38
HUNTER'S PRINCIPLES OF SURGERY.
 formation of parts, and the ultimate effect must be mechanical; for
 it is impossible to produce motion  in matter without having a me-
 chanical effect.
   Having considered simple life, and the general idea of what is
 called organization, we shall next consider the Actions of an Animal.
   We have said that animal matter is so constructed as to be endued
 with a power of self-motion, as in a muscle; and as we can hardly
 conceive any part of an animal  entirely passive or free from mo-
 tion, since all parts grow and are nourished", we must  suppose this
 muscular structure very universal  in  an animal body, though this
 power has been considered principally in  regard  to muscles,  pro-
 perly so called, whose actions are plainly visible to the eye.*
   The  different necessary circumstances attending the  composition
 of a muscular fibre, with the mode of action of a muscle, we  shall
 not touch upon, the  field being too large for my present purpose.
 I shall only observe that they are  the animal powers  by  the im-
 mediate actions of which every, the smallest, part of an animal is
 moved.f
  Every machine has  its power;  a clock has either a spring or
 weight, and so on.  In  mechanics  the parts are dependant on one
 another, so that some one power is  necessary to  put the whole in
 motion; in mechanics too there is commonly but one ultimate effect
 produced, whereas in an animal body there are a thousand.   The
 powers therefore of an animal body are  differently placed and cir-
 cumstanced from what they are in an inanimate machine :  it is not
 one power that is setting the whole  to work, because if that were
 the case an animal's actions would always be the same, but he is
 at rest in one part, moving in another, and so on; and as this is the
 case, he must have power in every part, so that  his  powers are
 diffused through the whole animal, which is  almost composed of
 powers.
  The  actions of an animal, considered as a whole, should be di-
 vided into two kinds.   1st, Those actions common to every  part
 alike, such as those which are employed in the internal operations
 of the machine, as growth, alteration, building up, taking down,
 &c, every individual  part  (the  smallest conceivable J) acting for

  *  [The author has elsewhere (see Introd. to Inflam.) defined life to be that
 power which renders the body " susceptible of impressions which excite action;"
 a definition which, however brief, exhibits in miniature the leadiug features of
Bichat's celebrated hypothesis, according to which all the actions and pheno-
mena of life are ultimately referred to two primary principles—namely, sensi-
bility and contractility.]
  t  [The reader is referred to Mr. Hunter's Croonian Lectures  on Muscular
Motion, in the fourth volume, where will  be found a more full account of this
subject.]
  X  [It seems  now to be generally admitted by microscopical observers that
 even the globules of the blood possess an inherent power  of motion, in  their
quality of organized parts.  Wolff, Dollinger, Treviranus,  Kaltenbrunner, &c.
have  noticed a variety of movements of this kind, which are principally of a
rotary or volvular kind.  See Revue Med. vol. ix.  1828, and Journ. des Prog.
des Sciences Med. vol.  viii. 1828, and also the Treatise on the Blood and Inflam- 
ORGANIZATION AND ACTION.
39
itself  only, which actions may be  called immediate.  These  are
probably performed by the ends of vessels, whether the termina-
tions of arteries or  the beginning of absorbents ; likewise the ac-
tions of the brain are of this kind.  2d, Those actions which are
of whole parts, and which vary according to their  composition or
construction, being  employed  chiefly respecting other matter, not
for the immediate use of themselves, as in those above mentioned,
but still  absolutely  necessary for the first.  These  actions are of
whole parts, as the stomach, heart, organs of respiration, organs of
sensation, mind and will.  That these  actions  differ from the first
is evident, because  the organs in which  they are found have also
the first, and are indebted  to the first for their existence, in the
same way that the first are indebted  to  the second for their con-
tinuance : the stomach, lungs, heart, and other organs of life, may be
said to be  continually supplying materials with which the first are
employed in building and repairing the system.  The second kind
may be called  labourers, being subservient to the first, which, as
being engaged in laying down and taking up parts, may be called
the bricklayers.  It is the first which compose the movements of
the true animal, being  those which  are immediately employed
about itself.  It is the operations of these which properly constitute
the animal economy respecting itself, and it will be principally
these which I shall consider.
   The whole of the first kind of actions are involuntary, the will
having no power over them, the mind being not even conscious of
them, although it  has  involuntarily considerable  influence  over
them under circumstances of diseased and irregular action.   Most
of the  actions of the  second kind are subservient to the first, and
are  absolutely necessary to  the  continuation  of  their existence.
These have therefore a certain degree of regularity, and according
to the  relationship or immediate  necessity of the second to  the
first are these second  permanent and  constant: indeed  we seldom
find in them any intermission, perhaps never in health; however,
in disease they are sometimes stopped.  There have been instances
where the motion of the heart has ceased, and also the involuntary
action of breathing :—this once happened to myself.
   I had the gout in my feet three springs successively, and missed
it the fourth.  In the fifth  spring, one day at ten o'clock  in the
forenoon, I was attacked suddenly with a pain nearly about the
pylorus: it was a pain peculiar to those  parts, and became so vio-
lent that I tried every position to relieve myself, but could get no
ease.   I then  took a tea-spoonful  of tincture  of rhubarb,  with
thirty drops  of  laudanum,  but  still  found no  relief.  As  I was
walking about the room,  I cast my eyes on  a looking-glass, and

mation, where this subject is further considered. Tiedemann calls the blood-
globules "the elementary organic forms;" and several of the French physiolo-
gists have thought that they might not improperly be classed with  the infusorial
animalculae.] 
 40           HUNTER'S PRINCIPLES OF  SURGERY.

 observed my countenance pale, my lips white, and I had the ap-
 pearance of a dead man looking at himself.  This alarmed me.  I
 could  feel no pulse  in either arm.   The pain still continuing, I
 began to  think  it very serious.   I  found  myself  at  times not
 breathing ; and being afraid of death soon taking place if I did not
 breathe,  I produced  a voluntary action of breathing, working my
 lungs by the power of my will.  I continued  in this state three
 quarters  of an hour,  when the pain  lessened, the  pulse  was felt,
 and involuntary breathing began to take place.   During  this state
 I took madeira,  brandy,  ginger,  and  other  warm  things ;  but I
 believe nothing  did  any  good, as the return of health  was  very
gradual.   About two o'clock I was able to go about my business.
  Here,  then, was a  suspension of the  most  material involuntary
 actions, so much so that the involuntary action of breathing stopped,
while sensation and all the voluntary actions  were as strong as be-
 fore.
  Quere, What  would have been  the consequence if  I had not
 breathed 1   At the time, it struck me  that  I should have died ; but
 that most probably would not have been the consequence, because,
 most  probably, breathing  is only necessary for the  blood when it
is circulating ; but as there was no circulation going on, so no good
 could have arisen from breathing.*
  The stomach appears  to  have been the seat of this  affection.
 Affections  of the stomach appear to have more influence on every
 part of the body than any other one part has on another; and this
 sympathy is reciprocal, for every part has a power of affecting the
 stomach, which  shall be more fully treated of hereafter.
  Of the second kind of actions, those which may be considered
 as having the nearest relationship to the first, are  digestion, cir-
 culation, and respiration;  these  are  all secondary actions of the
 machine.   Those which  are not so  closely connected with the
first, but respect more the actions of other  parts of  the same body,
 or what  may be called remote parts of the  animal  economy, are
the actions of  muscles  in  moving  the  limbs, sensations,  and
 voluntary  actions employed on  external  objects,  as progressive
 motion, modes of catching food, &c.   We may just observe, that in
 a muscle itself which has the power of moving other parts, we find
 the two kinds of actions; first, growth and support as in every other
 part: and secondly, the action peculiar to the muscle itself.  The first
 kind of actions'arise immediately from the  living principal, and have

  * [It is  probable that the circulation, although enfeebled, still continued to be
carried  on in  this case as in Lipothymia, occurring from severe and sudden
 injuries to vital parts.  It would be contrary to every  fact with which we are
 acquainted to suppose that the animal and organic functions could  be executed
or  maintained in an active state  without a due supply of fresh blood.  The
respiration is almost if not altogether suspended during the state of hybernation;
 but then the animal functions, and as far as we know the organic functions also,
 are suspended. The same thing likewise occurs in  those states which have
 been denominated trances and in cases of Asphyxia.] 
ORGANIZATION AND ACTION.
41
always been ranked as involuntary actions; the second are either
involuntary,  as the actions of whole organs,—the stomach,  the
heart, &c,—or are voluntary and dependent on the will, as com-
mon  muscles, &c.: but these last I shall leave till I have spoken of
the brain and nerves.
   Besides this  action  in  parts, which I  have said is  confined to
muscles, there is another mode of action introduced, that of parts
having the living principle which yet  have  not a power of self-
action like muscles; these are the elastic ligaments.
   The elasticity of these parts does not depend on  life, for it exists
equally in dead as in live parts.  Ligaments are employed to assist
muscles in keeping certain parts in their places, the position of which
is long  continued.  They may be considered as  producing a se-
condary action in the machine.  These are more common in some
parts in  some animals  than in others;  such as the neck of quad-
rupeds, especially those with long necks, as the camel; and on the
abdomen of some animals, as the elephant: this power is also intro-
duced in the vascular system.
   There are other parts' introduced into the machine which possess
no action that can affect any other part, but have a land of passive
use in the machine.   These vary  in their consistence according to
the  uses made  of them,  some being  extremely  firm,  as  bones,
tendons, &c, which sustain the actions  of different parts of the
animal, and  without which it  could  not subsist;  others are less
firm, and are employed in uniting the various parts as cellular mem-
brane.
   From all that has been advanced, we see that by the juxtaposi-
tion or union of living parts organs are formed, which gives us the
first mode of action, and  the form of bodies gives the secondary
mode.  By the union of  these various parts  compound  motion is
produced.   In this manner the  whole  of the  most complicated
animal  machine is produced.  The  power of  self-action  which
animal and vegetable matter possesses, distinguishes it from matter
endued with  any other properties than  life, and  also distinguishes
living from dead matter.*

  * [Muscular  contractility, which  bears  not  the slightest analogy  to  any
other power of matter, was  yet  frequently confounded at the time of Hunter
with the principle of elasticity.  Hunter was the first to show that  this was
never the source of actual power, like muscles,  but depended on a reaction in
bodies in a contrary direction to  the original impressing force, and always in
proportion to it.
  It is still, however, very difficult  to refer to  their true causes many of the
phenomena presented by skin, membranes, fibrous coats, &c. which obviously
contract and relax in various degrees under different conditions of the system.
Most frequently these phenomena are to  be  accounted for on the principle of
tonicity, a power analogous to muscular contraction.  Some, however, have been
disposed to assign elasticity as the sole cause.  (See Bostock's Phy., Vol. I.
ch. iii. and Majendie's Lect. 8—10, apud Lancet, Vol. I. 1834—5.)]
4* 
42
HUNTER'S PRINCIPLES OF SURGERY.
                        CHAPTER V.

            FUNCTIONS Or  NUTRITION AND ABSORPTION.

The Stomach ;—peculiar and essential to animals;—intimately connected with
  other vital organs;—less with parts not vital;—sympathy with internal parts
  greater;—compared with the sympathy of the brain with external parts;-—
  greater with ligaments and tendons than with muscles.—Sympathy of the
  stomach with the mind.
Vascular System;—its actions  necessary to be understood.—Arteries:—secre-
  tion.—Veins;—formerly supposed absorbents.—Absorbents.—Relative offices
  of the three systems of vessels.—Various kinds  of absorption;—modelling
  absorption, as during  the growth of bones;—absorption of entire parts.—
  Supposed solvent.—Mouths of absorbents.—Alterations of matter absorbed.—
  Table of absorption.

Of the Stomach.—Every animal body, however compounded, must
have the means of support, especially as it is by gradual increase
to complete its own magnitude.  To this end the living parts fitted
for preparing nourishment are thrown into the form of a bag, which
is adapted for retaining the food;  and this bag is endued with the
power of secreting a matter which has the property of converting
many vegetable,  and all animal, substances  into a substance of one
kind.   This part is called the stomach, and in the less perfect ani-
mals it not only makes a considerable part of the whole animal in
respect to size, but also in respect to its  use in the machine, being
the most considerable part of the whole.  It may be considered as
the first part  of  an animal, ever becoming more and more simple
as the animal becomes more simple ; and also as  the animal be-
comes more simple,  becoming proportionately the larger part of
the animal.
   The stomach is the distinguishing part between an animal and a
vegetable; for we do not  know any vegetable that has a stomach
nor any animal  without one.  It is the  converter of the food by
hidden powers into part of ourselves, and  is what may be called the
true animal, no  animal being without it;  and in many, perhaps in
most, it is  what  constitutes the principal part  of an animal.  A
polypus is little more than stomach.  An animal  can exist without
any senses, brain, or nervous system, without  limbs, heart,  or
circulation, in  s'hort, without anything but a stomach.  But for the
continuance of the species you must have parts of generation;  and
a polypus is a stomach and parts of generation in one ;* and  the
complicating  an animal  is no more  than adding  other  parts  for

   * [" Nothing more is necessary to complete an animal than the power of
continuing the species, which power is superadded to this bag in many."__
Hunterian (MS.) Cat. Phys. Series, vol. i. p. 113.] 
FUNCTIONS OF NUTRITION AND ABSORPTION.       43
various purposes.*  To one^animal which has a brain and nervous
system, you have ten thousand without them.
  The power and operation  of digestion is  perhaps as curious a
part of the animal economy as any whatever; at present, however,
it is not for me to explain these operations,  but it is necessary for
me to take some notice of the connexion between this viscus and
the animal economy in general; in doing which we shall find it to
be as much the seat  of universal stimulus and irritability as the
brain is of sensibility.  This connexion, as in  the case of sensibility,
is much greater in some parts than in others; the connexion that
all  the vital parts  have with the  stomach is  much greater than
between the others, which may be called voluntary, which is only
sayino- in other words that the connexions among the vital parts is
more immediate than between the vital  parts and those which are

 1 In diseases the brain seems to be intimately connected with the
 stomach, and vice versa.  It was as necessary for the stomach  to
 be connected with the whole body as for the brain, although not
 in so marked  a manner; but that it  is  as immediately connected
-with the body as the brain we may certainly say.   The affections
 of the  stomach with the  body  are not  so strong as those  ot the
 brain, the mind  being made  sensible  of the least injury done to a
 part, while the stomach is not at all affected  under many partial
 injuries of the body.
   The stomach is more affected from the internal economy of  the
 animal than from external influence, which is the  reverse of the
 brain ; for external influence in general can only be local, and local
 injury does not affect the stomach unless it be previously disturbed,
 or unless the  injury is in certain parts,  as the brain, the testes, and
 many of the vital organs, which,  as I observed, have a more inti-
 mate connexion with the stomach.
    The strongest natural affections of the stomach, as respects  the
 body, are those connected with nutrition.  These are of the greatest
 consequence  in the machine, and may be said to be of two kinds,
 namely, want, and the contrary.  Want  has  often been known to
 produce madness: the contrary  may be  divided into  two kinds,—
 repletion, and the want of health rendering nourishment unneces-
  sary ; and under such circumstances of the  machine it is refused to
  be taken in.  Perhaps repletion may be only a negative affection of
  the stomach with the body; the other is a positive one, and is often

    * r/Nothing can be more simple than the apparatus for digestion in the lowest
  animals; but in the higher animals "the  parts  preparatory and subservient to
  digestion become more complicated, and indeed so much so, that there "hardly
  any system in an animal more complicated in itself; and when we consider the
  varieties of these complications which take place  in  the various animals, they
  appear to be almost without end.
    " The parts subservient to digestion  in the complicated animals bear a  gjeat
  relation to the other properties of the animal," so that " animals in general might
  be tolerably well classed by these organs."—Ibid.] 
44
HUNTER'S PRINCIPLES OF SURGERY.
 carried  so far as  to produce a sensation in the stomach, namely,
 sickness.
   The stomach is affected by injuries in parts of the body which
 have no connexion with nutrition, and more especially with parts
 which have the least action  in the machine.  Although it may be
 difficult  to understand why it should happen, yet we find that the
 stomach is more readily affected by injuries  done to tendinous parts,
 and those which have little sensibility, than by injuries of muscular
 parts, especially of muscles under the control of the will.   This is
 very remarkable in strains of tendons and ligaments.
   The stomach is  no less  connected with the brain in the internal
 operations of  that vise us  concerning external objects or  mental
 operations than in cases of real injury done to that part.   A man
 cannot hear a horrible story or behold distressing circumstances but
 he will often  experience sickness, vomiting, or purging, especially
 the latter.
   The  Vascular System.—In many  animals, especially the more
 perfect, the nourishment, or  whatever is taken into the system,  is
 taken up and carried from the stomach to the heart, and from thence
 is thrown out to all parts of the system, through  tubes; and from
 the system it is  again returned to the heart by other tubes or vessels.
 It is absolutely necessary for the surgeon to have  a tolerably clear
 idea of the operations of these vessels.  The teaching of the struc-
 ture and offices of these different  vessels more properly belongs to
 the anatomist than to the surgeon;  but  as  there is one use of the
 absorbent vessels  not  generally known, and which is of great im-
 portance in many local  diseases, and has also  an immediate con-
 nexion with the original formation of the body, it will be necessary
 that I should  explain  this: at present, however, I shall do so but
 slightly, and .trace the  action more at large  in speaking of local dis-
 eases.  For  the better  understanding the  whole  action  of the
 absorbents, it  will  not be improper to give a short  sketch of the
 vascular system.
   An animal body has in general been considered under the idea of
 an hydraulic machine, because it appears to be almost wholly com-
 posed of tubes in which fluids move.  I  shall not at  present enter
 into all the different opinions concerning the uses of these  tubes,
 especially of that  system called arteries; how they are variously
 affected, and how  they produce  their various actions, according to
 the different stimuli either of health or disease;  but shall only give
 some general ideas of the most important uses of the three different
 sets of vessels, namely, arteries, veins, and absorbents.
  Arteries.—These carry the blood from  the general  reservoir, the
heart, to all the different parts; the veins bring it back again.   The
 arteries constantly dispose of a part of the fluid which they contain
in the different  operations of the body, according to the  different
functions of the parts:  adding to the whole where growth is  neces-
 sary; making up  losses where  the whole  is either improper or
destroyed;  and  throwing out of the  direct line of  motion  parts 
FUNCTIONS OF NUTRITION AND ABSORPTION.        45
of that fluid, which, according to the different affections and actions
of these arteries, become considerably altered in the process : this is
Prilled secretion*
  Juices so  secreted are  intended for  various purposes in the
machine: some for stimulants, as the bile ; some for mechanical pur-
poses, as the tears, synovia, saliva, &c.; some for  a store of nourish-
ment, as the fat, &c.; while others are thrown out of the body as
useless, because they have already performed all their purposes, as
tHp urine o£C«
  Veins.—The other set of vessels, the veins, are  considered as less
active, being principally employed in bringing back the red part of
the blood, after it has lost its most salutary parts, or done  those
offices, whatever they are, for which it was sent out.   1 his, of car-
rying back red blood, was not considered as the only office ot the
veins; many of their beginnings was supposed to  arise, not frornthe
terminations of arteries, but from  most if not all the surfaces of the
body, internal and external; making so many inlets into the general
system, and bringing matter into the common mass of fluid for the
support of the whole, and also to  bring back many of the parts
secreted by the arteries from the blood for the different purposes ot
the machine, such as synovia and lubricating fluids of  all kinds;
which fluids, having answered their different purposes, and having
become unfit  for every  other use  in the  machine, were obliged  to
be brought back again into the circulation, to be thrown out  of the
circulation by the arteries.
   Absorbents.—Such were considered  to be the uses of  the veins
before the discovery of the lacteals; but by the  discovery of these
they were deprived  of part of their supposed offices, namely, that  ot
 absorbing the chyle; still they were thought to absorb matter from
 the cavity of the intestines for the secretion of bile.   The other part
 of the absorbent system, called the lymphatics, though long known,
 was not in the least suspected of performing the operation of absorp-
 tion, but was still supposed to be the terminations of the extreme
 ends of the arteries, not large enough  to carry red blood but only
 serum or lymph, though from their similarity to  the lacteals, which
 were known to be absorbents, it became at last evident to common
 sense that they must absorb.
   Before this idea was started, the general opinion of the vascular
 system ran thus.  The  arteries were supposed  to carry blood  for
 nourishment, secretion, &c. throughout  the  machine; the veins  to
 return the red blood, as also to absorb  from every surface of the
 body; the lymphatics to return  the lymph or blood which came
 along the  arteries; and the lacteals to absorb part of the  chyle from
 the intestines.
   But some experiments which  I made to ascertain  whether  the
 veins of the mesentery absorbed, proved that they had not the power
 of absorption.*  I do not suppose the  veins, even in an erection ot
* [See the details of these experiments in Vol. IV.] 
46
HUNTER'S  PRINCIPLES OF SURGERY.
 the  penis, to have  the  power of absorption; but I consider  the
 corpora cavernosa as veins through  which  the blood is constantly
 flowing  from the arteries, and that other  veins carry off the  blood
 from the corpora cavernosa;  that in erection there  is  a spasm on
 the  extremities of these veins, which prevents the blood from flowing
 into them, in consequence of which an accumulation  and distension
 takes place, which causes an erection, and this ceases  with  the
 spasm on the veins.  By tying the veins of a dog's penis,  I found  I
 could cause an erection  at pleasure, while the arteries continued
 free.*  Now, therefore,  the offices of the three  systems of vessels
 were as follow:  The arteries remain as before ; the veinsreconvey
 the  blood to the heart, for a continuance of the  actions of the ar-
 teries as before, but have lost their  supposed power of absorbing;
 the  absorbents alone are employed  to take up whatever is to be
 carried into the circulating system.  Now let us consider  what are
 the substances  always allowed  to be absorbed.   1st,  Extraneous
 matter, in which is included nourishment.   2d, Secreted, superfluous,
 and extravasated matter, whether natural or diseased.  3d, The
 fat.  4th, That portion of parts which, being absorbed, causes the
 waste  of parts, as  muscles becoming smaller, bones  lighter, &c.
 Although these two last effects were perhaps not expressly said to
 be carried on by absorption, either by the veins or the other system
 of vessels, yet we must suppose it was understood.
  So far the absorbents have been considered as an active part in
 the animal economy; but, from a further knowledge of these vessels,
 we shall find that they are of much more consequence in  the body
 than has been imagined,  and that they are often taking  down what
 arteries  had formerly built up, thus becoming modellers  of the body;
 and  that they are also removing many diseased parts,  which were
 beyond the  power of cure.
  As these  vessels are productive of a vast variety of effects in the
 animal economy, which  are very dissimilar in their intention and
 effects, they may be viewed in a variety of lights, and admit of  a
 variety  of divisions.  We shall first consider them under two views.
 1st,  As absorbing matter which  is not part of the machine.   2d,  As
 absorbing the machine itself.

  *  [In 1830  Mr. Houston announced  the discovery of a muscle  in  the human
 subject which arises from the ramus of the pubes, and, crossing the  dorsum of
 the penis to unite with  its fellow in the mesial line, effectually compresses the
dorsal vein whenever this muscle  is brought into action.  (Dub. Hosp. Rep.
 Vol. v. p. 459.)  A similar muscle, but more perfectly developed,  was much
earlier discovered by Cuvier in several of the mammalia, to which that eminent
 anatomist assigned the true  use (Anat. Comp. Vol. v. p. 102);  in addition  to
which we may mention  that the tongue of the chameleon  possesses a  highly
erectile tissue, and is provided with a similar pair of muscles adapted to fulfil
the same object.
  Tiedemann, Cuvier, Moreschi, &c,  have confirmed the  accuracy of Hunter's
opinion respecting the  structure of these tissues, namely, that they consist of
veins enlarged at their origins, and  not of a system of cells as  has generally
 been  supposed.] 
FUNCTIONS OF NUTRITION AND ABSORPTION.
47
   The first is a  well known office of the absorbents, and is of two
 kinds : a, the absorption of exterior matter, in which may be ranked
 everything that is applied to the skin, as also the chyle;  b, the ab-
 sorption of interior matter, such as many of the secreted fluids, the
 fat, the earth of bones, &c.  It may be necessary to observe that
 I do not consider the fat and earth of bones as part of the  animal,
 as they have no  action within themselves, and have not the principle
 of life.*
   These actions of absorption are principally employed with a view
 to the nourishment of the animal, as also to answer many other pur-
 poses, as in the absorption of foreign matter, which is extremely
 extensive and is  very important;  for besides its  salutary  effects, it
 is often the cause of a thousand diseases, especially from poisons ;
 all which is not to our present purpose.
   The second office of the absorbents which we are to consider, is
 that of removing  parts of the body itself, which  may be of two
 kinds.   The first of these is where only a gradual wasting is pro-
 duced, either of the  whole machine,  as in atrophy,  or  of a part, as
 in the muscles of a  leg  or arm, from an injury done to a  nerve,
 tendinous part, or joint: this I call interstitial absorption, because it
 is the removing a part of the body out of that part  which remains,
 leaving the part still a  whole or complete part; a  muscle, for in-
 stance, that is wasted  remains  still a perfect muscle.   The  second
 is where the absorbents are removing whole parts of the body, and
 this may  be divided into natural and diseased.  In the natural, these
 vessels are to be considered  as the  modellers of the original con-
 struction of the body; and if we were to consider them fully in this
 view, we should  find that no alteration can take place in the original
 formation of many parts, either  in natural  growths  or in parts
 arising from  disease, without  the  absorbents  being in  action to
 take a considerable  part in it.  This kind of absorption I shall call
 modelling  absorption.   If I was to consider this function in these
 lights, it would lead me to a vast variety of facts, as extensive as
 those  connected with any principle in  the animal economy, for
 bones cannot  be formed  without it,  nor  probably many other
 parts.
   A part which was of use in one stage of life, and becomes entirely
 useless  in another, is removed.   This is evident in  many animals;
 the thymus gland is removed, the ductus arteriosus  and membrana
 pupillaris  are removed.   This process is perhaps more remarkable

  * [In regard to the earth  of bones, we may observe  that its  particles are
 arranged in a determinate and specific manner—constituting an organized body
 in the most extensive acceptation of  that word  as distinguished from inorganic
 matter generally, and from the  amorphous ossific depositions which sometimes
 occur in membranes, muscles, glands, tumours, &c, in which no  definite struc-
 ture is observable.   The peculiar stratification and fibrous texture of bone may
easily be observed by calcination.  This being the case, are we warranted in
saying that the earth of bones, forming an  organised part of the body, is not
alive t] 
48
HUNTER'S PRINCIPLES OF SURGERY.
 in the changes of insects than in any other animals.   The changes
 in an insect are very curious.  The insect is first a maggot or cater-
 pillar, then goes  into  the  chrysalis  state,  and comes out  a but-
 terfly.   Whilst in the chrysalis state it is totally changed, the old
 parts are almost wholly taken up, and new parts formed ; and it is
 this modelling process that occasions these  changes.*
  Bones do not grow by having new particles put into the interstices
 of previously  formed parts, so as  to  remove these  to a greater
 distance from each other, by which means they should grow larger,—
 as, for instance, if I put a sponge into water, the water getting into
 all the interstices makes it larger,—but  they  grow by the addition
 of new bone on the external surface.t
  I took a pig of a very large breed when young, bored two holes
 in the tibia, and  put  a shot into  each, measuring  on a card the
 distance of each from the  other.   I allowed this pig to grow up to
 its full size, then killed it and took out the bone, and I found the two
 holes at exactly the, same distance from one  another as at first.
 Now if the  bone had grown in all its  parts these two shot would
 have been removed to a distance from each other  proportionate to
 the growth of the bone.
  This fact  is also ascertained  by feeding animals on madder at
 different intervals, by which means we shall get strata of red and
 white bone.
  Since we know that bones do not grow by fresh matter being put
 into all parts, so as to push the old matter to a greater distance, but
 by new matter laid upon the external surface, let us see whether it is
 possible for bone to grow and retain its form  without being  taken
 down.  Let  figure 3, PI. III., represent the head of the thigh-bone
 of a foetus.  Now if the increase  was  accomplished  by superim-
 posed layers, one over the other, as in figure 4, the head of the bone
 would necessarily become of an enormous size, and in time would
 come down so as to occupy the middle of the bone, while the cavity
 in the centre would not be enlarged.   Absorption, therefore, must
 necessarily go on  to keep the bone of its proper  shape.  Hence  I
 call this the modelling process, for without this  combined action
 of absorption and deposition the animal could not grow as it now
 does.
  The absorbents possess the power of removing  complete parts of
 the body, in consequence of disease, an operation which is  some-
what  similar to the first of this division, or the modelling process,

  *  [It must be remembered, however, that in insects, where these changes, as
 Hunter observes, are  the most striking, no  proper  absorbent vessels exist, and
 indeed the vascular system generally is very imperfect.  The changes that take
place in the insect transformation  have been since ascertained  to be  rather a
development of parts previously existing in a rudimentary state than  a total
change of parts.  In the caterpillar are to be found the  rudiments of the future
butterfly.]
  t  [See Vol. IV. for a paper detailing the whole of Mr. Hunter's experiments
on this subject.] 
FUNCTIONS OF NUTRITION AND ABSORPTION.       49
but very different in the  intention, and therefore  in  the  ultimate
effect.   This process of removing whole parts in  consequence of
disease, in some cases produces  effects unlike what it produces in
others, one of which is a sore or ulcer; in other cases no sore or
ulcer is produced, although the whole part is removed.  The first I
call ulcerative absorption ; but for the other I have not been able to
find a  term.
   This process of the removal of a whole solid part ot the body, or
that power which the animal economy possesses of taking part of
itself into the circulation by the  absorbent vessels when necessary,
is  a fact that has not been in the least attended to, nor even been
supposed possible ; and as I now mean to give a general idea of it,
I may just  be  allowed once more to observe, that the oil or fat of
the animal, and the  earth of bones, have always been considered as
subject to absorption, and some other parts of the body most liable
to  waste have been  supposed  to  suffer by absorption ;  but that any
 solid part should be totally absorbed  is a new doctrine.   This use
 of the absorbents I  have been able to demonstrate.  The first hint
 I received of it was in the waste of the sockets of the teeth, and also
 of the fangs of the shedding teeth, which was in the years 1754
 and 1755 (see Treatise on the Teeth, first and second parts).   This
 opinion was strengthened by what I  observed in the process  going
 on in the exfoliation of bones.
    It may be difficult to conceive how  part of the body should re-
 move itself, but it is just as difficult to conceive how the body can
 form itself.  They  are both equally facts.  The knowledge of their
 mode of action would perhaps answer but little purpose.
    This, at least,  I may assert, that when any solid part of the body
  undergoes diminution, brought  on  in  consequence of disease, it is
  the absorbent system that has done it;  they are the thieves.
    The remote cause of absorption of whole and living parts implies
  the existence of two conditions, the first of which is a consciousness,
  in the  part to  be absorbed, of the  unfitness  or impossibility  of
  remaining under  such  circumstances,  whatever  they be,  and
  therefore  they become  ready for  removal,  and  submit to it with
  ease.   The second is a consciousness  of  the absorbents  of such a
  state of the parts.  Both these concurring, they have nothing to do
  but to fall to the  work.*
    Now the part  that is to be absorbed is alive, it must  feel its own
  inefficacy  and  admit of absorption.   The vessels must have the
  stimulus of imperfection of  this part, as if they were sensible that
  this part were unfit; therefore  take it up.  There must be a sensa-
  tion in both parts.

    * [The reader, I imagine, will scarcely refrain from smiling at the naivete
  with which  our author here ascribes consciousness and intelligence to an animal
  body, to an extent little inferior to Boerhaave, Van Helmont, or even Stahl.  It
  were devoutly to be wished that the body politic possessed a similar conscious-
  ness of what ought to be done, and an equal will and power to  carry its reso-
  lutions into  effect.]
                                 5 
50
HUNTER'S PRINCIPLES OF SURGERY.
   When the part to be absorbed is a dead part, as nourishment and
extraneous matter of all kinds, then  the whole  disposition is in  the
absorbents.*
   This is the  only mode in which this power is capable of  produ-
cing such effects, and, like  all  other operations of the  machine,
arises from  either  stimulus  or  irritation, all  the  other  modes of
destruction being either mechanical  or chemical.

   [It is by the progressive absorption that  matter, or pus, and  extraneous bodies
of all kinds are  brought to the surface of  the body.  It is by this process that
bone exfoliates and sloughs are separated.  It is the absorbents which remove
whole bones while the arteries are forming new ones.  It is this operation that
removes  the  alveolar processes when the teeth  drop out of themselves, or are
taken out by art; as also the fangs of the shedding teeth, which allow them to
drop out; and it is by this means also that ulcers are formed.
   It becomes in many cases a substitute for mortification, in which cases it seems
to depend upon a degree of strength and vigour superior to that where mortifica-
tion happens; and  in  many cases it finishes what mortification had begun, by
separating the dead  part.   From  all this,  we must see that  the causes of the
absorption of whole parts are many.
   Pressure appears to be one of the greatest causes of  absorption, and it is com-
monly a  cause  of the progression.  It produces its  effects not in all  cases in
proportion to the pressure, but according to the pressure and other circumstances
combined; for we find very different effects from the same quantity of pressure:
thus, under one circumstance, pressure shall give sign3 of strength, and produce
an increase, or thickening; but under another circumstance the same quantity of
pressure shall produce waste, or  an absorption of the  parts.  This difference in
effect, from the  same quantity of pressure, depends upon the pressure being from
 without or within, for the first effect of the irritation  of pressure from without is
 the disposition to thicken, which I have asserted is rather an operation of strength;
 but if it exceeds the irritation of thickening, then the power appears to give way
 to it, and the absorption of the parts pressed gives way to it.
    Pressure produced by an extraneous body surrounded on all sides, such as pus
 in an abscess, acts equally on every side of the surrounding parts, and therefore,
 ever}' part being pressed  alike, ought, from this cause singly considered, to pro-
 duce absorption of those surrounding parts equally  on all sides, supposing the
 parts themselves similar in structure, or,  which is the same,  equally susceptible
 of being absorbed : but we find that one side only of the surrounding living parts
 is susceptible of this irritation ; therefore one side only is absorbed, and this goes
 on in regular progression.  The side of the cavity which is  susceptible of this
 irritation is always that which is next to the external surface of the body ;  there-
 fore we have always extraneous substances of every kind determined to the skin,
 and to that side of the body on which the extraneous substance lies, or to which
 it is nearest, and  that without having any effect upon, or producing ihe lea6t
 destruction of,  any of the surrounding parts.   From this cause we find abscesses
 whose seat is in or near the centre of a part readily determined  to the surface or
 side in preference to another; and  whenever the lead is once taken, absorption
 goes on there only.  But as some parts of the body are more susceptible of" this
 irritation than others, we find that such parts are often absorbed, although they
 are not in the shortest road to  the skin; and of such structure is the cellular
  * [It is difficult to conceive how the absorbents can act on detached solid
Rubstances, incapable of solution, as bone  for example ; yet portions of dead
bone are often observed to be entirely absorbed in  cases  of necrosis; and in
some experiments made by Mr. Thomas Blizard, in which  disks  of bone were
bound  on over ulcers; the surfaces of these disks were found to be eaten out,or
destroyed, just as in  common caries.] 
FUNCTIONS OF NUTRITION AND ABSORPTION.
51
membrane.  We find exfoliations of bones, as well as all other extraneous bodies
approaching the skin in like manner, and from the same cause.  But the pro-
gressive absorption is  always  more or less attended with the interstitial, and
assisted by it.
  The vessels in general would appear to have more powers of perfecting them-
selves when injured than any other part of the body, for their use  is almost
immediate and constant, and it is they which perform the operation of restora-
tion on the other parts; therefore they themselves must  first be perfect.  They
would seem to  have more of the polypus in them than any other part of the
body.   This is perhaps more in the absorbents than in the arteries and veins, for
we can conceive a part injured  by accident, and, as it were, standing still for a
little while; but we  see ulceration going  on very rapidly, which prove6 an
immediate formation of vessels for absorption.*]
  The knowledge of the use of the  absorbent vessels is of late date,
and the  knowledge of their different modes of action  still later.
Physiologists have endeavoured to account for their modes of action
on  the principle of capillary tubes at their beginning, and this is the
most common notion, because it  is a familiar one.   But this is too
confined an idea for an animal machine; nor can  it  account  for
for every  kind of absorption.  But as solids are often absorbed, as
indurated  tumours, coagulated  blood, earth  of bones,  &c, they
were driven to the necessity of supposing a solvent.   This may or
may not be so; it is one of those hypotheses that can neither be
proved  nor disproved,  and must for ever rest as an opinion.  My
idea  is, however, that nature  leaves as little as possible to chance
alone, and that the whole operation of absorption is performed by
one action in the mouths of the absorbents.
   But even  under  the idea of capillary tubes, physiologists were
obliged still to have recourse to the actions of these vessels, to carry
on the matter absorbed;  therefore they might as well have extended
the action to the mouths  of the vessels.
   As we know nothing  of the mouths of these vessels, it is  impos-
 sible we can form  any opinion that can be relied on; but as  they
 are  capable  of absorbing substances  in  a  state  of solidity and
 fluidity, it is  reasonable to suppose that they have different  modes
 of action; for although any construction of parts that is capable of
 absorbing a solid  may also be  such as is capable of absorbing a
 fluid, yet  I can suppose a construction capable  of absorbing a fluid
 that  is not fitted for  the absorption  of a solid, though this is not
 likely.
    To see the possible correctness of  this notion more  forcibly, let
 us only recollect the variety in the mouths of different animals, and
   * The preceding paragraphs are transcribed from the Hunterian  Catalogue
 (Phys. Series, vol. ii. p. 5), and are also partly repeated in the work on Inflam-
 mation.  They are in Mr. Hunter's own words, and  serve to complete this
 subject.
    A long and  interestingf  note is added to this part of the  Catalogue by the
 author, asserting the claims of his brother, Dr. William Hunter, to the discovery
 of the lymphatics, in opposition to the pretensions of M. Noquez.  The whole
 note  is very characteristic, and affords an excellent specimen of critical and sound
 judgment, of a certain combativeness of disposition, and of that homely but vigor-
 ous mode of expression for which Hunter was distinguished. 
52
HUNTER'S PRINCIPLES OF SURGERY.
I will venture to say that  the  mouths  of all the  different  animal
have not a greater variety of substances to work  upon than the ab-
sorbents have; and it may be observed, that with  all the variety in
the mouths of different animals, this variety is  only for the  purpose
of adapting  them  to the forms  of solids, which admit of great
variety, every one being capable of absorbing fluids, which  admit of
no variety.
  I have often said, on this point, that if we could see the mouths of
these vessels, we might perhaps  class the modes of absorption  as
animals have been classed, by their teeth, &c.
  Matter taken into  the constitution by the absorbents is capable of
being altered in its nature from what it was out of the  constitution.
Although this may have been conjectured or imagined, it never has
been absolutely known, and  even now the only proof we have of it
is the change produced in venereal matter.   If the  matter of chancre
or gonorrhoea be absorbed, it produces disease ;  this disease is not
similar to the original;  it is not  pocky matter which  is produced
from the ulcers, but this matter has been changed from its  original
nature in  the circulation; although the change was  of such a kind
as still to retain its power of stimulating  and producing  disease:
but as it was changed, the disease produced was  not similar to that
from whence it came.
  That there is a change in venereal matter is very evident, for if
venereal matter out of the constitution be applied  to a living part, it
always produces an effect according to the nature  of the-part, which
part may be one of two kinds, either,  1st, a secreting surface, pro-
ducing then  gonorrhoea; or, 2d, a non-secreting surface, producing
then a chancre.
  That this process of altering substances in the constitution is not
a universal principle  and common effect of all kinds of matter which
enter the circulation, is evident; for we  do not  as  yet know, for
certain, of any other matter being altered.

                    TABLE  OF ABSORPTION.
    Absorption for ^ Extraneous matter to become useful, as chyle, fat, &c.
     nourishment. } lnterstitial absorption of parts of the body itself, as cellular
               ' (  membrane, muscles, &c.
    Absorption of fExtraneous,  'hat have been useful, as synovia and  other
      useless  in     secretions, become useless.
      convenient ~<                 f Producing wasting of a part, as  a leg,
      nr   hurtful 1                   an  arm, &c.; or  wasting of the whole
      parts        Parts  of the bodyJ  bodv-
                L  itself.         }                 rAs modellers in
| \                              |                    the   time  of
                                 L.                J   growth.
                                                   In consequence of
                                  Absorption of the    weakness, as in
                                    whole parts.   J   th?, removal of
                                                     calluses.
                                                   From parts  beco-
                                                    ming   wholly
                                                    useless, as the
                                                     alveoli. 
OF THE  BRAIN AND NERVES.
53
O a) .
a 2"S
f                         C of a leg or an arm, &c.; or of the whole
  t .   .-.- 1 C Partial wasting <  body, as in atrophy.
  Interstitial \            * £ of a callus of a ^^
 absorption. ^Totaj wasting   Df calluses, alveoli, testicles, &c.
             As when pus or any extraneous body~\
               is brought to the skin            I Attended with sup-
             In the process of exfoliation of bones, >  DUration
Progressive
absorption.
in me process ui exiuuauuu ui uuuco, /■  r,uration
In the process of sloughing,         I   ^
            In the formation of ulcers,
            In the removal of the fangs of the
              teeth.                        Without suppuration.
JMixed,      As in the progress of pus, tumours, &c. to the skin.
                        CHAPTER VI.

                   OF THE BRAIN  AND NERVES.

Passive and  active states of the brain;—too much influence attributed to  the
  brain in the bodily actions;—actions of the brain;—five modes of impression
  on the nerves, or senses.   Voluntary action becoming involuntary, as in
  chorea.—Of sensation.  Connexion of the actions of the brain and nerves
  with life.—Of sleep ;—its importance in the animal economy.

We have hitherto traced animal matter from its change from com-
mon matter to animal matter, the particles of which have possessed
such an  arrangement as to produce  life ;  still it has other modes of
arrangement, out of which arise other modes of action, and which
only take place in some animals.   These are the brain and nerves,
which produce sensation,  out of which arises mind and reason;  for
without sensation the mind could not be formed, nor could we rea-
son ; it being always about some object that the mind is affected, or
that we reason.
  In sensation the  brain is passive,  only receiving  the impression
from the nerves, according to their  actions, called so  many sensa-
tions.  In mind it is active.   Mind arises from  a peculiar quality
in the sensation, being expressive  of some quality  in the body
which is the object of sensation, and which  gives  an action to  the
brain answering to those  qualities, as agreeable and  disagreeable,
with  all their different species,  as  love, joy, hatred, anger, &c.;
which actions of the brain, or states of the mind, become the causes
of particular modes of action in the body affecting both involuntary
and voluntary actions.  The heart beats quick  or slow according
to those  states; sickness  may be  produced; purging, contraction
of the bladder shall take place ; the voluntary muscles  hardly obey-
ing the will, but performing  involuntary  actions, according to  the
state of the mind.
  Reason, by influencing  the will, becomes the cause  of the volun-
                               5* 
54
HUNTER'S PRINCIPLES OF SURGERY.
tary actions ;  and by this connexion all these principles can affect
one another.
   Now the brain  appears  to be capable  of two  modes of  action,
and out of these arises every property of the brain.   We may call
the actions of the brain, mind ; objects shall affect our senses so as
to form  a peculiar state of  mind:  this I  call  mental  impression.
Again, the mind can reason  and exercise  volition  respecting ob-
jects.  The  former is involuntary, and belongs  also  to  brutes ; the
latter is voluntary.  For instance, I am challenged  to fight  a duel,
volition, and reason determine me to  go to it;  but when  at the
place, my joints tremble, my stomach turns sick  : this  is the effect
of mental  impression, or feelings of the mind.   The  two operations
are very different; and in general the feelings of the mind, if  strong,
will prevent all reasoning.
   Much  more has been given to the  brain and nerves than they
deserve.*   They  have  been  thought  to be  the  cause  of every
property  in an animal  body; that independent of them the whole
body was a  dead  machine, and that it  was only put in  action by
them.
   But although their actions  are absolutely necessary in the ma-
chine, they are not so universally so as has been  imagined.   They
are not  the cause of growth, nor  do they even preserve  a part
from  death,  although  the whole as  a whole cannot live  without
them.
   The nerves have but  one  mode of action,  namely, that  of con-
veying impressions;  but this in two different directions: one from

  * [It may here be remarked, that the author, on the whole, lays less stress on the
nervous system in his physiology than it probably deserves, at  the  same time that
he gives disproportionate importance to the stomach.  Modern experiments have
shown  that the functions of  digestion, nutrition,  secretion, circulation, respira-
tion, &c. in the higher animals  are intimately dependent on the integrity of the
brain and nervous system ; and though in some of the lower animals no  traces of
this system are discoverable,  yet may we safely infer,  from the irritability which
these  animals manifest, that something  corresponding to a nervous  system
actually exists, constituting the materia vitse diffusa of the author.  Something
analogous to this has been  suspected in regard to the stomach itself, in certain
species of  zoophytes, in which either there are no visible stomachs, or else the
parts which are  generally considered as separate and independent animals are
regarded by others as merely  a multiplication of stomachs belonging to the same
individual.  Some experiments also have lately  been  performed in  America
which show that undressed animal food  undergoes a species of imperfect diges-
tion when  inclosed in fresh  wounds : from which  it  seems probable,  that not-
withstanding the centralization of the vital organs in  the  higher orders  of
animals, the separate parts still  exhibit traces of those vital endowments which
in the lowest order of animals are  diffused through the whole body, very much
in the same manner as in vegetables. The proper objects of  comparison, how-
ever, in the present case, are  the stomach with the great  sympathetic  nerve or
nerves of the viscera rather than with the cerebral  masses.  The superaddition
of the latter has reference  principally to the organs  of external relation, very
few of  which exist in zoophytes and  the simpler forms <>f beings.  Physiologi-
cally,  it is as difficult to. conceive of sensibility and contractility  without  a
nervous system, or something analogous to this system, as it is to conceive of
nutrition without digestive and circulatory organs.] 
OF THE BRAIN AND NERVES.
55
their extremities  in  the  body towards the brain,  conveying im-
pressions made on them to the brain, in order to  excite  actions
suitable to these impressions; the other, from the brain to the ex-
tremities, conveying  the mandates of the  will, &c.
  That mode of action which is from the body towards the brain
is of two kinds.  One is the internal feel  of the  body, of perfection,
imperfection, power, want, &c.   The other is of those feelings of
the body which are to call forth the powers of the will to perform
what are called voluntary actions, for the subsistence of the body,
or to effect the actions which it cannot perform.
  The actions of the brain towards the body are also of two kinds:
one in consequence of the feelings or state of the  mind at the time,
whether the actions  of fear, courage, anger, love, &c.; the other,
in consequence of the command of the  will, called voluntary ac-
tions.
   Those of the body to the brain are the  first in order; for  it is the
receiving the impressions  that  gives  rise to the others.   Of the
latter, the first are the feelings  of the mind, and the second the
will and its  consequences, namely, voluntary actions, or all those
actions, directed principally to external objects, for  which muscles
are provided.
   As the nerves are perfectly passive till impressed  by external
objects, no one could have  any sensation except while an  impres-
sion is made on some of the senses.  Therefore a man should not
feel that he exists but in thought; nor could he do that if he had
never received impressions to think about, for thinking is no more
than the memory of impressions  put into order by the mind; nor
should  he have  those actions which naturally arise from the brain
till the brain makes the impression on the nerves.
   The impression is made on the body,  but the sensation is in the
brain, for the effect (of a person's feeling  in a part to which a nerve
is distributed) on cutting or otherwise injuring a nerve, proves that
sensation is in the brain, and not in the  body; for  if it was in the
body, the sensation would be referred to  the part injured ; but sen-
sation being in the brain, and brought from the brain by the action
of the nerves, or sensation  being formerly in the brain, the action
of the nerves we find is referred to the beginnings of that action by
the combinations of  the  other senses ; otherwise it would be only
in  possession of the sensation without any reference.   The  refe-
rence produces a feeling in the mind receiving sensation, by joining
it with the seat of impression.
   There are five modes of impression of nerves,  or perhaps rather
five modes of construction of parts, which are  adapted to so many
kinds of impression.  These are  called  the five  senses; but there
are a great many kinds of sensation conveyed to the brain or sen-
sorium.
   The five senses are no more than parts constructed so as  to be
capable of receiving impressions, or so many properties of matter.
Perliaps all  are  capable of receiving the impression of touch, or 
56
HUNTER'S PRINCIPLES OF SURGERY.
pressure, if it could be applied to all, so that every nerve  may be
said to feel.*
   But, besides pressure, there are other properties of matter.  Many
bodies  have qualities besides  being tangible ;  some only when in
solution making  an impression  on the  tongue  and causing taste;
the same bodies when thrown  into vapour give  smell:  air, besides
being  tangible, has a peculiar motion, arising  from its repulsive
quality, called vibration, which strikes the ear and  produces  hear-
ing.  There arises another property in  another species of matter,
called light, which we  know less of than any other, which  has a
power of pervading some bodies, called transparent, and gives us
the sensation of  sight; and from  peculiarity in the formation of
those transparent parts light becomes more determined  in its direc-
tion.
   The sensation  of the glans penis, tickling, and itching would
seem to belong to feeling.  The first, however, is certainly  a dif-
ferent mode of action of the nerve from common feeling, and both
itching and tickling require a particular mode of impression to pro-
duce them.
   An  animal can bear with ease  a certain  quantity  of common
sensation, which  quantity  being  particularly applied will  give
pleasure ;  but if  common sensation  be increased  beyond certain
bounds, it gives great  pain ;  so that pain  is no more than an in-
creased sensation, such as the sense of violence  committed to a
part.f
   All  the five senses  are subject  to the same mode  of sensation
when applied in the same way, namely, by touch, and if the impres-
sion is  too strong, give  the sensation of pain.  For instance, if the
retina be hurt, it  gives pain,  but not light; if the ear be hurt, it
gives pain, but not sound ;  if the nose be hurt, it gives pain, but not
smell.J  But  there are exceptions  to the two  first, for a blow on

  * [It would seem that Mr. Hunter thought that all the nerves of the  senses
were capable of conveying the sensation of touch or pressure, in addition to the
sensation which they are specially fitted to convey.  This opinion is not war-
ranted by more  recent discoveries.  An impression  on the  retina, of  whatever
kind, excites the sensation of light.  Majendie found that on  touching the retina
with a couching-needle no pain was excited, but the sensation of  light: a blow
on the eye has the same effect.  If pressure be made with the finger on the scle-
rotic, a dark spot  will be seen immediately at the point of pressure, where the
function of the nerve  is probably impeded, with a hallo of light surrounding it.
Of the auditory  nerve we know little;  and on the tongue and nose the gustatory
and olfactory nerves are so intermixed with the fibres of the fifth or nerve of feel-
ing, that it is not  easy to distinguish  between their actions  in such an experi-
ment; but galvanism, which excites a pricking sensation in the  skin, causes a
peculiar flavour when applied to the tongue; and the smell of the electric  fluid is
well known.]
  f [If this were the  case, we should expect to find pain differing  only in decree,
but not in kind.   Some structures, as bone, ligament, and the fibrous structures
generally, exhibit no common sensation, although they are actually alive to pain
under circumstances of injury and disease.]
  X [To each of these organs are distributed branches of the fifth nerve, or th» 
OF THE BRAIN AND NERVES.
57
the eye often produces light, and on the ear sound.  And besides,
those senses are subject  to diseases, where  the sensation  often
arises without impression from without.
  The common actions of the body, that commonly arise from the
will,  often become involuntary, as in palsies, St. Vitus's dance, &c.;
but I suspect that these  actions  still arise from the brain or mind,
though not the will, because  they do not take place in sleep ; nor do
we find the same diseases in any animal but the human.
  Our senses being such, have their  peculiar degree of sensation
and their peculiar mode of receiving impressions, and when this is
carried to too great a  length, they become extremely uneasy : but
it is an uneasiness different from pain ;  it is the peculiar sense carri-
ed beyond what the mind can bear.
  Sensation is in proportion to the impression made on a part, joined
with the susceptibility with which the nerve is ready to act.   But
for distinct sensation two things  are necessary, namely, time and
space.  It is necessary that  the impression should be some time  in
performing, because an impression may be too quick to excite sen-
sation, or quicker than  any  action in the nerves, such as a ball
passing through a man's  body  without his feeling it; but he  is
capable of feeling it afterwards, which arises from an action of the
injured part, not from the violence itself.   Neither must the time be
too long, for an impression or an injury may be so slow as not  to
affect the nerves at all,  so as to throw them into any action.   A
person, for  instance, shall become dropsical, and  the belly shall fill
with water so gradually as to give no pain from the stretching  of
the muscles, peritoneum, &c.: but if you were to attempt to stretch
the belly of another person in a given time to such a degree, it
would produce pain in proportion to the violence.
   The space must also be determined, for a given quantity of im-
pression may be concentrated so  as to be within  bounds of sensa-
tion ; for it would appear that a  single nerve or a very few nerves
are not capable of conveying sensation, however affected; for in-
stance, a given quantity of light  may be concentrated into such a
small point as not to  be  seen.
  Every sensation, every mode  of sensation, and every sense ap-
pear to depend on the quantity of nerves acted upon, and in a given
time; therefore we have a great quantity of nerves going to  parts
that  are allotted for strong sensation,  that  no impression may be
made without affecting a great many  nerves at the same time.
   The uneasiness arising from too strong impressions we can easily
assign a reason for, as it becomes a means of avoiding  that  vio-
lence; but  itching and tickling appear not to be so very necessary:
however they must be of a service in the animal  economy.  I can
conceive itching becomes a  cause of  our  keeping ourselves clean,
free  from vermin, &c,  and becomes a substitute for pain: it na-
nerve of sensation; it is by means of these that common sensation is furnishpd to
the organs of sense, and through them that lesions excite  the feeling of pain.
See the preceding note.] 
58
HUNTER'S  PRINCIPLES OF SURGERY.
turally leads us to the cure, which gives pleasure ;  and the perfor-
mance of it is almost similar to the indulgence of our natural appe-
tites.
  This principle  of sensation is our director with respect to all
other external actions, but has no absolute power over the internal
economy of the machine.  But this first principle we shall  find can
influence the others very materially, and thus a compound principle
will be produced.
  The brain and nerves also give  the  body a consciousness  of its
own muscular powers.  This is more remarkable in other animals
than in man: thus, a  horse will at once  know what he can leap,
and will  leap no  more, nor attempt it;  and indeed a man  can for
the most part tell.  A nobleman (the Duke of Queensbury) who had
broken his tendo-Achillis was fearful of walking  about his room;
but I advised him to do it as well as he could, assuring him that his
gastrocnemius muscle,  knowing  its own business better  than its
master, would refuse to act if he walked, and  that the action would
be performed by other muscles.   This he found to be true.  But in
the night time, I told him, I could not be answerable for what his
muscles  would do, therefore I thought proper to put the leg into a
fit posture and secure it by a bandage.
   As the brain and nerves are composed of animal matter, and as
that  animal matter  has life, or  the  first  principle of action, in
common with all the other matter composing the whole  body, there
arises necessarily an intimate connexion  between those principles,
and,  though totally different in their peculiar actions, yet they be-
come blended with each other, so  that one seldom acts  perfectly
unless the other is in perfect  order, each of them calling  on the other
to do its part; and when both these  principles are in vigour and in
perfect harmony the whole machine is in health.
   Life is  coeval  with the existence of the animal  or vegetable
 matter itself; but  sensation is a later principle, does not take place
 until birth, when a new economy is set  up, in  which  sensation  is
 called in by the living principle for the support  of the whole, begin-
 ning first in the stomach by sympathy, and  then going on in a series
 of actions.  These compound actions, therefore,  cannot take place
 until sensation takes  place ; and it is reasonable to  suppose that a
 child in the womb has no sensation, for it  is just as well formed in
 all its parts without brain as with it, and  the nerves are indebted to
 the brain for their formation.*

   * [This statement is  incorrect.  The nerves may exist  without the brain or
 spinal marrow, which are accessory, not the fundamental parts.  The same law
 obtains in regard to the heart and blood-vessels: and indeed it may be observed
 generally in regard to the progressive development of the higher animals, that at
 first they follow the type of inferior animals, but  afterwards advance to those
 which are still higher and higher in the zoological  scale.   Hunter in the main
 was well acquainted with this law of development as regards the higher animals,
 as will appear from the following passage, in which we may remark that he has
 anticipated many of the leading discoveries on this subject by modern anatomists.
 The  passage occurs in the  introduction to the description of the drawings relat- 
OF THE  BRAIN AND NERVES.
59
  But  the moment a  new mode  of action takes  place,  actions
arising from  sensation must be performed for the support  of this ;
and an animal must die if these sensations are not produced, which
cannot be produced if there is no brain.*
  Actions arising from the union of the two  principles, life  and
sensation, are extremely evident;  being all those  actions  which
constitute a state of mind, or those  feelings  of the mind from which
instinct arises.
  Sleep.—A singular result of our  being possessed of  the sensitive
principle is sleep.  Perfect sleep is  an annihilation of the power of
present sensation, of the power of thinking, and all traces of  the
past, or what we call  memory.  We find that there  is, of course, a
cessation of all voluntary actions; the will itself is in every respect at
perfect rest, and we are at this time, in respect to ourselves, in a state
of non-existence.  But sleep has its degrees;  perhaps in all cases there
is a loss of these considerable principles, especially sensation;  but the
effects  of sensation are  not always  lost, namely, those  operations
of the mind which produce  actions which  are  very nearly volun-
tary.  During sleep,  therefore, the mind may be thinking, which
forms what  we call dreams; but as our present sensations do not
become'directors of those actions which   the  mind  is  employed
about, no such action takes place as the mind  forms  to itself.   It
is even possible  to dream when awake ;  it  is only necessary for the
thinking power to take possession  of the mind, and to proceed with
 an action with which the  present  sensation has nothing to do, so
that a person neither sees objects, hears sounds, nor feels anything
 that touches him; and when  the mind ceases to act  and sensation
 returns, we call it a  dream. Now whenever the body loses the
 consciousness of its  own  existence, it may be called  a waking
 dream, and this is often the case when people are in deep  thought.
 Sleep appears to be to the sensitive what I have already described
 to take place in the  living  principle, when I mentioned  my own
 case; but that arose  from disease, while sleep  is necessary.
   When both these principles undergo a cessation of their actions
 it is called  a swoon.   Here there is a cessation of all actions which
 naturally arise  in  the body, but  still a capability  of having them
 ing to incubation.  " If we were capable" (he says) "of following the progress
 of increase of the number of the  parts of the most pprfect animal, as they first
 formed in succession, from the very first, to its state of full perfection, we should
 probably be able to compare it  to some one of the incomplete animals themselves,
 of every order of animals in the creation, being at no stage different  from some
 of those inferior orders; or, in other words, if we were to take a series of animals,
 from the more imperfect to the perfect, we  should probably find an  imperfect
 animal, corresponding with some stage of the most perfect."  (Hunt. Cat. Phys.
 Series, vol. ii. p. 4.)  Many other passages might be adduced  which evince
 that Mr. Hunter's  extensive acquaintance with comparative anatomy had enabled
 him to deduce the true principles  which regulate the formation of the body  and
  the coexistence of the different systems of parts in the same individual organism.]
   * [Mr. Hunter must have been aware of many examples  of fetuses without
 brains which have lived for some time after birth.  He must here mean the me-
  dulla oblongata, without which respiration cannot take place.] 
60
HUNTER'S PRINCIPLES OF SURGERY.
reproduced,   Now in a fainting  fit  there seems rather a cessation
of the actions of sensation, the animal becoming totally insensible
to itself; but in a swoon we  have this carried further; the cessa-
tion takes place not only in the  sensitive but in the living principle
itself, for we  shall have people  fall  into a trance  or  swoon, and
they shall remain in it without any kind of motion,—respiration,
circulation, digestion, and every operation of the body at total rest;
and if the  disease, or the cause of cessation of that action, should
continue a long time, they  may lose the power of reproducing this
sensation again.   Fainting from bleeding,  fear, &c, is a swoon in
a certain degree, for these principles are diminished, especially the
sensitive.  Sleep is not only a  cessation of voluntary action, but
produces cessation of involuntary action of voluntary parts, arising
from their diseases, as in St. Vitus's dance, &c.
   Sleep is of such material consequence to the sensitive principle
of the constitution,—namely, sensation, mind, and will,—that it may
be said  to  constitute one  third  of  its  duration.   As it is  only an
annihilation of sensation and all its consequences, one might  suppose
that it was of little consequence  to the machine; but it is as essen-
tial to it as food.
   Sleep, or rather a cessation of sensation, thus taking place, while
the action  of life is going on, shows that  there must be a peculiar
structure, and a principle arising out of  that structure superadded,
making a compound which is  endued with life;  for life for a time
can go on without sensation, but cannot always go on without it.
   Sensation, then, is a fatigue to life; and in proportion to the exer-
tion of sensation, in a given time, the sooner is life wasted.  For
this reason, when we are in health,  sensation stops  at proper times;
life then appears  at ease.   This slighter effect of health  is often
increased preternaturally,  as in cases called lethargy.*

  * [Dr. Marshall Hall found that the muscular irritability of hybernating ani-
mals was greatly increased during their state of torpor.  In the same way, sleep,
" nature's second best course," seems to  be intended to recruit the exhausted
irritability of the system after the labours of the day ; and accordingly during the
condition of sleep the organs both of animal and vegetative life  are in a state of
repose, the one completely, the other only partially so.  Various causes have
been assigned for this state, none of which is completely satisfactory.] 
OF SUSCEPTIBILITY TO IMPRESSIONS, ETC.         61
                       CHAPTER VII.

OF SUSCEPTIBILITY OF IMPRESSIONS ; OF STIMULI ; OF DISPOSITIONS OF THE
                  BODY J  OF HABIT  AND CUSTOM.

Difference between impressions  on animate and inanimate matter; of internal
  susceptibilities.—Of stimuli;—carried too far they become irritants ;—animals
  susceptible of stimuli at one time and not at another.—Of dispositions of the
  body ;—less well  understood than those of the mind;—in health arising from
  impression;—in disease  without it.—Of dispositions in the mind;—their
  ultimate effects are on the body.—Of dispositions of the body compared with
  the  preceding;—both compared  with  the actions of machines.—Want of
  balance betwixt the parts of animals ;—parts weakest when at a distance from
  the sources of power;—why.—Of the memory of impressions;—to be found
  in the body as well as the mind ;—example.—Of the effects  of repetition of
  natural  actions.—Definition of  habit  and  custom.—Of custom;—lessened
  effects from repetition of impression ;—increased effects.

Every species of matter, whether inanimate or animate, is capable
of impressions, and the effects of the impressions, are according  to
the nature of the impression and the part impressed.   All matter is
not capable of acting or reacting according to the impression, which
passiveness belongs to inanimate matter, though not to all. A piece
of dough receives impressions, but seems chiefly passive, not having
the power of reacting, and making but little resistance.   Elastic
bodies  receive impressions, which they restore in a contrary di-
rection,  producing ultimately various effects, which I have said are
the soul or life of mechanism.
   In animal bodies the effects of impression are more various and
complicated  than  in  inanimate matter, because  the most  simple
animal  is  more  various  and complicated in its susceptibilities  of
impression, and of course more complicated in its dispositions for
action.
   In inanimate matter there are no actions within  itself excepting
the disposition  to reinstate itself,  as  in elasticity; therefore im-
pressions are not rising up  within  itself, in consequence of its own
actions, as in animals, so as to produce consequent dispositions and
actions,  unless we could conceive  that chemical and  fermentative
operations were of this kind.   But animal matter having internal
actions, these actions are producing impressions which are forming
dispositions to  action in  the parts impressed; and, secondly, it is
capable of being  acted upon or  impressed  by common inanimate
matter, in both which cases the impressions will be according to the
nature of the impressions and part impressed conjoined.
   When a man is so affected  as to feel within himself that he cannot
live, which is very common, it arises from the mind being  made
acquainted with the state of the body; the living powers  are be-
                                6 
62
HUNTER'S PRINCIPLES OF SURGERY.
come weak, inactive, &c, and the nerves are communicating  the
intelligence.  Accordingly, their actions  are  expressive of the  ex-
tinction of life going on, and the  action of brain is expressive  of
such actions of the  nerves; and as death is a something we know
takes place, and this sensation of ours is not such as we feel in
health, we conclude, from  an habitual species of reasoning, that we
cannot live, and we are often not deceived.   This effect is often so
quick that it may exceed the sensation of it, or at least may hardly
afford us  time to communicate these sensations to others.
  The internal susceptibilities, with the consequent impressions and
dispositions, are, first, of want, and, second, of repletion; and all the
other internal operations of the machine arise naturally from these
two, especially repletion, as digestion,  circulation, respiration,  se-
cretion, the intercourse of the  sexes, &c.  But the first movement of
these actions appears to require the  impression of external matter,
the powers of digestion  being  excited  by food being thrown into
the stomach, in  consequence of which circulation, respiration, se-
cretion, &c, all follow, arising out of the internal  operations of the
machine ; all which have  nothing to do with  the sensitive principle,
but are wholly dependent on the living principle.   The  desire of
food, or susceptibility of  the stomach to digest it, arises  not from
external objects, but from its own organization.
   The  second kind, susceptibility of  external  impressions, affects
principally  the sensitive principle,  but may  also  affect the living
principle, as  in medicines.    These are  called  stimuli; and when
both principles  are affected they may be said to  have the man-
agement of the machine.*
   Impression or stimulus, produces  a disposition  to act, or rather
action may or may not take place.   But all  impressions, either  on
the living or sensitive principle,  are not stimuli;  some go beyond
stimulus,  and become  irritants ;f and other  impressions  are from
their nature not stimulants, but produce a disagreeable impression
either to the mind  or body, and are  also  irritants.
   Stimuli—An animal, I  have observed, is susceptible of impres-

   *  [It is impossible to avoid remarking here  the  similarity  of this view of
Hunter's to Bichal's division into organic and animal actions.]
   |  [It may safely be said that almost  all stimuli, when applied in excess, ope-
rate as irritants, and, if carried to their utmost point, as direct sedatives.  Thus,
electricity, which  in a moderate degree irritates the  system or  rouses it to an
unusual degree of  action, in a  concentrated form immediately extinguishes life.
 Cold and heat have the same  effects, and  so have most other stimulants.  The
same remark applies to those stimuli which in a  healthy state proceed from the
mind and  produce agreeable impressions ; as, for instance, joy, which may be
exalted to ecstacy, and so occasion sudden death.
   It is probable that the same principle obtains in regard to the internal economy,
and that those powerful sympathies which are the result of disease are many of
 them merely to be regarded  as exaltations of natural impressions primarily
 subsisting between the different parts,  which may be carried to any conceivable
 extent, so as to produce increased action,  pain, or an entire destruction of the
 function.  A different class of affections, will, on the other hand, arise from a
 deficiency in these impressions.] 
OF SUSCEPTIBILITY TO IMPRESSIONS, ETC.
63
sions; which impressions, I  shall now observe, are  to  become
causes either of immediate or remote disposition to  action, either
in the part impressed, or some other by sympathy.   These impres-
sions, which excite or increase the disposition, are called stimuli;
therefore we may say that a part is stimulated, or such an appli-
cation, substance, or object is a stimulus ; and a part either readily
increased in action by impression, or brought into action, we say
is very susceptible of stimuli.   I could wish we had some one word
expressive of this condition of the part stimulated, as stimulable,
and also of the stimulus, as stimulative, to answer to irritable, sen-
sitive, &c.
  An impression which becomes a stimulus by sympathy may have
been carried so far as to have been an irritator of the part to which
it was applied, as a mote in the eye irritates the tunica conjunctiva,
which irritation acts only as a stimulus to the lachrymal gland, for
this  gland  can only act by sympathy.  The  power  of a  stimulus
must be according to the nature of the stimulus and  of the part
jointly,  for as almost every part of a body has a peculiarity in its
mode of action, every part must have its peculiar stimulus.
   An animal is so constructed as to have  its parts  susceptible  of
stimuli  at one time and not at another.  An animal has a power of
improving its parts so as to make them susceptible of such stimuli
as are  adapted to the  disposition of the parts; for instance, an
animal  improves all those parts peculiar to the sexes.  When those
parts are perfect, which is called  the age of puberty, they stimulate
the mind and various other parts connected with that, giving rise
to the  passion of love or the appetite of lust.
   On the  other  hand, want becomes the  cause of  impression: a
 part becomes susceptible  of such want, so that  the  ultimate effect
or stimulus is completely produced,  and an  appetite arising from
such stimulus takes place.  Thus, the stomach when empty is sus-
 ceptible of the stimulus of hunger.  This kind of stimulus  may  be
 carried so  far as  to excite a diseased action,  and must then be con-
 sidered as an irritant.
   Of Dispositions of the Body.—It may be  difficult  to  define  a
 disposition  of the body,  but  that  the body has  dispositions is un-
 deniable ; and  without  knowing  this, and  therefore coming at  or
 endeavouring to come at the knowledge of these dispositions of the
 body, a man must be a very confined surgeon in his  practice.
 But the term disposition  is more commonly applied to the mind
 than the body.  In the  mind it is more easily comprehended, be-
 cause the mind has the power of investigating its own feelings or
 dispositions, also  the power  of communicating  them,  by means of
 the body, to the  minds of others, so as to be understood or felt by
 those minds.
   Every man has felt perhaps every disposition that  can arise in
 the human  mind, and is therefore perfectly sensible  of those dispo-
 sitions  when they occur in others.  But in the present inquiry the
 mind has no intelligence of the feelings or dispositions of the body, 
64
HUNTER'S PRINCIPLES OF SURGERY.
and  is obliged to compare the effects of the one with those of the
other, and where they are  similar to suppose that the  causes are
also  similar.
  A disposition either in the mind or body, when in health, always
arises from some impression; but as both mind  and body  are ca-
pable of seemingly spontaneous actions, these may arise from dis-
eased dispositions in both, producing madness in one case and
strong disease in the other.
  As disposition may arise in consequence of some impression, it is
capable of being destroyed by a counter-impression, which in dis-
ease is  the  method of cure that will be called  specific.   Many
dispositions wear themselves out, or are such as the body or part
cannot go on with.
  A disposition is different from  a visible action, yet it  is possible
it may be itself an action.   If we compare the actions of the body
with those of the mind (which is comparing from analogy, and per-
haps the only mode we  have,) we shall gain a  pretty good notion
of them.
  A disposition of the mind, then, certainly arises either from some
action of the brain, or a certain position of the  parts of the brain
takes place, giving them an inclination to action.  But  this action,
or the position which produces the inclination to action, we  know
nothing  of;  it is only  a sensation  of the  mind, or  rather  a con-
sciousness of the mind of  such inclination, which sensation or con-
sciousness, is different from the sensation of the  brain, arising from
other actions of this viscus :  and also knowing  that such action of
the brain as produces such sensation in the mind, is endeavouring
to set other parts of the  body into  action which may be called
voluntary,  or  rather actions in voluntary parts ;  and  that  when
such  actions of the brain have  taken  place, such dispositions of
the brain are lost; I say, knowing so much, we may, knowing from
analogy, form some idea of bodily dispositions.   But the dispositions
of the body appear to differ in this respect from those of the brain,
that in the brain there is only the disposition, the  ultimate  or con-
sequent  action  taking place in  the  body.  But  this  is, perhaps,
because  we are not much acquainted with the immediate effects
of the disposition in the  brain, being led away by the visible actions
which take place in  the body.
  To explain this, let us suppose that I have an impression made on
my body in such a manner that my sensitive principle is sensible of
it; if, for instance, a man  gives me a knock on the head that makes
me angry, I form a disposition from that for resenting it: that dispo-
position in my mind produces an action in my brain which forms a
peculiar state of the mind, which is  anger.  If it was an action of
some other kind, it might be affection or gratitude.  The brain can
do nothing by way of retaliation, whether it be gratitude or revenge
which directs, but to set  parts of the body to work. Having received
a blow  on my head, the  disposition  in my brain to produce the
action of revenge sets my hands to work to give  my enemy another 
OF SUSCEPTIBILITY TO IMPRESSIONS, ETC.
65
blow, and then the disposition is at an end.   So that whenever  the
action has taken place, the disposition is gone.*  The ultimate effect
is made sensible to us, and we are apt to imagine that it is the imme-
diate act of the disposition of the brain; but it is only that the immediate
action which took place in the brain made other parts of the body
act secondarily, so that three actions are necessary to the ultimate
effect; but  they are not  all three actions  of the brain.   There is,
1st, the action which produces the  disposition: 2d,  the action of
the nerves in consequence of the disposition: 3d, the action of the
voluntary muscles in consequence of the action in the nerves;  but
only the two first actions  belong to the brain.t
  Let us see how far this disposition and consequent action of the
brain correspond with the dispositions of the body  and the actions
arising in consequence of these dispositions.
  If on any part of an animal an impression is made, a  disposition
is  formed suitable  to  that  impression, which is the first; and an
action in the same part suitable to that disposition may take place,
which is the second, and is the ultimate; but if a sympathetic action
takes place, it becomes somewhat similar  to the ultimate effect on
the body, arising from a disposition in the brain.
  We may, with  great propriety, compare the disposition and action
of either the brain or the body with the disposition or action of an
elastic body.   An elastic body, when acted on, (which is similar to
an  impression made on the  body,) acquires a disposition or inclinar
tion,  which, if allowed, will  produce action in all parts of the elastic
body, which destroys the  disposition.   The disposition to  action,
and the action, are two very different  things in themselves, even in
the elastic body: when the elastic body has performed its action,  it
remains at rest until acted upon again; but it always acquires action
to  destroy disposition.
   We must make a material distinction between a disposition  and
an  action in diseases, for  what will cure an action will have no
effect on a disposition.
   Every machine is composed of very different parts, yet all tend
to  some ultimate effect.   Every machine, whether  natural, as an
animal body,  or constructed by art, however simple it may be, yet
is always composed of more parts than one; and it must be observed,
that no two parts have the  same action, although all are  tending
even in the most complicated, to produce some one ultimate effect,

  * [The disposition does not cease because the action has taken place, but be-
cause a new feeling, that of gratified revenge, has arisen in the mind, and taken
the place of the previous  disposition.  Had the blow of retaliation missed its
aim, the disposition would have continued, notwithstanding the action had taken
place, until a second and more effectual one had been given,  This mode of rea-
soning from metaphysics and false analogy is extremely unsatisfactory, although
K must be admitted, that many striking analogies exist between the powers and
actions of the mind and those of  the body, which  Hunter seems to have studied
with attention, and of which he has adduced some apt examples.]
  f [Or rather to  the sensitive principle, which he supposed to be 6eated in the
whole of the nervous system.]
                                6* 
66
HUNTER'S PRINCIPLES OF SURGERY.
   For instance, some machines of art are intended for the division
of time, as a clock, which  may be  so simple as to  perform  that
effect by one wheel, the effect being expressed by an index.   Some,
again, are much more complicated, all the parts,  however, being
employed to the same ultimate effect, namely, the movement of this
index, which expresses  the ultimate  effect;  and  the different parts
composing the clock may be called organs.
   So it is with natural machines ; some animals are so simple as to
have apparently but  one operation, and  that is support, and these
may be called one organ.  Others are complicated, being composed
of different parts,  whose actions  and effects  appear complete in
themselves, as the action of a kidney, a liver, &c.; yet all combine
to produce an ultimate effect in the machine, namely, the  preserva-
tion and continuance of the species.
   To produce  the ultimate effect  in any  machine,  there must be a
succession of actions,  one  naturally arising out of another, each
part taking on  the action  peculiar  to itself; the preceding action
being always the stimulus to the next succeeding one ; and thus the
parts go on acting in regular succession  until the ultimate effect is
produced, and then the  whole is at rest until stimulated into action
again.  In some parts  this is almost immediately, as in the heart,
organs of respiration, &c.; thus, when the heart has thrown out its
blood, it has done  its business; when  we  inspire  and expire, the
organs of respiration have done their business, but there is a ne-
cessity for a recurrence of the operation again, and so immediately
that it seems almost  constant.  But in others  there is a greater
distance of time before  the  action is renewed, as in hunger,  evacu-
ation of the faeces, urine, &c.
   An animal body so constructed, gives  us an idea of perfection,
for as each part  has its particular appointment, one should natu-
rally  expect equality or powers  suitable to  these  appointments
would be found through the  whole.  But this certainly is  not the
case, at least in the more complicated animals, whatever it  may be
in the more imperfect and simple.   We find this in the more per-
fect, where life depends for  support in the action of some one part,
as the heart; also where many actions of the animal depend on the
powers of another part, as the voluntary actions  on the brain ; and
not only the simple voluntary actions of  the  body depend  on this
viscus,  but  their  real  strength depends  on it,  for whenever the
power of the brain is taken  off, they waste; and this wasting does
not arise from the brain supplying  these  parts  with  nourishment,
and that being now  cut off they  lose their future support, but  it
arises from want of necessity  to keep these  parts in a  state fit for
action* wrhen action cannot take place,  because the will  cannot

  * [If the exercise of every part is its natural stimulus to perfection, as it cer-
tainly is, by exciting the natural actions of which every part is capable,  then the
want of exercise is the cause of this wasting. The same effect would equally be
produced, although the parts should  be supposed perfectly capable of executing
their proper functions  if called upon  to do so. The stomach that has lonor fasted, 
OF SUSCEPTIBILITY TO IMPRESSIONS, ETC.         67
now stimulate them to action; and the same thing takes place in a
proportionate degree when a joint is simply rendered, either wholly
or in part, unfit for motion, where no injury has been done to the
nerves.   Hence it must appear, that  as the power of support is in
one part of the machine, and the power of many actions in another
part of  the machine, it is possible that all parts of  the body may
not be equally served by the  first, namely, the heart;  nor equally
influenced by the  second, namely, the brain; and we do find that
the more distant parts from these sources of power are the weakest.
This, perhaps, is better illustrated in disease  than by any actions of
health.   We may just observe,  that all the vital parts are near the
one, and all the acute sensations near the other. In disease we see a
mortification arising in the extremities more than in the other parts,
and more  especially if the  person is tall, so that the  heart is not
capable of propelling the support of life to those distant parts in
such a  state  of the constitution.
   How far the blood may lose its power of nourishment before it
reaches the extremities,  I will not say.   If our acute sensations are
near to the brain, it is reasonable to suppose that proximity of parts
adds to the power of the nerves in communicating sensation; if so,
it is reasonable to suppose that proximity of parts will also add to
that power which the brain has over the actions of voluntary parts
 by means of the nerves.
   On Habit  and Custom.—Memory, or recollection  of past  im-
 pressions, has, I believe, principally  been applied to, or supposed to
 be an  attribute of,  the  mind only; but we know that every  part
 endued with life  is  susceptible of impressions, and also that they
 are capable of running  into the same action without the immediate
 impressions being repeated.  Habits arise  from this  principle of
 repetition of, or becoming accustomed  to, any impression, and the
 same thin* exactly takes place in the  mind.  The  memory of the
 body is of much shorter duration than that of the mind.  The mind
 not  only goes more readily into action the second time of an im-
 pression, though a considerable  distance of time has taken place
 since it went into the same  action before, but seems to take up the
 action with more ease, from merely  collateral causes, from a re-
 collection of the similarity,  or  often without any possible recollec-
 tion whatever, as if the actions, in consequence of the former im-
 pression, were taking place in  the brain  again.   This does  not
 appear to be so much the case with  the memory of the body, tor
 this only arises from immediate impression, but goes  into action a
  second time  more  readily  than at first.   Possibly, however, the
  action arising from the first impression may be repeated from some

  or the  eye which has long been  deprived  of light, lose the power of performing
  their ordinary functions just in the same manner that a joint which has  ong been
  confined in one position loses its suppleness and strength, and the) muscles waste.
  This tendency on the part of our author to suppose a sort of'intelligent^ un der-
  standing subsisting among  the different parts of the  body has  been already ad
  verted  to.]                                       , 
68
HUNTER'S PRINCIPLES OF SURGERY.
collateral or similar impression to  the  first; if so, it comes very
near to that of the mind, though not so strong.
  A gentleman rubbed in mercurial ointment for the reduction of
two buboes;  he had only used it a few times when  it affected his
Constitution so much that he was obliged to leave it off: he became
feverish, the fever being of the hectic kind, with a small quick pulse,
debility, loss of appetite, no sleep, and night sweats.  He took the
bark, with James's powder.  As the effects of the  mercury went
off,  and his buboes were advancing, it was necessary to have re-
course to mercury again;  he now  rubbed  in a considerable quan-
tity without its having the least effect on his constitution or mouth;
but  the buboes spreading, made  me order it to be left off again, and
they were opened.  He had recourse to the ointment the third time
without its producing any disagreeable effect.  The buboes took
on  a healing disposition,  but then became stationary.  I  ordered
him to leave off the ointment, to go to the  sea, and bathe, and then
they began again to  heal.   In  about three  weeks it was thought
necessary to rub in again :  when he began, it almost immediately
affected his mouth very violently ;  he left it off till his mouth was a
little better, when he began for the fifth  time, and it had not  so
much effect, and he was able to pursue the  mercury.  Now in this
case he had lost the  mercurial habit during the time he was  at the
sea, the parts had forgotten the mercury  altogether, and the mer-
cury coming on such a state of constitution, produced the same
effect as it would have done if he had  not taken mercury.  So that
the body had, as it were, lost the remembrance of the effect  of the
mercury on it in so short a time;  but the  mind would not have
lost it.
  Custom  is with me the negative of habit; by custom comes an
insensibility to impression, the impression diminishing although the
cause  is the same, and the parts becoming  more and more at rest;
whereas from habit  there comes an increased facility to go into
action, as  also an acquired perfection in the action itself, the im-
pression continuing the same though the cause is diminishing.
  These may be  reckoned as  secondary principles in an animal,
and produce two very opposite effects,  both  according to their
modes of impression.
  Habit is the continuance of actions  we have been accustomed to
produce, without  any immediate assistance, or even  continuance,
of the  first cause, as a body set in motion  continues to move after
the cause of motion has ceased to act.
  Custom  arises from  external impressions, either  in the mind or
body,  and is of two kinds, one when, the cause  continuing, the im-
pressions and consequently the actions, are diminished, the parts
becoming habituated to the impression.  We shall see the  effect of
this in our applications.   If we apply a medicine to a sore,  Which
shall affect it in one way or another, (it is immaterial which  for the
principle, but we will suppose it heals,) from becoming accustomed
to that application, it shall lose  the impression, and  shall at last do 
           OF SUSCEPTIBILITY TO IMPRESSIONS, ETC.         69

nothing;  therefore you will be obliged to make  the  application
more stimulating, more active, or change it for something else.   It
is exactly so with the mind; if a man goes into a strange place he
is affected by the new objects about it; the next time he goes he is
less struck; the third time less, till at  last, when he goes into the
place he can hardly perceive anything  strange in it.   These very
different effects  arise from a difference in the degree of impression
resulting from  the state  of the mind or body  at  the time.  In
the first instance, if the  impression or  cause  be  very slight, so
as hardly  either to alarm  the part or the constitution, they will
get familiar with it, and will become insensible to  it; a ring on
the finger,  the  use of snuff, our  very clothes,  and physic itself
are striking and daily instances of this.  The habit of insensibility
will  soon be formed  if the sensations  of the mind  and body be
not very acute.  If  the  first  impression be  violent, and such as
produces considerable effect, it is not necessary that the  same
degree of violence should  be  inflicted to  produce a similar  effect
the second  time.  One can easily imagine that  these  impressions
may  be continued until the parts continue to act without the im-
pression, which would then become habit.  If a dose of an  emetic
be given, which affects the  stomach much, the same quantity  is not
necessary a second time to produce the  same effect;  the  second
must be given, however, before the stomach has lost the impression
of the first perfectly.*
  The same effect is produced on the mind  as on the body, for
whatever  has made but a slight  impression, soon wears out, and
we think no more upon it.   On the other hand, if an animal has
met with anything that has affected its mind much, as fear,  &c, it
is not necessary for the object to appear  in  the  same  manner to
produce a similar effect.
  Those  effects will  be more or less, according to the state of the
body or mind at the  time of the first affection; the more  irritable
or the more ready it is  to  fall into the first action at the time, the
more readily will it take it up  the second time, although it may not
be particularly irritable or susceptible of this  particular action.
  Habit.—A habit of acting arises  from a repetition of acting, which
repetition of acting is custom, and which becomes the cause of the
continuance of the same action.  So that custom is always prior to
habit, or, as it were, forms habit,  which may be ranked as one  of
the secondary principles in the machine.

  * [This arises partly from habit and partly  from the fact that the emetic has
produced an irritable state of the stomach, which renders it more susceptible of
the action of any irritant.   It would appear that mere impressions, or the passive
part of habits (called by Mr. Hunter custom), always diminish in intensity by
repetition, but that the actions or thoughts that are put in train by those  impres-
sions recur more easily the oftener the impressions are repeated.  The reader
who is desirous of pursuing this subject is referred to Bishop Butler's admirable
treatise on the Analogy of Natural and  Revealed Religion, Part I. Chap. V., a
book which, like Hunter's Treatise on Inflammation, was the product of upwards
of twenty years' labour, and  is stamped  in every page with characters of the
most profound genius.] 
70
HUNTER'S PRINCIPLES OF SURGERY.
  The first action being produced by a disposition in, or force upon,
the part, this being repeated or continued a sufficient length of time,
the action  at length goes on, when that original disposition or force
is gone, until some other power counteracts it, or it wears itself out.
The more  we have been in the habit of thinking on any  object, the
more readily does the train of thinking relating to that object occur.
This princip'al in the animal is  similar to the vis inerticn in matter,
for by it a  motion begun is continued, and their remaining at rest is
from the  same cause.   This  principle  becomes the  cause of the
actions of the mind; it does not allow men to think differently from
what they have  been accustomed  to think.    Men in general  go
through life with the same modes of thinking, and thus it becomes a
cause either of the retardation or improvement of the understanding.
It retards  improvement, because it gets the  better of  even present
sensations, and does not allow men to wander into novelty.  It
promotes improvement, because it makes men perfect  in what they
have been  long employed about.
                        CHAPTER VIII.

                    OF  THE  HEAT  OF ANIMALS.

The principle of heat a great principle of action in nature;—nature of, unknown;
  —opposed to cold ;—unequal distribution of on the earth ;—measures of sensi-
  ble heat;—absolute heat  of bodies,  unknown;—of  the sensation of heat;—
  destructive when in a high degree, as is cold.—Natural heat of animals capa-
  ble of diminution without loss of life;—certain functions first cease ;—propa-
  gation of the species first;—digestion in some animals, as reptiles.—All animals
  endowed with heat,  but in different degrees ;—erroneous notions of its causes ;
  cases in which  the function was remarkably deranged ;—experiments, showing
  the power of animals to generate heat in proportion to the necessity;—order of
  cessation of functions from cold;—diminution of heat during sleep.—Experi-
  ments on hedgehogs.—Heat of lower animals varying with temperature of the
  air.—Standard  heat  of higher animals not exact.—Experiments to  ascertain
  whether cold acts as a stimulus  to the production of heat.—Resistance to ex-
  ternal heat;—experiments;—those by Fordyce.—Observations  on animals
  having a standard heat;—differences in the capability  of different animals to
  produce heat.—On  differences of climate resulting from temperature;—other
  causes also act.

The principle of heat is one of the first principles of action in nature;
it is that which unlocks matter, and allows it to  act according to its
natural properties, or  according to  its combinations.   It may be
even said to compel matter to action.  But that  idea arose, I imagine,
more  from  the effects  which extreme heat has both on our  sensa-
tions, and its immediate effects on our bodies seeming to  produce a
species of violence, for we do not annex this idea to moderate heat,
although moderate and  immoderate heat act on the same principle 
OF THE HEAT  OF ANIMALS.
71
of putting matter in such a position that certain actions in the matter
must take place, all which arises  from the nature of the part heated.
How far it is an active principle is  not easily ascertained, though
we must allow it has every appearance of being one.
   The term  heat meant originally simple sensation,  arising from a
property of matter capable of producing  that sensation, which is
only an effect of  that property.   But  philosophers having  inquired
into the  causes and effects of  this matter, have, from a poverty of
language, applied the word which was at first only expressive of a
quality  to the  thing itself,  so that by heat now is also meant  the
matter of heat abstracted from the sensation which it occasions.*
This is so much the case, that Dr. Blackt  makes use of the term
latent  heat  to signify that heat which a body contains without
imparting it to the  senses, as we  might call the water which goes
into the  formation of salt latent water:  in other words,  that water
which the salt contains without losing its solidity.
   It has been much disputed whether  heat  is matter, or only a pro-
perty of matter.  If it is simply matter, then, wherever there is heat
there must be that matter present.   If heat is a property of matter,
there  must  be both matter  and property present.   If heat is only
an action in a particular matter, then there  is that matter with
its action,  as also the body which  throws this matter  into  the
action.^
   Heat and cold are opposite principles, and cannot inhabit the same
place.§   They occupy  different parts of  the globe, and  in some
places alternately ; these, therefore, are subject to the variations of
temperature, which cause varieties of  climate.  These will be further
 spoken of hereafter.
   Heat, although  not equally  distributed all over  the globe, yet

   * [The sense of this  inconvenience has given  rise to the  general  use of the
term caloric for the agent which produces the sensation of heat.]
   | [In connexion with the name of Dr. Black, we may mention that  it was not
until this able philosopher had completed his train of researches on the subject of
heat that the true theory of respiration  began to be understood, or  the  connexion
 which  subsisted between this function and the production of animal heat.   Pre-
 vious to this time the  lungs were considered  merely as the agent for cooling the
blood.]
   X [Whether heat consists of a highly attenuated  subtle matter which pervades
 all things, or of a vibration among the atoms  of matter, has not yet been decided.
 Its leading feature is evinced in the repulsion which it produces among the par-
 ticles of matter, in which respect it is the proper antagonizing force to attraction.
 Whatever it is, we do not know anything of the principle itself, or of the manner
 in which it produces its effects.
   The subject of animal heat  occupied  a great deal of Mr. Hunter's attention, in
 consequence of which he made it the subject of two express papers in  the Philo-
 sophical Transactions, besides recurring to it again very  fully in the Treatises on
 Inflammation and the Animal OEconomy.  The reader is ieferred to these works
 in the third and fourth volumes for fuller information.]
   § [Cold was formerly thought by philosophers to be a positive  principle, like
 heat, instead of a mere negation  or absence  of heat, as it is at present almost, if
 not quite, universally considered.  It is in  the former view that Mr.  Hunter
speaks of it.] 
72
HUNTERS PRINCIPLES OF SURGERY.
exists in such a degree as to pervade all matter, and is therefore to
be found in some proportion everywhere.  Heat destroys attractions
of all  kinds, by which means it becomes the principle of fluidity,
and  consequently the reverse of the cohesive attraction, or principle
of solidity.   By means of this effect, motion is allowed to take place
among the particles of matter.   We have no other idea respecting
the variations  of heat, except as regards quantity.   The  quantity
of heat has always been estimated by some  visible effects, at first
probably by our sensations alone, but afterwards by its effects on the
expansion  of bodies, especially of metals,* all of which is called sen-
sible heat.   But it  has been discovered lately that many bodies
retain more heat than can be  made sensible by any of the commonly
constructed instruments; therefore a body may have  the matter of
heat in it without its producing  any sensible effects.   Hence  heat
has  now been divided by some into  sensible and absolute heat.  It
may be possible that many bodies  may have their whole heat made
sensible: if so, then their sensible  and absolute heat are  the same.
But  it is most probable that the absolute heat of a body can never
be known, for  the measure of the quantities of heat from every expe-
riment is always by  sensible heat,  which can never be a proof of the
absolute heat in a body.
   The real increase of heat  must alter  the position of parts so  as
to produce the sensation called heat; and as this heat is diminished,
the  texture  or position of the  parts is  altered  the contrary  way,
which, when carried to a certain degree, becomes the cause of the
sensation  of cold.    Now these  sensations could not take  place
without a real increase or decrease of  heat in the parts.   When
heat is applied to the skin, it becomes hot in some degree, according
to the application.  This may be carried so far  as actually to  burn
the  living  parts.  On the  contrary, in  a cold atmosphere a man's
hand shall become so cold as to lose  the sensation of cold altogether,
and  change for that of pain.t

  *  [It has lately been discovered that minute variations of temperature, utterly
inappreciable by the ordinary instruments founded on the principle of expansion,
may  be rendered evident and estimated by  means of electro-magnetical currents,
which are found  to traverse certain arrangements of the metals when unequally
heated.  The degree in which the needle deflects from its mean position indicates
the quantity of caloric which has entered the heated body, and may be measured
by an index of degrees.]
  f  [It is improbable that the sense of heat and cold  depends simply  on an
"alteration in the [texture or]  position of  the parts," for if this were the case
the same temperature, by inducing the same condition of parts, should always
produce the same sensation, although it  is well known that this is far from being
the case. What to one hand, just removed  from a vessel of hot water, feels very
cold, shall feel very hot to the other hand just removed from a vessel of cold
water; or a  part shall feel hot or cold when the reverse of these  states is actually
present.  The sense of change, or the intensity of the impression, is estimated in
relation to the previous state rather than  to its absolute quantity, or else depenJ9
on some peculiar and morbid condition  of tqe sentient  organ. Thus, the eye
which has long been secluded from light is oppressively affected by the common 
OF THE HEAT OF ANIMALS.
73
  Real heat and cold may be carried so far as to alter the texture
of parts on which the actions of life depend.  Nature has allowed
the heat of most animals to come much lower than the heat neces-
sary for performing  all their natural functions.  This is most so in
the more imperfect animals, although it exists in a considerable de-
gree in those possessed of a  better regulated standard of heat, as
the most perfect.
  This answers the  wisest  purposes, for by allowing  the heat to
come to that degree  in which many actions are suspended, or anni-
hilated, the state of the animal is adapted to the state of the atmo-
sphere, which is such as would render the  effects of those actions
unnecessary or of no effect.
   The first  action that  is suspended is the propagation of the spe-
cies ; for if birds were to  hatch, or animals  to  bring forth their
young, in winter, there would soon be an end to propagation in the
temperate and frigid zone, as animals in general only breed once a
year.
   Cold also annihilates the powers of digestion in all those animals
whose food is rendered impossible to be procured in the winter, and
which have not power of emigration, such as frogs, lizards, snakes,
bats, hedgehogs, &c.
   The power of generating heat was the first considered; the pos-
sibility of generating cold  being hardly suspected, because most
people who made observations on this  subject lived in an atmo-
sphere colder than their own body.  They observed, that in almost
all animals there was a standard of heat, which in common language
has been called blood heat.   However, they extended their obser-
vations a little further, and  called a certain number of animals the
cold-blooded animals, but made no experiments either to ascertain
the effects or the principle on which they depended.
   If we  examine  any class  of animals, we shall find them, more or
less, endowed with this principle, though varying from one another
very materially in this respect.  The heat of the human body being
always considerable, even in the coldest climate, it  has necessarily
attracted a good deal of the attention of philosophers and physiolo
gists, and various have been the opinions which they have formed
respecting its cause.
   Friction  being a cause of the production of heat in many bodies,
 was supposed to be  the cause of heat in animals, especially, too, as
 they thought it could be easily explained on this principle, for they
observed there was sufficient motion in the body for such an effect,
 which motion was principally that of the blood.   They calculated
 the size  of  the internal surfaces of the arteries, which increases as

 light of day; and the same thing may be asserted of stimulants and their effects
universally.
   It is a singular fact that excessive cold should produce effects very similar to
 those produced by excessive heat. Frozen  mercury, for instance, occasions a
 sensation of  burning, and destroys the life of the part  which touches it if the
 contact is prolonged only a few seconds.
                                7 
74
HUNTER'S PRINCIPLES OF SURGERY.
they divide.   They  calculated the  size and number of  the  red
globules;  all of which furnished  an amazing extent of surface for
friction; and when they calculated the velocity of the blood moving
on this extent of surface, as also  of the globules on one another,
they thought they saw a sufficient cause for  the heat of the body,
especially as they saw that when this motion was increased, as in
fevers, the heat was to appearance greater.  But we may say at
the same time, that they did not  see the objections to this theory,
which  are many.
  Dr. Stevenson* observed, that  there was another cause for the
production of heat  besides  friction, viz. fermentation, and on  this
principle he accounted  for animal heat.  But  the fermentation of
animal substances does not produce heat.
  The superstructure built on the foundation that the  friction, from
the motion of the blood, is the cause of animal heat, falls immedi-
ately to the ground on the observation that fluids have no power of
generating heat; nor have two solids, if  kept asunder by the inter-
vention of a fluid of any kind.  If this had not been a fact, still fric-
tion probably would not  have accounted for all the  variety in the
production of animal heat.  Nor could the principle of fermentation
account for all the phenomena which attend the heat of animals;
therefore  some other principle must be referred to as  the cause.
  It being discovered that the absolute heat of bodies differs very
much in different substances, and perhaps in the same substances
differently combined, it was thought that this would account for the
production and continuation of animal heat.   It is supposed that the
air which we inspire has  much more absolute heat than the same
air has when we expire it, and that the superabundant heat  of the
inspired air is given to the animal.  But this  chemical method of
accounting for heat  will not account for all the varieties in the  heat
of animals at different times, especially in disease, when the breathing
does not equally vary or correspond with the heat of the animal.
  A remarkable case fell under  my observation of a gentleman
who was  taken with an apoplectic fit.   He lay insensible in  bed,
covered with the blankets.  I found his whole  body would become
extremely cold in every part, and continue so  some time,  and in a
short time would become  extremely hot.  While this was going on,
several hours alternately, there was no sensible alteration either in
the pulse  or the breathing.
  A man  fell from his horse, and pitched on his head, and produced
all the  symptoms of a violent injury.  There was concussion and
perhaps extravasation of blood, but no fracture could be seen.  The
pulse was at first 120°, but came to  100, and sometimes to 90, and
  * [Edin. Med. Essays, vol. y. Part II. p. 806, et seq.   These Can only be re-
garded as specimens of  the opinions and modes of reasoning adopted by the me-
chanical and chemical physiologists of the last and the preceding centuries, to
the subversion of which  the efforts of Hunter, united with those  of Haller, Stahl,
and Cullen, mainly contributed.] 
THE HEAT OF ANIMALS.
75
was strong, full, and rather hard.  He was very hot in the skin, but
breathed remarkably slow, only half the common frequency.
  His breathing, pulse, and heat therefore did not correspond with
this theory of heat.
  February, 1781.—A boy about three years  old appeared  not
quite so well as common,  being attacked with a kind of shortness
of breathing in the night.   It had become exceedingly oppressive
about five o'clock on Sunday morning, so difficult that he appeared
dying for want of breath.   In this state he lay till ten o'clock
when I saw him.  He was breathing so slowly that I thought every
breath would be his last, about two and a half inspirations, or even
less, in a minute.   (The common rate of breathing in such a  boy
is about thirty inspirations in a minute, and about twenty in a man.)
When he drew his breath it  was with a jerk;  but  his expiration
was extremely slow, generally  continuing through five seconds.  I
 often could not distinguish the  pulse, at other  times  it  was very
 manifest, although very faint and slow, not more than sixty.  On
 tying up the arm the vein did not rise in the least, so that the blood
 did not go its round.   His eyes were turned under the upper eyelid ;
 while his body had a purple cast, especially the lips, which is easily
 accounted for,—it was owing to the blood not getting the scarlet
 red in its passage through the lungs,  and whatever  it might get
 there was lost in its slow motion through the arteries of the body.
 He had a fine warmth on the skin all over the body, although  in a
 room without a fire,  not covered with more clothes than  common
 in the month of February, with snow falling at noon.
   Here it cannot be said that the heat of the body, which was neither
 great nor deficient, could arise from the constant supply furnished
 by  respiration.
    It appears from the  account given  in the Philosophical Trans-
 actions  of the experiments made in the heated room, under the
 direction of Dr. George Fordyce, that Dr. Cullen long ago suggested
 many arguments to show thaf life itself had a power  of generating
 heat, independently of any common mechanical or chemical means;
 though  we may observe, that the  experiments  here related  only
 tend to  show the power of  producing cold,  which they effec-
 tually do.
    I own I had formed an opinion  on this subject.   I rather sup-
  posed that animal heat was owing to some decomposition going on
  in the body, and in pretty regular progression, though not the pro-
  cess of fermentation.
    In consequence of an experiment  made on two carp, to explain
  another principle  in the  animal economy,  (where every common
  action  was meant to be wholly suppressed,  or so far  suppressed as
  to render them incapable of producing heat,) I found an  effect pro-
  duced  while the animals were  under the experiment which I did not
  suspect.   I began, in consequence, to suspect some  other cause of
  heat than the common or natural actions of an animal; for during
  the experiment I observed a remarkable reproduction of heat taking 
76
HUNTER'S PRINCIPLES OF SURGERY.
place in these two animals.  Until this time I had not an idea that
there was a possibility of calling the principle forth,  or that cold
could excite it.
   Experiment.  In the year 1766 two carp were put into a glass
vessel with common river water,  and the vessel was  put  into a
freezing-mixture.   The  water surrounding the  fish  froze very
rapidly on the inside of the glass  all  round.   When  the freezing-
process approached the fish it became, as it were, stationary ; and
the remaining water not freezing fast  enough, in order  to make it
freeze sooner, I put in as much cold snow as made the whole thick.
The snow round the carp melted.   I  put  in  more  snow,  which
melted also. This was repeated several times, till I grew tired, and I
left them covered up to freeze by the joint operation of  the mixture
and the atmosphere.   After having exhausted the whole power of
life in the production of heat, they  froze; but that life  was gone
could not be known till we thawed the animals, which was done very
gradually.   But with their flexibility they did  not recover  action,
so that, they were  really dead.  Till this time I  had imagined that
it  might be possible to prolong life to  any period  by freezing a per-
son in the frigid zone, as I thought all  action and waste would cease
until the body was thawed.  I thought that if a man would give up
the last ten years of his life to this kind of alternate  oblivion and
action, it might be prolonged to a thousand years: and  by getting
himself thawed every hundred years, he might learn what had hap-
pened during  his frozen condition.   Like other schemers, I thought
I  should make my fortune by  it; but this  experiment  undeceived
me.*
   This  experiment laid the basis of many of my  future conjectures
on animal heat.
   I think  we  may observe in the  common occurrences of life that
for the actions of an animal a certain  quantity of heat is necessary;
and this quantity I find to be  in some degree according to those
actions, the greatest degree of heat being  always wanted  for the
least essential action in every order of animals.   However, every
order of animals in general requires a heat peculiar to itself, though
not always so, some  admitting of a much greater variety than
others even of the same order, as  in the insect tribe.
   The actions of an animal may  be placed in the following order
with respect to its heat, which is the inverse order to that of their im-
mediate use in the machine.   Propagation  first;  digestion; sensa-
tion, in which maybe included wakefulness ; secretion ; circulation;
each requiring its degree of heat for complete action.   Propagation
  * [Blumenbach observes that the pupa? of many insects are in winter so tho-
roughly frozen as to ring like glass or icicles when allowed  to drop on the
ground, and  yet without any injury to  the  torpid animal  within.  "The
eggs of silkworms and butterflies  hatch after exposure to a cold  of 24° below
zero. On the other hand, insects may be frozen repeatedly, and  recovered as
soon as thawed." (Elliotson's Physiology, p. 247.)  This faculty of enduring
cold is infinitely  less surprising than that referred to by the last-mentioned au-
thor, which allows beetles and  other insects to survive being boiled.  See note.] 
OF THE HEAT OF ANIMALS.
77
requires the  greatest, digestion  may be carried  on with a  degree
less, secretion in two degrees less than propagation, and so on.
  In the insect tribe there is a difference between  a bee  and a
wasp and  many flies.   A bee at  all times requires a heat  above
90 (?)  degrees* to support life with  ease, while  a wasp  can allow
its heat to vary with the atmosphere without losing life.
  When the external heat is so much  diminished that it does not
assist the natural powers of  an animal, and it is obliged  to vary
its proper standard  and become colder, then  many of the actions
are either lessened or totally suspended, not being necessary: gen-
eration is suspended, and insensibility takes place, commonly called
sleep ; but it is not sleep.  Sleep  is  an effect which takes place in
all degrees of  heat and  cold, though when a  man is  asleep he is
colder than when he is awake, and I find in general the  difference
is about 1§ degree, sometimes less.f   This difference  in the degree
of heat between sleeping and waking is not the cause of  sleep but
the effect; for many diseases produce  a  much greater  degree of
cold in an animal, without any tendency  to sleep.  Besides many
of the  operations of perfect health are going on in the time of
natural sleep, at least in the perfect animals, as digestion, secretion,
&c, while none of these operations are going  on  in  the tribes
called sleepers during their torpid state.}:   In these animals,  where
a great many  actions  are suspended, it appears an effect  arising
from a certain degree of cold acting as a sedative.
  Now this  degree of cold in some cases seems to act as a stimu-
lant ;  the animal powers are roused to action  for self-preservation.
It is probable  that  most animals are under  the  influence of cold,
and that every order has its degree  of cold in  which many of their
actions can  be suspended
   In some countries, where there is  summer  and winter, there  are
some  animals whose  actions are  suspended  during  the   winter.

  * [Hunter found the thermometer rise to 93° or 98° in a hive of bees in spring;
to 104° in summer; to 82° when the air was at 40°, and to 73° in winter. (See
his Paper on Bees in Vol. IV.)]
  f [There is  the same  close relation between the ordinary sleep of animals in
general and the ordinary sleep of hybernating animals,  as there is between  this
last and absolute torpor.  In the 1st, the respiration is  diminished and the tem-
perature lessened 1^°; in the 2d, the respiration is still further diminished, and
the temperature reduced to within a few degrees of the external medium; and in
the  3d, the respiration is altogether suspended, and the temperature reduced to
the surrounding medium.  Cold is evidently a predisposing cause to  all these
states.  Cuvier, however, has remarked that in some warm latitudes, as, for ex-
ample, in the Isle of France; there are certain animals  which fall into a state of
torpor only during the hot months.]
  X [There is  a good deal of difference in thi9 respect in different animals.  The
hedgehog and  dormouse awake every three or four days  when the weather is
mild, and during the interval of activity pass the urine and faeces freely, which
could not be the case if they did not digest and secrete  during their state of tor-
por.  This has never been observed of the bat, because the bat is an insectivorous
animal, and would awake in vain  if there were no insects.  The circulation,
however, is continued even in the  bat at the rate of twenty-eight strokes in the
minute during the state of torpor.   (See Phil. Trans., 1832.)] 
78
HUNTER'S PRINCIPLES OF SURGERY.
This suspension of several of their actions seems natural  to them,
being part of the economy of such animals.  In other  animals,
where a suspension of several of their actions takes place from cold,
it seems a force on those  actions, as it  rather seems to lead to the
destruction of the animal than the preservation of life.  We cannot
give a stronger instance of  the forcible power of the suspension of
actions in animals from cold than what happened to  Dr. Solander
and others in their voyage round the world.
  Returning  from a hill in  Terra del  Fuego, they wrere suddenly
surprised with a degree of cold beyond what they ever felt before.
Dr. Solander advised that they should immediately make their way
to the ship as fast  as possible, and he himself would bring up the
rear.  However unnecessary it  might  appear, Dr.  S., who had
crossed  the mountains in Switzerland, well  knew the  danger of
being left, and told them that they would soon be  attacked with an
almost irresistible  propensity to sleep ;  that whoever gave way to
the  feeling would  sleep, and whoever slept would die.  But after
this very serious caution, the doctor was the first who felt the sen-
sation he described, and could scarcely be  persuaded by the united
efforts of Mr. Banks and the others to proceed.  Mr.  Banks's black
servant, Richmond, was the next  whose desire of sleep was  very
great, so much so that, notwithstanding the consequences, he begged
that he might be left to die.  The Doctor only begged  to sleep a
little, and  promised that he  would then  proceed.   Mr. Banks, find-
ing the case grow more serious  every  moment, sent  forward four
of the company to the first place where they could light a fire, the
rest staying and endeavouring  to  bring up the few who had lain
down.   The  Doctor was awaked, but  their efforts were  less suc-
cessful on poor  Richmond.   In the midst of their  endeavours to
rouse him, they felt the same symptoms stealing on themselves very
fast; it  was in vain to attempt carrying, every one being  scarcely
able to  carry himself.  Having proceeded  about a quarter of a
mile, they met two of their  party with the  welcome news  of a fire
being kindled at the distance of half  a  mile.  These two were des-
patched in search of Richmond.  Having warmed themselves, and
becoming apprehensive for  the fate of the two, a party set off in
search of them.  They had  missed their way, and become victims
to the malady from which they had endeavoured to restore the black.
Richmond was found just crawling, and  brought back, but no means
had the  least effect on the other two.*
  *  [Many thousands of Napoleon's army are reported to have perished nightly
from the same cause during the retreat from Moscow.
  Sir B. Brodie classes the effects of cold in the following order:
  "1st, It lessens the irritability and  impairs the functions of the whole ner-
vous system.
  " 2d, It impairs the contractile power of the muscles.
  » 3d, It causes contraction  of the capillaries, and thus lessens the super-
ficial circulation and stops the cutaneous secretion.
  "4th, It probably destroys the  principle of vitality equally in every part, and
does not exclusively disturb the functions of any particular organ."
                   (MS. Notes of Lectures by Sir B. Brodie apud Paris.)] 
OF THE HEAT OF ANIMALS.
79
  Winter.—I took two hedgehogs, not full grown, from their huts;
the  weather for some days preceding had been severe and frosty;
the  heat of the atmosphere was 44°.  In one the thermometer was
introduced at the  pelvis, and the mercury stood at 45°; and at the
diaphragm at 48°.  In the other I found the heat  in the pelvis 46°,
and at the diaphragm 50°.
  The degree of  heat of these  animals being so low, it was com-
pared with the heat of a puppy.  The heat of the atmosphere during
this experiment being  50°, a thermometer was  introduced into the
belly and  pelvis of the puppy ; the mercury stood  at 101°, and also
at the  diaphragm.
  Summer.—Atmosphere at 78°.  A thermometer was introduced
into the belly of a freshly-caught hedgehog.  In the pelvis the mer-
cury rose to 95°, at the diaphragm to 97°.
   From the foregoing experiments we find that the temperature is
allowed to fall lower than the standard, which is productive of no
evil excepting suspending such functions as require the standard
degree of heat for their actions.
   Animal matter endowed  with the  living principle, whether en-
dowed with action or not, or whether of the first or second order
of  animals, as far as I am  acquainted, admits of the temperature
going somewhat  lower than would serve for the congelation of the
same  matter in a dead state.
   The more imperfect animals vary their heat  according to the at-
 mosphere in some degree.
    I made the following experiments on fowls, which I considered to
 be one degree above the amphibia, and one degree below what are
 commonly called quadrupeds.                      %     .
    I introduced  the ball of the thermometer successively into the
 rectum of several  hens, and found the mercury  at 103°, 103£ , or
 104°.   Cocks furnished the same  results.  In hens during incu-
 bation the heat was the same.   Living  eggs  under the same hens
 raised the thermometer to 99°; an addled egg only to 97 .  bo
 that the  living egg had  some power of generating heat.   In  the
 more perfect animal, as the fowl, the heat is not allowed to come
 so low as in the  more imperfect.                   _
    The power of generating heat keeps the higher  animals as near
 one standard as possible ;  but it was not  necessary that this stan-
 dard  should be very exact,  therefore we find that they are in some
 degree influenced  by external heat and cold, somewhat similar to
 inanimate matter and the more imperfect animals.*
    As parts recede from the common mass, as extremities, fingers,

    * [In  the more  perfect animals the temperature of the vital parts is.more
 easily elevated above the natural standard than depressed below it.  Thus, it
 was found in Capt. Parry's second voyage, that out of sixteen foxes, which were
 Slea while the Lrmornete, was from 3° to 32° below zero, the *"V$™«
 eleven varied from 100° to 106}° ;  and so  in other cases it has been obswjed
 that the temperature of the blood at the heart bears no relation to the external
 cold ; a fact which cannot equally be affirmed in regard to neat. J 
80
HUNTER'S PRINCIPLES OF SURGERY.
toes, the combs of cocks, &c, they are more subject to be affected
by cold, and will  raise or sink the thermometer in some measure
according to the external  degree of heat or cold applied ; though
not in a proportional degree to this  application, as would  be the
case in inanimate matter.
  I put the ball of the  thermometer under  my tongue, and  kept it
there for some minutes, when it rose to 97°, but would not go higher.
I then took several pieces of ice and put them in the same situation,
allowing them to melt.  This I continued ten minutes, and found on
introducing the thermometer that  it fell  to 77°, and gradually rose
again to 97°.
  I thought the urethra would do  still better, and I introduced the
ball of a thermometer into a man's urethra.  At one inch from the
extremity  the mercury rose to 92°, at two inches to 93°, at four to
94°; at the bulb of the urethra  it rose to 97°.   Thus we see that
projecting  parts are subject to have their heat  lowered  by sur-
rounding cold.
  To render this  experiment  more  conclusive, I endeavoured to
render this part colder by applying a colder medium to the penis than
the common situation.  This part was immersed in water at  65° for
a minute.   The thermometer, introduced an inch and a half, rose
to 79°.
  To find if there was any difference in the quickness  of  heating
and cooling between living and dead parts, as also what difference,
I made the following experiments.
  I procured a dead and a living penis:  the heat of the living penis,
an inch and a half in, was 92°.  I heated the dead one to the same
degree, then immersed both in water at 50°.  The dead one  cooled
fastest, but only two or three degrees ; the living one coming down
to 58°, while the dead one came down to 55°.   I repeated the same
experiment several times with the same  result.
  The standard heat of the human body is about 99, and I believe
that degree is  pretty regular;  however, this  regularity in some
degree arises from  there being in every  body a considerable mass
of matter  which causes less consumption of heat.  This standard is
necessary for the more material actions  of life.
  The heat of the more imperfect animals is not the same in every
part of the body, even when there  appears an equal mass of matter.
To ascertain this,  I took a healthy dormouse, the atmosphere being
at 64°.  I put the thermometer  into the  belly, nearly in the  middle
between the thorax and the pelvis; it rose to 74°: at the diaphragm
it rose to 80°, against the liver to 81^°
  As there is some difference between the heat of an animal at the
source of the circulation and that of the  mouth, pelvis, and rectum,
we must make an allowance in  judging  of the heat of the heart by
that of these parts.
  I next wanted to ascertain if cold applied to an animal would act
as a stimulus, and therefore greater heat  be  produced than the
common  standard. 
THE HEAT OF ANIMALS.
81
  I took a healthy mouse,—atmosphere 64°,—introduced the ball of
the thermometer between the thorax and pelvis.  The mercury rose
to 74^°, at  the liver to 8150.   I put the mouse into an atmosphere
at 30°, and when the ball was again introduced into the belly the
mercury rose to 92°,  at the  liver 93°, the animal being  still very
lively.  Here was an increase of 17£° in the belly, and llf at the
liver, and this produced by the application of cold to the skin.
   Of the Resistance to foreign Heat above the standard.—We have
found that animals evidently possess a power within themselves of
producing heat when in a cold atmosphere, so as to keep their bodies
in a temperature suitable to  the  economy of the animal.  But as
animals are often placed in an atmosphere much hotter  than their
standard heat, I wanted next to  see how far they have a cooling
power, or, if they have not, to what degree the heat of an animal
might be increased, and wThat  might be the consequence of that in-
crease, supposing it possible; for a priori we should suppose that
the standard heat, or that heat at which all the animal functions are
best  carried on, would be the medium heat of the animal.  But I
find from experiment that the  standard is generally within a degree
or two of the ultimate  heat that the animal can bear.  As allowing
the heat to  rise above the standard could answer no wise purpose,
Nature has  put a check to it by making the stimulus of heat the
 cause of its own annihilation, just as the stimulus of cold produces,
 on the other hand, an  increase of heat.*
   This would appear  to take place in two different ways:  one is by
 evaporation, which arises from the action of the living powers; and
 the other  by an immedate power of destroying heat.   So that
 animals have two means of destroying heat, while it would appear
 that they have only one for the production of it.
    I put a viper into an atmosphere at 108°, and allowed it to stay
 in seven minutes, when the heat in the stomach and anus was 92£°,
 beyond which it could not rise in the above heat.
    The same experiment was made on frogs with nearly the same
 success, t
    I now tried to what degree of heat I could bring a more perfect
 animal; and as I found the penis the best part for trying the experi-
 ment with cold, I imagined it would be the best for the trial of heat.
 The experiments were made in the same manner with the former,
 only the water was now hotter  than the heat of the man.  These
 were only simple experiments, but I chose to make a comparative
 one with a dead penis.
    A living and dead penis were immersed in water gradually made
  warmer and warmer, from 100° to 118°, and continued in this heat

    * [The cause of animal heat is considered in  the Treatise on  Inflammation,
  Part II., chap. iii. sect. 3; and the mode by which the temperature is regulated,
 at sect. 4.  The reader is referred to this part of the Work, as well as to the
 author's paper on this subject in Vol. IV.
   f [According to De la  Roche, the temperature of frogs does not rise above
 80^ to 82° in a medium of 110° or 115°. (Journ. de Phys., torn, lxiu.)] 
82
HUNTER'S PRINCIPLES OF SURGERY.
for some minutes.   The dead penis raised the thermometer to 114°,
while  the  living could  not raise  it higher  than  102i°.   It was
observed by the person on whom  the  experiment  was made, that
about  a minute  after the part was put in water the water did  not
feel hot, but on the water being agitated it felt so hot that he could
hardly bear it.  On applying the thermometer to the sides of  the
living glans, while in the water, the mercury fell from 118° to about
104°, while it did not fall above a degree when put close to the dead
penis, so that the living glans produced a cold space of water about
it.*  This  experiment  may furnish a useful  hint about bathing in
water, whether  colder or warmer than  the heat of the body;  for
if it is intended  to be  either  colder or hotter, as it will soon be of
the same temperature with  that of the body,  the patient, if in a
large bath, should move from place to place, and  in a warm bath
there should  be a constant  succession  of  water  of the  intended
heat.f
  The experiments made  by  Dr. G. Fordyce in heated  rooms
prove, in the  clearest manner, that  the  body has a power of  de-
stroying heat.
  The action of evaporation produces  cold, and  in proportion to
the quickness of the evaporation is the  cold produced;  and from
experiment we find that the evaporation  of spirits of wine produces
cold faster than that of water, and of asther faster than  spirits of
wine.  On this principle we suppose that evaporation is one means
of producing  cold in the living body.J
  It appears from Dr. Fordyce's experiments that the living powers
were very much  assisted in generating  cold by evaporation,  but
that evaporation was not the sole  agent  in keeping the  body cool.
There is  therefore a further provision of Nature for enabling ani-
mals to support great  heat.  In order to keep up a just balance of
temperature,  it  is probable that the living  powers exert greater
effort as  evaporation is deficient, and  less effort as evaporation in-
creases.   In  emergencies,  evaporation  is not  sufficient: when a
greater power of producing cold than ordinary  is  required,  the
powers of the animal  are called forth.
  As animals can only destroy a certain quantity of heat in a given
time, so the  time  they  can  continue  the full exertion of this  de-
  * [These experiments on  parts of the  body are evidently  inconclusive,  inas-
much as any elevation  of temperature is necessarily prevented by a continual
influx of fresh blood, which carries c-.T the heat.]
  f [Upon the  same principle the sirocco and  scorching winds of the African
deserts are so destructive of animal life.  In the expedition to  discover the
N. W. Passage, the sailors  found a temperature at zero  attended with  a breeze
far more difficult to resist than a temperature at 50° below zero attended with a
calm atmosphere.]
  X [The influence of evaporation in producing this effect has  been fully inves-
tigated by De la Roche, who arrived to the general conclusion that evaporation
from the lungs and skin is the main cause by which the temperature is re<mla-
ted in all cases, and the sole cause by which this effect is  produced when the
body is exposed to a temperature above  its own natural  standard.  (See Journ.
de Phys., torn, lxiii. lxxi,  and lxxvii.  See also Treatise on Inflammation, loc.
cit.)] 
OF THE HEAT OF ANIMALS.
83
stroying  power  seems also limited.   It is probable that both the
power of destroying heat,  and the time in which  that power can
be exerted, may be increased by frequent  exercise.
  When Dr. Fordyce was  in the heated room, his  hand became so
hot as to make his body feel cool to it.*   It  is probable that that
part, from its habit of changing its degree of heat,  is more ready to
take on different degrees of heat applied.  It is found from experi-
ment, in the application  of cold, that all the  extremities are  more
subject to the laws of inanimate matter  than the body; and the
nearer the source of circulation, the greater the deviation is from
these laws.   Possibly the  same may be  observed with regard to
heat.
   In  animals which  have a standard heat it would appear to be
more natural to  form than to destroy heat, (although the power of
destroying it appears to be much greater than that of producing it,)
for we may observe that they live with much more ease to them-
selves when in  an atmosphere considerably lower than their stan-
dard, in  which they must constantly be generating heat, than in an
atmosphere even of their oWn temperature,  in which  it cannot be
necessary for them to form heat;  so that either this action simply
of generating heat, or being in such  a degree of cold as makes this
action necessary,  proves salutary to the constitution.-j-  Perhaps the
medium between  their  extreme heat, which is 98°, and the lowest
degree they can come to, is the proper and most  wholesome tem-
perature of the  atmosphere, and this is about 63°.
   Some of these animals which are endowed with this property of
a standard heat have this power of generating heat much stronger
than others, and  are  always  best  in those situations where this
power  can be exercised:  we should naturally suppose  that this
power  always  requires  a  necessity for that exertion equal to  its
power, so that the power and  the necessity  should always be pro-
portioned.  This  cannot be the case with those imperfect animals
which have little or no power of  forming heat, but are obliged to
the atmosphere  for heat.
   When we consider the white bear, the  fox, and  wolf, in the more
 northerly climates, inhabiting  countries where the temperature  is
below zero, yet having a power of preserving their noses, feet, tails,
 &c, while  man, with all his care and  art, loses his extremities in
 the same degree of cold, we must acknowledge that those animals
have by much the greater power of  generating  heat of the two.
 When we compare the above animals with the  lion, tiger, monkey,
&c, we find the proportion in the power ofgenerating heat between

   * [This effect probably arose from the superior  denseness of the cuticular
 covering  of the hand preventing perspiration.]
   X [It is certainly a remarkable proof of Hunter's penetrating sagacity that he
 should have been able to arrive at so general a  truth without being acquainted
 with the true cause  of animal heat, or  the intimate connexion which subsists
 between  this function and that of respiration.   (See Treatise on Inflammation,
 loc. cit.)] 
84
HUNTER'S PRINCIPLES  OF SURGERY.
those two classes of animals still greater;  for if the human species
finds it impossible to generate  heat like the  white  bear, &c,  the
lion and  tiger must find it impossible to generate heat equal to man:
for though they may not  lose parts of their  bodies when in cold
that is tolerable to the human species, they  lose their lives in  the
end.*
   It may be desirable to  inquire  into  the proper temperature  for
each of those classes above mentioned, that is, the  temperature in
which they carry  on their ultimate actions.t   This must be ascer-
tained with great difficulty; perhaps the temperature suitable to the
white bear, &c. is about 50° ;  for the human species about 60°; for
the lion, tiger, &c. about 70°: and there may be some which require
a still higher temperature, though probably none will require a lower
than 50°.
   On the Effects of Climate.—By climate  we mean  that state of the
atmosphere which is peculiar to any particular part. Climates vary
as much as anything in nature.   Their difference  may be said to
arise chiefly from the influence of the sun, from their moisture or
dryness,  which will depend partly on the shape of our globe and its
oblique direction with regard to the sun, and also from  the nature

   *  [Habit in this instance has great  influence, so  that the calorific  function
actually increases or strengthens in winter and diminishes in summer, (Edwards,
De l'influence, &c, pp. 162 seq., 242 seq.) an effect which we cannot but observe
in those who have resided in  the East  and West Indies returning to an Euro-
pean climate.]
   X  [By ultimate actions Hunter  probably means generation, as he  has stated
the continuance of the species to be the ultimate end for which the vital powers
are given  to animals.]
   X  ["Vegetables and animals are prepared for almost all climates, and for
temperatures higher than the  heat  of any country.  Dr. Reeve found larvae in a
spring at 208° ; Lord Bute, confervas and beetles in the boiling springs of Albano
that died when  plunged  into cold water. A species of chara will flower and
produce seed in the hot springs of Iceland,  which boil an egg in four minutes.
One plant, uredo nivalis, which is  a mere microscopic globule, is  said to grow
and  flower under the snow.
   "  Some cold-blooded  animals bear heat very badly.  Dr. Edwards says that
frogs die in a few seconds in water at 107°, [but Dr. Marshall Hall states that a
frog plunged into water at 120°,  "first struggles violently, then experiences
convulsive movements, and then promptly dies, whilst the limbs become exceed-
ingly and permanently rigid.  After  apparant death, all  sensibility and motion
having ceased, the heart is found  to beat for  a considerable time, presenting the
singular phenomenon of an animal dead to animal life and maintaining a sort of
vegelative existence  only."   (Hall  on Circ, p. 174.)—Editor.']  Yet a species
of taenia has been found alive  in a boiled carp ; but then the carp which it inhabits
will live in water as hot as human blood.
   " The germs of many insects, &c. are unaffected by a great range of tempera-
ture,  I know a gentleman who boiled  some  honeycomb two  years old, and after
extracting all the sweet matter, threw the remains into a stable, which was soon
filled with bees.   Body lice have appeared on clothes which  had been immersed
in boiling water.  Spallanzani found long ebullition in the open air favourable to
the  appearance of the animalcules of vegetable infusions; and the application of
 great heat in close vessels, although  it  prevented  the appearance of a larger kind
 of animalcule, did not that of a smaller."—Elliotson's Phys., p. 246   See note
 p. 284.] 
OF THE HEAT OF ANIMALS.
85
 of the surface, whether hilly, or flat, or woody.   The different sea-
 sons are dependent on the form of the earth and its motion round
 the  sun.  Between the tropics the variations of seasons are less;
 still there are kinds of seasons, and the climates are very various.
 The greatest variety  of climate  is near the tropics.   The world
 there, being chiefly, if not altogether, heated by the sun, works very
 hard to gain as much of its influence as possible;  it exposes itself
 to it as much as possible in every direction.   The air of the equator
 is very different from that of the poles;  few can live in the climate
 of the poles, either animals or vegetables, and even of those which
 can live many become torpid  during the winter.   It is wonderful,
 considering the necessity of heat to  animalization  and vegetation,
 and how  partial Nature has been in  the distribution of it, how both
 these processes go on so well as  they do.*  Nature, however, has
 been obliged to adapt animals to their different climates as well as
 vegetables, except the bramble, which lives between the tropics and
 at the poles.
   Some animals become torpid during the  cold, others even of the
 same order do not;  this seems to be because the food of the first is
 not  to be found during that season: so Nature formed  them either
 animals of passage, as some birds; others she constituted so as to
 become torpid.  Animals of passage, however, seem to have their
 peculiar climate ;  fish, which wander more than most animals, have
 their climate, and the general cause of their moving south is for the
 purpose of propagation.  So herrings come from  the  North Pole
 to the coasts of Europe and America, for no other purpose than to
 lay  their spawn.  Quadrupeds seem  the best formed for variations
 of climate, though their heat is more  stationary.   There  are ex-
 ceptions, as  the dormouse, bat, &c.; but men, dogs,  deer, horses,
 &c, live  tolerably well, though not without disease, between the
 tropics and also far north.  Nature has furnished some animals with
 mechanical means for adapting them to climate, as hair,  feathers,
 &c.   The use of hair  is clearly to preserve warmth : the porcupine
 of Italy has no hair, but only  quills;  and the southern bears have
 only bristles, without hair.  There are some animals furnished with
 proper non-conductors of heat, as seals, sea-cows,  &c, whose hair
 can  be of little use to them while living in the sea,  and is therefore
 only useful  to them perhaps while  on land.   Those  animals, as
 whales, which, from living constantly in water, could derive no ad-
 vantage from hair, have an immense quantity  of  fat,  which is  a
worse conductor of heat than water by nine to one.t

  * [Cold, however, interrupts the growth and nutrition of organized bodies, as
 may be seen in the short stature and small size of the Greenlanders, Laplanders,
 Esquimaux, &c, as well as in all the plants and animals of cold and mountainous
regions.]
  f [The white hair, white skins, and white flowers  which characterize the pro-
ductions of the frigid zone are designed for the same purpose, in as much as heat
radiates from white bodies more slowly than from those which are coloured.  In
                               8 
86             HUNTER'S PRINCIPLES OF  SURGERY.

  External heat and cold produce  diseases peculiar to themselves.
Men are the only animals which go to  climates not congenial  to
themselves, and consequently they  are alone subject to the conse-
quences of an  unfit climate.  Too  much heat  produces diseases of
the liver, though, as Dr. Blane observes, this must depend on  some
other cause than mere heat, as these complaints are not so frequent
in the West Indies as in the East.*   Diseases of the bowels and
tetanus are also often produced by heat;  it also tends to produce
fevers.   The diseases produced by  cold are chiefly those of debility,
as chilblains, scurvies : also diseases  of the lungs, which  are  more
dangerous than those of the liver. Cold also increases some diseases,
as the lues venerea: and changes  from heat to cold produce  some
diseases, as scrofula.
  As heat is able to volatilize almost  all bodies, the impurities of the
atmosphere must very much depend on it; but, as Dr. Blane remarks,
the same heat which volatilizes  bodies will  very  often decompose
them.   The plague has not been known between the tropics, nor the
jail fever, and very warm climates abound much less with diseases
of a putrid kind than temperate climates.  How does the atmosphere
affect the  body ?   Is it by the lungs or  by the  skin ?  This  ques-
tion it is perhaps impossible to solve.  The purest air seems, cceteris
paribus, to be the coldest: and the worst, the warmest,  especially
when moist, where the situation is low, and where animal substances
suspended in it  are allowed to putrefy. In a very hot air substances
may be volatilized so rapidly that decomposition cannot take place;
this air will prove  destructive by different modes: 1st, By preventing
respiration; for if many substances are volatilized, the air containing
them will not reach  the lungs, except in too small quantities for the
support of animal life.t   2dly,  By  specific  poison, producing a
variety of diseases, often sedative, as debility and agues,  in marshy
grounds ;  in  other places,  fluxes  and different kinds of poisons.
3dly,  The effects  of an impure atmosphere  are found in jail dis-
tempers and hospital diseases ; very  few  of  the former places are
ever free from foul air, and most hospitals are more or  less affected
with it.  There are different modes in  which  these poisons may
affect.   A stranger in  a  marshy country is  much sooner affected

the same manner, all the  finer furs and downs come from the high latitudes,
whereas cats, rabbits, and other animals change their fur into hair when they are
transplanted to a meridional climate.]
  * [If, as Tiedemann and  Gmelin conjecture, the functions of the liver and lungs
are, in one sense, correlative, viz. that they both tend to free the  blood of its
carbon, then it is  not  difficult to understand the  greater tendency to diseases of
the liver in these climates.  The blood equally requires purification, and yet this
cannot be effected by  the lungs  without the  production of more animal heat than
is required; in consequence of which the liver is called upon to fulfill this extra
duty, and from over-exertion falls into disease.  In the  West Indies the sea-
breezes materially tend to prevent those consequences which take place in the
inland continents of the  East.]
  X [It is extremely improbable that a case of this kind ever occurred, considered
merely in respect of climate.] 
OF THE HEAT OF ANIMALS.
87
 than a native or an inhabitant.  A person'who has not long been used
 to a jail will earlier, and with more certainty, be  affected with jail
 distemper.  An instance of this occurred at Salt Hill in 1760.  The
 effects were at first attributed to the wine ; but they wrere evidently
 caused by a few paupers, who were examined by some gentlemen,
 although the paupers did not appear to be affected.  In 1775 some
 prisoners were examined at the Old Bailey who infected the whole
 Court, and many  died ;  the judge on the bench, the jury and evi-
 dences, &c.  Many poisons are of this kind : a person may carry
 the infection about with him without being affected himself.*   The
 air is capable of carrying most poisons, and communicating their
 irritations.  The venereal poison cannot be thus raised  in a state
 of vapour, or if it can, it loses its effects in the change.
   Perhaps next to never coming  within the influence of such efflu-
 via at all, it is  safest to live  surrounded by them in large cities,
 where, either  from the habit of being exposed to their action, or
 from one effluvium  destroying another, the effects are prevented
 from taking place to the extent that might be expected.  However,
 if the atmosphere, being impure, produced  an effect only on those
 coming into it, all the old residents would be equally healthy as the
 strangers who  come to reside for a time only ;  yet this  is not the
 case, for they  are by no means all robust; -therefore what may be
 styled its unfitness produces a debility, and  the persons are neither
 so strong nor so healthy as those  resident in a healthy atmosphere,
 though they feel not the sudden  effects with which strangers are
 attacked.f
   We have a kind of atmosphere which spreads over various coun-
 tries or climates in particular seasons only,  as lately over England.
 These have had different names  at different times; we call it the
 influenza; it affects at first dogs, then horses.   In 1775 the dogs wrere
 all ill; and afterwards the horses, before men, felt the influence of it.
   The atmosphere is the menstruum for  various substances,  some
 of which are  held in a  state of  solution, and others in a state of
 mixture  only.    Water  is held in solution in  the  atmosphere, and
 when much of this is suspended, it renders it heavier, as  the baro-
 meter shows ; and when a decomposition of the solution takes place,
 the water is precipitated as rain or snow, and  the  air  is made
 lighter, as the barometer also shows.  This decomposition  may take
 place, although neither snow nor rain is produced, and this in con-
 sequence of a fresh  combination  taking place before  the  ultimate

  * [The catalogue  of infectious diseases is much curtailed in modern times,
 actually as well  as speculatively; at least, the  non-contagionists are now the
 prevailing sect.  The infectious miasm probably consists of some compound in
 which hydrogen is an ingredient.  This appears from the facility with which the
 odour and  noxious qualities of putrid exhalations are destroyed by the vapour of
chlorine.]
  f [The late population returns have exhibited in a striking light  the serious
effects of crowded houses and a crowded population, in doubling, and in some
instances in trebling, the rate of mortality, a fact which is still more strongly ex-
 emplified in some of the capital cities of Europe.  See Count Chabrol's statisti-
cal account of the department of the Seine.] 
88
HUNTER'S PRINCIPLES OF SURGERY.
end is produced.  When the  above decompositions take place, the
birds and beasts seek their shelter; and an effect is produced on
wounds,  particularly when in a healing state,  and in diseases  and
ailing parts of the human body, so that persons become, as it were,
a weather-glass.  We have lately been informed by a German that
the variations of the  magnetic needle have appeared so much to
take place  with change  of  weather, that  as  much  might  be
learned from it respecting the prognostics of the weather as from
the barometer itself.  Winds may be easily supposed to bring with
them the effluvia of disease.   Extraordinary effects are produced
by the Harmattan wind, a wind which blows off the interior part
of Africa to the coast of Guinea.  It generally comes three or four
times a year, at certain seasons; it is always attended with a fog,
which has no taste, nor could anything be discovered in it by means
of glasses thinly covered with molasses.  The fog is thickest on the
beach, and gets tolerably thin about four miles inland.  It lasts often
for a fortnight, and produces a pain and dryness in the mouth and
nostrils, not  as if from mere dryness, but from some  acridity: if it
continues three or four days, the scarf skin falls off, and the tongue
applied to that part of the skin denuded of cuticle is  sensible of an
acrid taste.   Though very prejudicial to vegetable  life, it is salu-
tary to animals, curing fluxes  and  other  epidemic  disorders, and
often restoring weakened constitutions.   Fevers  which  had been
imprudently reduced by bleeding, got  well in spite of the doctor.
The small-pox always yields to it, while it prevented the inoculation
from taking effect in some African slaves.  Such as were inocu-
lated before the  Harmattan set in had the small-pox, and all  did
well; but such as were not then seized  with the symptoms, and
these were  sixty in number, never felt any other affection but a
slight fever  and nausea during the continuance of the wind; after
which it showed itself in twenty of them:  the others  were reinocu-
lated, and all did well. 
GENERAL  PRINCIPLES OF DISEASE.             89
                         CHAPTER IX.

                 GENERAL PRINCIPLES OF DISEASE.

Disease  the consequence of unnatural impression;—may arise from faulty pri-
 mary arrangement.—Diseased actions often established on the same principles
 as healthy actions;—some diseases  end  with the cause;—others continued
 from habit.—Diseases common to all parts, or peculiar to some ;—obscurity
 of the physiology of disease.—Of susceptibility to impression and consequent
 action;—difference of  susceptibility in  different  individuals.—Distinction
 between susceptibility and disposition;—predisposing causes  only suscepti-
 bilities.—Susceptibilities of constitution  and of parts for different actions.—
 Universal  susceptibility producing  local diseases.—Susceptibilities almost
 specific—Temperament.—Of diseased dispositions.—Dispositions unnatural,
 but not diseased ;—dispositions for restoration ;—of necessity;—and of disease.
 —Diseased dispositions have an allotted time for action.—Action.—Disease a
 disposition for wrong action ;—action the effect of disposition ;—symptoms the
 result of action.—Action, healthy or diseased ;—diseased action of two kinds.—
 First symptoms of disease.—Diseased actions arising without proper stimulus.
 —Too great action ;—too little action.—Diseased actions simple.—Of wrong
 actions.—Habit of diseased actions.—Of sedatives and  stimulants.—Irrita-
 bility.

Now that I have treated of some of the  properties of the animal
in  health,  I shall go on  to  treat of its imperfections, or diseases.
To understand these it was necessary, in the first place, to describe
its perfect or healthy state.   To  describe the parts in a  healthy state
belongs to the anatomist; their actions in this state to the physiolo-
gist ;  but the diseased state of these actions,  and the restoration of
parts to health, to  the physician and surgeon.
   It is hardly to be  supposed  that  disease  is  ever natural to  an
animal; it can only be the consequence of some unnatural  impres-
sion which interferes with the  natural action of the  body, which
impression may take place at the very first formation, or  original
arrangement of the animal, so  as to stamp a permanent  unnatural
action; or it may take place in  the first life, namely, in utero;  but
much more frequently after birth, when it is exposed to a thousand
variations, all which  are impressions, and  are contrary to  the
natural actions of the animal, or are, as it were,  a forcing it to take
on actions which  are either to remove  those impressions or to
destroy itself.
   It is most probable that diseased actions are established on nearly
the  same  principles that the actions of  health are.   They are at
least similar in a great many of their principles;  they destroy the
dispositions  of parts;  they  produce growth;  they produce  the
power  of  removing natural parts;  they are  ruled by habit;  they
are affected by every external influence.
   An animal  is so constructed as  only to continue some diseases
so long as the immediate cause  lasts, as in scrofula, when it arises
from climate; or  which is  so  constructed   as  to  continue  other
                                 8* 
90
HUNTER'S PRINCIPLES OF  SURGERY.
diseases from habit, as a  gleet, so as to go on  with a disease,
although  the  first cause is gone; and this may be only for  a time,
as in gonorrhoea; or it may be for ever, as in lues, cancer, &c.
  Diseases are either common  to  all parts alike, or are peculiar.
They are common to all parts alike, as inflammations of  all kinds;
as,  also,  tumefaction,  scirrhus, dropsies,  &c.   The peculiar are
those in which there is a fault in the peculiar actions of  a part, as
involuntary action  of voluntary muscles, too  much or  too little
secretion  from any of the  glands, in  short, wrong actions of any
part in its peculiar mode of action.
  After the disposition, the action which should destroy the dispo-
sition takes place;  the action having taken place,  the disposition
ceases and the natural action of the parts returns.   But this is not
always the case.   The disposition  may be affected  in  one  of the
following ways: 1st, The  action may destroy the disposition, for
instance, in gonorrhoea (and perhaps in many other complaints); in
this case  the  action destroys the  disposition, or the inflammation
destroys the disposition of the virus. 2dly. The disposition is  destroyed
for a time, and returns at intervals, or after certain spaces, as in all
periodical diseases, or others where the disease ceases for a time,
and the disposition continues.  3dly. Where the action takes place,
yet does not destroy the disposition, as the venereal  disease, which
goes on till it  is cured or kills, and  the action of it never destroys
the  disposition.*
  Many diseases often require their full action before they produce
their  effects, as the gout and many agues.   Vomiting is the action
following  the disposition  to  sickness, and is often its cure, for
without it the nausea and disposition will continue.  Sometimes
chronic diseases will be cured  by acute  ones, in which  case, the
full action being given, the disposition is removed.
  General  Observations  on  Susceptibility and  Disposition,  consti-
tuting Constitutions, and on Actions forming Symptoms.—The phy-
siology of disease is more extensive, more obscure, depends less on
general laws  of nature (being often a prevention  or perversion of
those laws),  and  is therefore  more irregular than any  part of
science, and is of course less understood.
  The most simple idea I can form of an animal  being capable of
disease  is, that every animal is endued with a power of action and
a susceptibility of impression, which impression  forms  a  disposi-
tion,! which disposition may produce action,  which action becomes

  *  [It is scarcely necessary to observe that this dogma respecting the venereal
disease is no longer entertained ; and indeed it may be questioned whether there
is any disease, unattended with actual change of structure, which is not suscep-
tible of a natural cure.   This at least  seems to be the broad and leading distinc-
tion between curable and incurable  diseases, although in  practice it is often
extremely difficult to  say what does  and what does not constitute change of
structure, the simple consequences of  inflammation being always excepted.]
  f Susceptibility has been too often called disposition.  A man is said to be
well disposed, or parts are said  to be well disposed when they are only suscep-
tible.  Disposition is a degree further than susceptibility. 
GENERAL PRINCIPLES OF DISEASE.
91
the immediate sign of the  disease; all of which will be according
to the nature of the impression and of the part impressed.
   That every action, whether natural, preternatural, or diseased,
arises from this susceptibility of impression, I think we must allow,
which susceptibility may exist without even disposition or action,
if no impression or stimulus is made; for the disposition is only
formed in consequence of  some impression, and the action is only
the consequence  of the disposition being so strong as to incline a
part for action rather than for resolution.   Therefore action is the
ultimate consequence of impression  being made  on a part endued
with a susceptibility of impression and the power of action, which
impression gives them the  disposition to  act.  For from what was
said above, parts having susceptibility do not necessarily have the
disposition;  the disposition arises  from  some impression,  which
will, in its turn, produce the action,  and this action, or disposition
to action,  must be sufficient to overcome  the natural  and habitual
actions of the part or whole, just as force overcomes the vis inertice
of matter.   But susceptibilities are in some so strong as  almost to
approach a propensity to act, which is probably as strong  as the
disposition, or often probably stronger.*
   The actions of the body, and  the  cause of these  actions, with
their effects, are exactly  similar to those of the mind, and as we
are  sensible  of the  actions of the  mind themselves, abstracted from
their causes or effects, we reason about them as much as we can
reason about  their causes and effects.   This is not the case with
the  actions  of the  body, for in them we are only acquainted with
the  causes and effects, not the action itself;  therefore our minds
are  only reasoning about them from analogy.
   The susceptibility for action of the mind  is not known to the
mind itself,  but by  the consequence  of such  susceptibility.  Some
minds are much more susceptible of certain actions  than  others;
thus, some men are more susceptible of anger, others of love.  But
this does not imply that one mind is always  in  anger, another in
love, &c.
   * [The reader will probably agree with the Editor that the distinction which
is here drawn  is not tenable.  The author, for instance, says, (p. 99) that action
is not disease, but the effect of  disease ; but what proof is there that the dispo-
sition (which  according  to the author seems identical with the disease), exists
at all, except from the action which it produces  and the visible  effects of that
action ? And, particularly, what proof is there that this latent disposition differs
from susceptibility 1 A part may be  more or less prone to or susceptible of in-
flammation, but can a part have the disposition to inflammation (in Mr. Hunter's
sense), without showing the action of inflammation 1 If it can, then where is the
proof of its existence, except from the proneness or readiness of the part to act
in that particular manner 1 which is the idea conveyed by the term susceptibility.
I offer this criticism with diffidence; at the same time I cannot but regard the
whole argument, so far as it is founded on this distinction, as based on a meta-
physical subtlety which ought not to be admitted in philosophical discourse.
   As there  can be little doubt that Mr. Hunter formed  these  opinions from ob-
serving that  the disposition (so called) to  the venereal disease often remained
after the visible symptoms had  been apparently cured, the reader will naturally
turn to this part of his works for further information.] 
92
HUNTER'S PRINCIPLES OF SURGERY.
   With this susceptibility of mind, a stimulus must  be applied to
 produce the disposition  to  action.   A  stimulus  of one  kind will
 produce anger, of another kind, love.  The action of the  mind em-
 ploys other parts to complete the whole, as when the  actions of the
 mind are  employing  other  parts to produce  the ultimate effects.
 But these are not necessary to  the action of anger,  for anger could
 exist without the action of employing other parts, and indeed con-
 tinue longer ; for this tends  to destroy the action  of anger, because
 the effect being produced the cause ceases.
   Every animal has a variety  of susceptibilities  which admit of a
 variety of  impressions,  each impression producing  a disposition
 peculiar to  itself.   Also  every animal has some  of those suscepti-
 bilities  stronger than it has others,  out  of all which a vast variety
 of diseases is  produced.  Each tendency to  a  peculiar mode of
 action gives the character of the animal respecting disease.  The
 sting of a bee, for instance,  affecting some people much more than
 others,  demonstrates  that there is a susceptibility in some for such
 actions more than in others.   In many  the susceptibility will be so
 strong  as  only to  require a stop to be put to the natural actions,
 when the disposition and the disease too will take possession of the
 part or of the whole.   An instance  of this we have in scrofula, for
 it often happens that  common  accidents, as strains, bruises, fevers
 of all kinds, produce the disease even in situations the most calcu-
 lated to prevent it,  as in the West Indies.  Even poisonous dispo-
 sitions  are  produced  in this way, a blow on the breast or testicle
 shall produce a poisonous mode of action, e. g. cancer.
   From this account no animaf is formed with' a  disposition for the
 action  of  disease.  The natural actions are  for  the good of  the
 animal; but they  can  be perverted, they can be made to destroy
 the whole.   These circumstances are similar to those of the mind ;
 some minds are more susceptible of some impressions than they are
 of others, which produces a disposition to act, which action will be
 according to the impression.  The susceptibility  of the constitution
 may be increased, so as almost to be similar  to  a  new formation,
 but is never originally formed, by art.*   Where the susceptibility
 is weak,  it  may be  increased and kept so much on the brink of
 forming the disposition, that it shall only require the least increase.
 or some other  immediate cause, to produce the effect or  form  the
 disposition, as  a man  not naturally fearful may be worked upon so

  * [If by art Hunter means the influence of external agents, this statement does
 not appear to be correct.  When, for example, hospital gangrene is prevalent in
 a ward, probably three-fourths of the  inmates would be attacked by this disease,
after any operation performed on  them.  The susceptibility of the disease  has
surely here been generated, yet they would probably have escaped, if the opera-
tion had not  come to convert this acquired susceptibility into action.   The
operation under different circumstances would not have been followed by similar
consequences ; the body, that is, is not naturally susceptible of  this  disease, in
the same way that it is susceptible of inflammation or  small-pox, without pre-
vious preparation ; a new state of the constitution must  first  be induced,__a
point which is clearly admitted by the author in  his Treatise on  Inflammation.] 
GENERAL PRINCIPLES OF DISEASE.
93
 that  the  least thing may alarm him.  Susceptibilities may be  so
 increased as almost to deserve the  name of acquired; constitutions
 long habituated to particular climates will form a scrofulous habit,
 or  an aguish habit, and a certain way of life will produce a rheu-
 matic or gouty  habit.   On the other hand, persons naturally sus-
 ceptible  may be made  by degrees considerably less so, by being
 gradually accustomed to  the  immediate cause, beginning within
 the degree of impression necessary to excite disposition  to action.
   There  is  no such  thing, strictly  speaking, as a  predisposing
 cause.  What is commonly understood by a predisposing cause is
 an increased susceptibility to form  disposition to action.   When I
 say I am predisposed for such and such actions, it is only that I am
 very  susceptible of such and such impressions, which impressions
 must  form the disposition; or  if it is intended to dispose a person
 for such and such actions, it is only to render him more and more
 susceptible of such and such impressions.   The susceptibility must
 always precede the disposition.    A  disposition is a determined
 thing,—a thing formed,—a kind of resolution.
  Of Susceptibilities of  Parts  and  Constitutions for different  Ac-
 tions.—Every constitution is more susceptible of some constitutional
 actions,  both natural and  diseased, than  it  is  of  other actions,
 whether natural or diseased;  and  every  constitution is more
 susceptible of some local actions, natural and diseased, than it is of
 others.
  Every constitution is compounded of parts whose natural actions
 are very different from one another.   Thus, the natural actions  of
 the liver are very different from those of the lungs.  Therefore we
 also find the diseased actions of one are often different from those
 of the other;  although  every  part  of the body may. be subject  to
 some  one or more common diseased actions, as e. g., the liver kand
lungs, which may be subject to  common inflammation, or they may
both have the same specific disease,  as scrofula.
  Every constitution being composed of different parts, whose  na-
tural and diseased actions are different from one another, as above
mentioned, these actions being according to the nature of each part,
and each part in some constitutions being more susceptible of natural
actions peculiar to itself  than the same part in other constitutions,
 so also  in some constitutions each  part is more susceptible of its
diseased actions than the same part is in other constitutions.  Thus,
as the liver in some constitutions is more susceptible of secreting
 bile, which  is its natural  action, than it  is in others, so also it is
more  susceptible of its peculiar diseases in some constitutions than
it is in others.  Constitutions may be  said to  be more or less sus-
ceptible of this or that universal  action, among the first of which
may be marked the irritable and the indolent.
  Secondly, some constitutions are more susceptible of some diseases
than others are of other diseases.
  Thirdly, some constitutions are more susceptible of some diseases
than others are.  And those constitutions not  susceptible of this or 
94
HUNTER'S PRINCIPLES OF SURGERY.
that disease may be at the same time more susceptible of some other
diseases than the first-mentioned constitutions  are.  For example,
some constitutions are more susceptible of inflammatory fevers than
of any other fevers; others are more susceptible of putrid fevers;
while  either  one or  the  other of these constitutions might have
some other  disease, either violently or mildly, as small-pox, mea-
sles, &c.
  Constitutions maybe more susceptible of some one specific disease
than  the same  constitution of other  specific  diseases, e. g., some
constitutions are more susceptible of  small-pox than of measles, or
vice versd.
  Some constitutions may be more  susceptible  of  some specific
diseases than other constitutions  are,  e. g., some  constitutions  are
more susceptible of the small-pox than others are,  and yet  have  the
disease mildly.
  All of which characterize the constitution at large.
  Of universal Susceptibility  to  produce  local Diseases.—Bodies
may be said to  be  both constitutionally and locally  susceptible of
diseased action.  The erysipelatous  fever, which is constitutional,
being attended  by the erysipelatous inflammation,  which is local, is
a strong instance of this.
  Constitutions are more or less  susceptible,  both universally and
locally, of  the  same  disease, as the small-pox fever,  when violent,
has more violent and extensive local effects; when mild, more mild
local effects.
  Constitutions may be said to be more or less universally suscep-
tible of this or  that local  action, when one part takes on action
without any visible immediate cause, or when any injury (whether
constitutional, as fever, or local,  as  accident), makes parts so in-
jured run into a much worse diseased  state than the same injury
would  have  done in others;  many  parts  even taking on specific
diseases, whenever the immediate cause is produced, as  scrofula,
venereal gonorrhoea, &c.
  Constitutional susceptibilities for diseased actions may be divided
into three kinds, and there  are also others which are  mixed.*

  * [There is probably not a more abstruse subject in  physiology than that of
susceptibilities, which most frequently depend on causes with which we are en-
tirely unacquainted.  Mr. Hunter has classified susceptibilities according to their
effects and remote causes, without attempting to explain the physiological  con-
ditions on which they depend.   But we ought not, I conceive, to repose here, as
if further progress were  impracticable, but to ascertain, if possible,  the actual
conditions of the organization on which they depend, or the particular manner in
which the functions reciprocally react on one another so as to produce them.
The pathologist should seek to trace the remote cause to its utmost effects, so as
to arrive as near as possible to the immediate efficient cause of the susceptibility
in question.
  An example  of this kind has been already adduced in regard to the suscepti-
bility of the liver  to disease in hot climates, (see note,  p. 86,) arising from a re-
ciprocity of function between it and the lungs, of which many similar instances
might be given in respect of the other organs.  The heart and the brain are  said
to be more susceptible of disease now than  they were  formerly, although  this 
GENERAL PRINCIPLES OF DISEASE.
95
  1st,  An original constitutional;  that is, where there is a  uni-
versal  susceptibility for diseased action of one kind or another, in
which, however, the whole must  be in action,  as  inflammation,
fever, small-pox, &c.; also sympathetic fevers of all kinds.   Persons
may be very  susceptible  of the whole of these, or only of one or
more.
  2d, Original local; that is, where the whole is so constructed as
to be universally susceptible of  going  into  diseased action in  any
one part; but the actions will be always local and independent of
every other part, as scrofula, gonorrhoea, or chancre.   Hence the
venereal disease is  worse in one than  in another, and  yet is local;
the same with scrofula.
  3d, A susceptibility to fall into universal indisposition, as if there
was something teazing the whole ; which then can call on a part,
and  that relieves the whole, as in gout, rheumatism, and  perhaps
all those diseases where the local action is critical.   Most  of these
can be relieved by  a universal facility to action, or retarded by the
contrary, which will affect either the local action or the constitu-
tional one.
  Strong susceptibilities of a constitution to take on diseased dispo-
sition and action, whether of the whole as such, or a local  effect of
a constitutional  disease, (which last I call an act of the  constitu-
tion), only require  the impression of the immediate cause for the
disposition and action peculiar to these susceptibilities to take place.
These immediate causes may not be the  same in two  constitutions,
although both have a strong susceptibility for the same action ; for
what will produce the action in  one constitution may not produce it
in another.   One constitution will require one immediate cause and
another another, though both constitutions may have a susceptibility
for the disease.   Two  men equally susceptible may be exposed to
the cause of an  ague : one  may have  the disease the other not.   It
is exactly similar with the  mind : two  men  may be  naturally or
constitutionally  equally susceptible of anger,  but each must  have
his immediate cause ; what will bring forth action in one will  have
but little effect on the other, and e  contrario.   It is the same thing
with every effect of the mind.
  Most susceptibilities  are so much of a specific  nature  in them-
selves  that each susceptibility shall be brought into action, in nine-
teen people  out of twenty, in one way, and probably in the twentieth
it has been prevented  by  what produced it  in the others.  This
accounts for the same  diseased action in people arising from so
many  different causes, and  also  accounts why such disease, though
having a specific mode of action, may be varied in the same person

may solely depend on  the complicated interests and passions  of modern life,
which  necessarily induce particular  physical conditions of these organs which
directly tend, on known principles, to the production of disease.  The constitu-
tional susceptibilities are, in general,  far more obscure, and scarcely at all admit
of this mode of explanation.] 
96            HUNTER'S PRINCIPLES OF SURGERY.

in different ways, still more in different people, and even often
require different modes of cure.
  This theory  may be  illustrated by every disease that takes on
full  specific  action;  whether  a full constitutional action, as an
ague, or a local one, as the gout.   As an ague is a well-known  and
well-marked disease, this theory will of course be illustrated by this
disease.
  Every constitution  has more or less  susceptibility to fall into an
aguish habit; but there must be in  all  an immediate cause to pro-
duce the disease.  The immediate cause may be such  as will make
nineteen  people out of twenty fall into aguish action ; but many
constitutions, though  they have a susceptibility of  falling into an
aguish habit, yet when the immediate cause takes place, may have
no disposition to take on the full action of that disease ; by which
means the constitution is teazed by what is called a badly-formed
ague.  If the immediate cause be some local disease in the body,
as diseased liver, spleen, &c, then the cure must be effected by the
cure of the liver, &c.
  This reasoning may be taken in another point of view.   Suppose
twenty people having  different  susceptibilities;—introduce  some-
thing that shall endanger the  constitutions of the whole  number,
and each shall take on the disease that  he was at that time most
susceptible of, whether ague, gout, or any other.
  But often that which would become the immediate cause in those
already susceptible of action, or already predisposed to it, by repe-
tition or continuance becomes the predisposing cause  in others not
susceptible.  If two men, one so susceptible as only to  want the
immediate derangement, the other not at all susceptible of an ague,
be sent into the fens of Lincolnshire, the first shall have  an ague
immediately, because he only required  the  immediate  cause of it;
the  other, if he does not get  the better of the  climate  by habit,
shall become aguish  in  time, because the country  will become
both a predisposing and an immediate or exciting cause.
  We may substitute for the disease of ague some other disease,
and the whole of the above reasoning will be perfectly applicable.
But where it is the nature of the disease to take on  local  action, as
in gout,  there  must  not only be a  universal disposition  for  such
disease, which is the original, but there must also be a local prefer-
ence, or  rather a local susceptibility superior to the  rest;  and when
the immediate cause takes place, so  as  to form the disposition,  that
part takes on the whole action, which  relieves the constitution of
such disposition, except it should produce another constitutional
effect by a vital part taking it up, by which means  it  would effect
the whole  constitution similarly to any of the  affections of this vital
part, where a diseased disposition is formed, but  does not take on
the regular type of the  disease, or  does not  take  on the full  and
complete action; as in  the aguish disposition  not having gone
through the regular stages of the ague, or gout not having formed
a regular fit. 
GENERAL PRINCIPLES OF DISEASE.
97
   In those diseases that become local, as gout, some attention is to
 be paid to the seat of action;  for if a vital part takes it up, it must
 be much  worse than when there is  only a constitutional affection.
   The qualities of periodicity  and  regularity  in  constitutional
 diseases,  or the  power of a constitutional affection to become local,
 are, I believe, but little understood.
   Susceptibilities for dispositions and  actions appear to me to be
 the same  with what are usually understood by temperament.  Tem-
 perament is  the state of  the  body fitting it for  the  disposition or
 action it  is then in, whether it is only a state of susceptibility, of
 disposition, or action.  The action is always the  best  test  of that
 state : but, although the action is the best test, yet there are some
 circumstances attending animals that either dispose them for, or  are
 concomitant upon, such and such susceptibilities; and from these
 circumstances we can say beforehand, although only in a general
 way, what are  the  most predominant susceptibilities for  certain
 actions in this or that animal.  We see that even colour in animals
 depends on a difference in their temperaments, or is concomitant
 with temperament; for  animals with fair skin and  hair are more
 susceptible of cold  than the dark,  as also  of pain.   This  is well
 known in the army, where we find  that the power of bearing vio-
 lence committed on the body is in proportion to the darkness of the
 individual.   Fair people are  more  irritable in their minds, more
 susceptible of anger, and probably  of  all other passions.   Fair
 people are also  more susceptible of certain diseases than  the dark,
 as of scrofula.   This may arise from their  not being  able to bear
 the vicissitudes  of  climate; for it is  in  changeable climates, espe-
 cially where there  is cold, moisture, &c, that scrofula is more pre-
 dominant.  The irritable inflammation also  is more common in  the
 fair than  the swarthy.  As the fair are less able to resist cold than
 the dark,* it  might be supposed that the dark are less able to resist
 heat, therefore more ready than the fair to run into diseases  which
 warmth has a tendency to bring on.   But from the estimate made
 by Dr. Young in the Island of St. Vincent's, it would appear that
 there is some reason to suppose the  contrary; from which it would
 appear  that  the dark-coloured are  rather fitter  for  all kinds of
 climates.
   Of diseased Disposition.—Dispositions are natural  or unnatural,
 including  diseased.   The  natural belong  to the  healthy animal,
 therefore  are not to our present purpose.
   Dispositions maybe unnatural (and of course the actions arising
 from them unnatural), and  yet not diseased.

  * [This must be understood with some limitation.  The inhabitants  of high
 northern latitudes,  who are often very fair, are far less susceptible of scrofula
 than the darker-complexioned races of more southern countries;  as, on the other
 hand, the African and the half-caste are more liable to this  disease when trans-
 planted to a northern latitude than the natives.  It is not merely cold, but cold
and moisture, associated with a variable climate, which predispose so 6trongly
to this disease.]
                               9 
98
HUNTER'S PRINCIPLES OF SURGERY.
  Unnatural dispositions  and actions we  shall divide into three
kinds, or they may arise from three causes, which are remote.
  1st.  The disposition of restoration, in consequence of some injury
done, which is also a consequence of every disease which is curable.
  2d. The disposition arising from necessity, as the thickening of
parts from  pressure, ulceration  of every  kind.   This includes a
great variety.
  3d. Diseased dispositions of all kinds, which also includes a vast
variety.
  From  this division we see that there are two preternatural dis-
positions that are not diseased, so much so  that  the first may be
reckoned a disposition of health; therefore there is but one preter-
natural disposition to  action, which can be called diseased, namely,
the  disposition to destruction, and which is  to be cured by substitu-
ting the first disposition.
  Diseased  dispositions may arise from some fault in the animal
powers themselves, or some extraneous matter in the constitution
or circulation, as in the case of many poisons, or from many sub-
stances acting  on  the  stomach called  poisons,  or from some
substances being applied externally to the body which disagree with
animal life in general, as too  much cold, too  much heat, &c.
  Every diseased disposition most probably has its allotted time for
action after the  impression, or after the formation of the disposition.
This is remarkably the case in specific  diseases; but yet this will
differ according to the susceptibility.   The same with poisons: the
small-pox is about six, seven, or eight days at a medium; the measles
the same.   The venereal disease has a medium, although it varies.
But some specific diseases shall remain a considerable time before
the action takes place;  and this  will  be much longer in some than
in others, according  to the nature of the diseased disposition and
parts.   In cancer it is often  very tedious.   I have  seen  instances
where it was years after all continuance of the cause was removed
before the glands in the armpit had taken  on diseased action after
contamination.
  A girl  at  St. George's Hospital, fourteen  years of age, born in
the West Indies, left that part of the world when  ten years of age.
About a twelvemonth ago she had an eruption on the skin in several
parts of the body, especially on the  face,  arms, and  hands.  The
eruption arose like warts, or like large moles, about the size of half
a crown piece, above the surface of the skin, irregular in their base.
some standing single, others running into one another, of a browner
colour  than the common skin, which was  clear  and of a  firmer
texture.
   Now  this was a West Indian disease;  therefore I say that the
girl was  contaminated in the West  Indies.  The impression  was
made  there which  was  the first cause, and  the disposition was
formed; but the disposition did not come into action for three years
 after.   The removal to a cold climate, though it could not remove
 the disposition or prevent its effects, yet protracted them.
   It may be further remarked, in specific diseases and in poisons, 
GENERAL PRINCIPLES OF DISEASE.
99
that if the specific disease or poison is such  as is capable of con-
taminating different parts, whose powers or readiness to act is dif-
ferent, the same  disease will  show itself  at different intervals in
these places in the same person, though perhaps every part is con-
taminated at the  same time.  Thus we  have the venereal disease
appearing in different parts at different intervals in the same person,
arising from the natural susceptibility for action in some parts being
greater than in others.  The skin and tonsils being most susceptible
of contamination, as also of action, are therefore affected soonest;
the bones and tendons less so, and are  therefore later in  taking  on
the action.  The  disposition simply does not seem to affect  either
the constitution or the part, (see note, p. 91) for  either  shall go on
well with all their natural functions, and powers  of restoration
when injured or affected  with diseases of every other kind, although
at the same time  in the disposition of some other disease.
   Dispositions of one kind may be restored  after being destroyed
for a time by a more powerful impression, or such as the constitu-
tion is more susceptible  of, which shall supersede the first disposi-
tion, and go on with its actions; and when its action is completed,
the first disposition shall again take place, as will be illustrated when
we come to talk of actions simply.
   Action.—I have explained that a disease is a disposition for a
wrong action, and that the action is the immediate effect of the dis-
position, and that either the actions, or the effects of those actions,
produce  the symptoms which are generally called the disease, such
as sensations, which are commonly pain of all kinds, sickness, altera-
tion visible or invisible in the structure of the part or parts that act,
and sympathy.
   The animal, or part disposed to act, generally takes  on action,
which is of three kinds: natural, restorative when injured, and  the
diseased; each arising from the corresponding class  of dispositions,
and therefore divisible into the same.
   The actions of health arise from  a disposition to act properly,
that is, according to the combined laws of the machine, which may
be either universal or only partial;  for  a man may be wholly in
health, or only so in part.   The actions of restoration are for  the
falling back into the above natural  actions,  and which will  be
according to the  nature of the injury done and the parts combined.
The diseased actions are many, but may be ranked under the fol-
lowing heads:
   1st. Improper actions of natural parts, as spasms of muscles; irre-
gularity  in the times of  action of a compound part.  The nerves
have the credit for being the remote causfc of all these.
   2d. Unnatural  or improper actions of the vessels;  and these may
be either attended with an increased or diminished action.
   The ultimate and visible effect of disease is action; but this is not
the disease, for the action  is only an effect, a sign,  or symptom of
disease.   But the disposition being only discovered by its effects, we
are apt to go no further in our inquiry, the cause  being to many 
100
HUNTER'S PRINCIPLES OF SURGERY.
 only an object of curiosity.  However, the effect must be attended
 to, for  it is this which  leads us to the cause.   These actions may
 arise from poisons,or substances improperly applied to the surface;
 from cold; from substances  taken into the stomach:  these usually
 give a  sensation to the animal, so that it  can judge that the parts
 are diseased.   But sometimes  the  action  is too slow to give  an
 alarm to  the part; or the disease is  felt through the irritation; or
 by a part remote from the diseased part sympathizing, as worms in
 the intestines, producing  convulsions, an itching at the  nose, &c.
 When  the hip or loins  are affected, the  sympathizing part, before
 the disease is felt in the original seat, is the knee.  Passing a bougie
 has caused sickness before it was felt in the urethra, as has a clyster
 before the rectum was sensible of any inconvenience.
   Often the internal feeling of health is  the forerunner of disease.
 People  just before a disease shall be in better spirits, and feel strong,
 so  as to take notice of it themselves.
   A gentleman had better health before a spitting of blood came on.
   A boy had  more spirits than  usual the  night before he was at-
 tacked  with the cold fit of fever.
   Perhaps  the cause of disease gives the first feeling of health or
 vigor: the animal powers are called up on the first alarm of disease;
 and when  they sink, which is the second  stage, they  produce cold,
 or  shivering, which is  generally supposed to be the first  symptom.
 In children I have often observed that the  smell is affected  before
 diseases.   The first impression here is made on the olfactory nerves.
   Some diseases come  on extremely  rapidly, producing at first very
 violent  symptoms, called  acute:  others come on very  slowly, and
 do not produce any sensible first  symptom.
   I have already observed,  that all the  actions in a  healthy state
 are only produced by their proper stimulus; but sometimes we have
 actions  without proper stimulus, which are diseased actions.   In all
 organs  I have observed there is a regular succession  of  action, as
 in the secretion of different substances,  according to the wants of
 the parts  which become  the stimuli; but  they may  perform this
 office without the stimulus.  The vessels are very active parts, and
 have often wrong actions, producing  diseases in a  great variety of
 parts, and  are peculiarly active in the operations of disease.
  Too  great  action  will produce disease, according to circum-
stances. As the powers are equal, or greater, the action is universal or
local: if universal, as in inflammatory fever, it will either produce
resolution or death; if local, as in inflammation, either resolution or
suppuration; or if the action  is greater than the power, irritability;
or it may keep up a constant inflammation; or if very violent, pro-
duce mortification.  Too great action will often in the end produce
too little action ; but not often vice versd.  General action or fever
may produce local, as  inflammation; or local inflammation will pro-
duce general, as fever.  They often attend one another from  acci-
dent, and then they generally increase one another.
  Too little action arises from a disposition to act within the neces- 
GENERAL PRINCIPLES OF DISEASE.
101
sary bounds of health, which produces real weakness and a bad
state of health, with debility, without any visible state of disease, as
we often see in fine ladies.  If the part debilitated be not necessary
to life,  it only produces its effects on that organ.   Too little action
may subject the person to many more diseases than what the active
are subject to.   Even the habit of indolence in the mind, joined with
inactivity  of the voluntary  actions  (which  is generally produced
from an indolent state of the mind), produces the same effects, es-
pecially as we see in women.  So that  weakness is attendant  on
many diseases, and although somewhat necessary to many, yet it is
not actually the disease itself.  For instance, weakness attends  the
scurvv, and is necessary before the full effects of the specific disposi-
tion, namely, the action, can take place.   The same in locked jaw,
scrofula, &c.  Weakness becomes one of the causes of irritability,
as will be explained.  Weakness, too, produces  an increase of  the
disease.   It may be local or universal, for many  parts of an animal
body may be weak, while others are strong; and if the weak parts
are "not essential to life, then the effect is only debility in performing
the function, and the vital parts may not suffer.  If the nerves  are
weak, the voluntary parts suffer; if the stomach,  then the  whole
will suffer, or there may be  a weakness which  includes the whole
without destroying  it.  It sometimes seems that  the suspension of
action  for a time,  increases  the  power afterwards; and lessening
the power of action, increases the real strength at other times.
   All diseased Actions are simple.—A disposition of one kind may
and shall  exist in a part or whole, while an action  of another kind
is going on; and when the action ceases, the disposition, or dormant
action, if we may be allowed  to call it so,  shall  then come into
action.
   There are certain natural actions arising in an  animal body in
consequence of every irritation, whether appearing as a spontaneous
injury  or from accident.  These common actions I shall  illustrate
by inflammation.
   Inflammation, then, is  one  of  these simple  actions; but we  find
inflammation may be joined with a specific quality which shall not
alter its apparent mode of action, yet shall cause its ultimate effect
to vary ;  thus, though the mode  of action is altered, the action itself
is not altered.
   It appears to me that every disposition must be simple, and there-
fore be only capable of producing simple action.  Parts so disposed
may be irritated by something that alters the disposition.   If the old
disposition be destroyed, a new one  must be produced: but if the
disposition be only altered in part, there may be the two dispositions
in the  same part, the old in part and the  new  in  part.   But it  is
possible that a new disposition may be formed out of the two, dif-
ferent from either of the two which formed it; still it must be con-
 sidered as a simple disposition.
   This is plain in the cure of the venereal disease ; a third disposi-
tion (namely, the healthy,) arises out of the two, that of the disease
                               9* 
102
HUNTER'S PRINCIPLES OF SURGERY.
and that of the  remedy.  This is likewise shown in the action of
Dover's Powder, for neither vomiting or sleep is produced, but a
third action, namely sweating.
  But  a constitution or part may  have equally  a susceptibility to a
variety of diseases,  as venereal, scrofula, &c,  some of which may
have a common cause, others a specific, as lues : yet the constitution
can have at the same time only one specific action.  As  there are
susceptibilities for dispositions, so there must be also dispositions for
actions; yet two of these cannot exist at  the same time in the same
part or constitution.
  Two children were inoculated for the small-pox.  Their arms
inflamed ; but about the third  or fourth day from the inoculation
symptoms  of fever  arose, and the  measles  appeared,  and went
through their progress as usual.  During this time the inflammation
in the  arm was arrested; but when the measles were completely
gone, the  small-pox took place, and went through its progress.
  Here a disposition for  the measles had taken hold of the body, but
although it had done that previously to  the small-pox, yet  it was
not in  such a w^ay, as stopped the progress of the  small-pox.  The
small-pox  matter  was capable of contaminating,  and produced
inflammation, which went to a  certain length, but the moment the
measles changed their  disposition into  action, as the two actions
could  not  go on together, the action of  the  small-pox was sus-
pended till the measles had gone  through its  action, and the mo-
ment the constitution got free of this, the small-pox began to act
again.
  A lady of rank was inoculated by Mr. Sutton.  A few days after
a fever came on,  of the languid or  putrid kind, but without any
eruption,  except  a few petechiae  on the breast: she went through
the process  of a  low fever,  and afterwards the small-pox com-
menced ;  yet  when the pustules  maturated they spread wide and
were very large : also a different  set of eruptions succeeded, so that
thirty  days passed before the skin was clear of the eruptions.
   These cases show that but one  mode  of action can take place at
the same  time; yet I could conceive that two actions might produce
a third one, which might have been a new poison, as the last case
 in some measure seems to show.
   Of  wrong Actions.—I have already mentioned, under the animal
economy, the two different kinds of action in  an animal: 1st, The
natural powrers of growth, modelling, &c.; 2d, The powers pecu-
liar to each part, voluntary or involuntary. Now, the first may act
 improperly: it may push forth unnatural and unnecessary growth
 in some parts, and too little in other parts.   They may also act in
 such  manner as to obstruct the necessary actions of the machine,
 as  by unnecessary masses called tumours, increase  of the bones,
 &c.   The seeond may  also act wrong, that is, may act. without the
 necessity for action, as in spasms, locked jaw, over-secretions, pal-
 pitation of the heart, &c.   This  is in every respect similar to the
 former, only the improper action   is on a different part.  If, then, 
GENERAL PRINCIPLES OF DISEASE.
103
improper actions fall on a part of importance to the machine, they
produce  disease:  or they  may act too little, and  thus produce
diseases of a different kind.
  Diseased actions, like the actions of health, become accustomed
to impressions, and we see many of them subject to the same laws.
This is of two kinds: first, where the diseased part becomes less
and less  affected  by stimulus, from a continuance of the applica-
tion ;  second,  where the whole  body,  or a  part, becomes more
easily effected by  the stimulus, from a repetition of the application.
  People constantly exposed to the cause of certain diseases become
less affected, or  less liable to be affected.   Perhaps the best way
to prevent being affected by some infectious diseases would be to
live constantly where the infection was.   People coming out of the
country  into the  town are more  liable  to be  affected by  certain
infections, as the small-pox, than those who live constantly in large
towns.  The constitution having once felt the stimulus of the small-
pox, is not afterwards affected  by it; yet I can readily conceive
that if a man were to live two hundred years he might arrive at
that period when he would again be susceptible of the impression.
  Of Sedatives and Stimulants.—Perhaps there is no idea  of any
principle, simply  as an idea, more correct than that conveyed by
the word sedative, stimulus, irritation ; yet I think it is probable that
there is  no idea  so little understood in practice; and it may be a
very  difficult task, and next to an impossibility, to say what  real
state  the body or part is in, or can be brought into, to  be affected
in either  one  or  the other  w7ay.  This  arises from our imperfect
knowledge of the true state of  the body or parts, or of their eco-
nomy ; for what might act as a sedative at one time,  might  be a
stimulant  at another, or even an  irritant;  or what  might  be a
sedative to one  part, might be either  a stimulant  or  irritant to
another, which we shall see to be really the case, for whatever
will excite action,  even the  common  action  of parts, will  be a
stimulus, and whatever will excite actions beyond the real strength
of the body will be an irritant; and this cause of excitement beyond
the common action may be no more than what at another time would
act as a  sedative.
   For example, without heat,  probably no action could  take place
either in common vegetable  or animal matter.  Heat admits of
becoming  an  exciter to action; but as heat, in so far as it can,
only excites natural actions, and, in  due proportion to the strength
of the parts, it may be called  sedative; for we may suppose that
by sedative is  not meant  an unnatural reduction  of action  (for
which, indeed, we  have  no  expression),  but the production of
a natural  action from  too great an action.  It may increase or
diminish action, according  to circumstances.  But to ascertain the
precise degree of heat suitable to every state of body or part, so as
neither to  increase nor diminish action, is probably impossible.
   When animals are extremely weak, their actions should be suit-
able to their strength.  Or if an animal is  only moderately  weak 
104           HUNTER'S PRINCIPLES OF SURGERY.

in the whole, considered  as  a whole, yet there will be parts that
will  be very weak;  and if those  parts are  under disease,  care
should be taken that those parts are not thrown into action above
their strength.
  The temperature of the body, or parts respecting heat and cold,
should be in proportion  to  this weakness,  which will regulate the
action, and to apply warmth at such time  would be applying a
stimulus ;  and if the body was still more reduced, warmth might
become an irritant;  or if the body was not able to act up to this
stimulus, it would be an irritant.
  To lower actions suitably to the  state  of the constitution, what-
ever this may be, is the use"of a sedative; but  in some  constitutions
it may be requisite to bring it even lower.  So it is often necessary
to produce  fainting ; but this  cannot be called a sedative ;  it is
probably only weakening.
  Irritability.—There is  no  word perhaps more improperly applied
than irritability ; it is often used for stimulus, and stimulus often
used in place of it.  Indeed we must  allow that there is a resem-
blance between  them in several of their properties, both exciting
actions of the living  parts; but they differ very much in the  con-
sequent action, as, indeed, irritability appears to be nearly allied to
susceptibility.
  I have  already  explained, when on the animal economy (p. 62),
that stimulus excites or increases natural actions; but an irritation
either excites an unnatural quantity of a natural action, or an entire
new one ;  and susceptibility is the readiness with  which they can
be excited.
  Some constitutions are so easily excited, or in  other words, so
susceptible of diseased impression, as to take up actions so readily
as to make them appear natural, which  in others are only brought
on by disease.  That a natural action may be increased beyond its
natural bounds we see every day.   Salivation is an instance of this.
That irritation produces new  action is perhaps more evident than
the former.  Accidents of all  kinds are  of this kind.   Blisters act
on this principle.   In short, every new  action which  takes place
may be said to arise from  an irritation produced in  the part, or
something similar.   Irritations are often producing salutary effects,
and therefore may be said to terminate in a stimulus, which is
owing to a kind of irritation,  such as those  which are in conse-
quence of many accidents, which new action produces a restoration
of the  part injured, as in wounds, compound fractures, &c.
  There are new  modes of action  taking place  every day that
would appear to arise spontaneously (therefore  from  no possible
irritating cause, which, on the contrary, most probably arises from
this new mode of action). The immediate cause may be so slight as
hardly to approach to an irritation.   Such constitutions are called
irritable, which is only saying that one part may be irritated by what
would have no effect on another.  Those unnatural  spontaneous ac-
tions often arise from a want of power to act properly, with a strong 
OF SYMPATHY.
105
disposition to action, which is the reason why weakness, or want
of power, becomes the cause of irritation, which  produces new
action, which new action will be according to this want of power
and the nature of the part combined.
  Necessity often becomes  the cause of irritation, as when a  small
opening is made into a large cavity, and not  allowed to heal by
the first intention, the whole becomes under the necessity of taking
on a new  action to  restore the  whole;  therefore irritation  often
produces  salutary effects.
  Many of the preternatural actions are so slow in their motions
that we can hardly make them accord with our ideas, which ascribe
them to irritation, especially in those that seem to arise spontane-
ously, as the formation of many  wens, encysted tumours, &c.
  Irritation may be divided into common, specific, and poisonous:
1st, Common, is that which will affect all animals ; 2d, That which
will affect only the same species ; 3d, Is also  very much  confined
to species; one only, as  far as I know, being  excepted,—the bite
of a mad  dog.   So that the disease of one  animal, although  com-
municable to  another of the  same  species,  is not so to one of an-
other species.   Small-pox,  chicken-pox, venereal disease,  measles,
hooping-cough, jail-distemper, itch, scrofula,  are peculiar to the
human.  The disease of black cattle is confined  to them ; the rot
to sheep ;  glanders to horses ; mange to dogs.*
                         CHAPTER  X.

                          OF SYMPATHY.

Disposition to action arising from sympathy;—without direct impression.—
  Sympathy of two kinds;—connexion of principles of action in the living body;
  —sympathies of sensation doubtful.—Sympathy between different bodies.—
  Sympathy natural or diseased ;—not always reciprocal between parts;—gene-
  rally  single;—common or  uncommon;—similar or dissimilar;—partial  or
  universal.—Varieties of partial sympathy;—varieties of universal sympathy;
  —fever, inflammatory, hectic.—Certain parts sympathise more strongly than
  others.—Of similar and dissimilar  sympathies ;—of  simple sympathies ;
  difference of sympathies from modes of impression.—Sympathy of body with
  affections of the mind ;—of  the mind with the living principle;—use of sym-
  pathies—Of delusion ;—explanation of it;—delusion in dreams.

I have endeavoured to show that there are two principles  in  the
higher animals, namely,  life and the action of the nerves, which
last is  called sensation and volition; or rather, perhaps, there is but
one principle,  life, which becomes the basis of the other and  of


  *  [There are some  of the above diseases which aTe now known to be commu-
nicable to  other animals.] 
106
HUNTER'S PRINCIPLES OF SURGERY.
every action of the body.   I also endeavoured to point  out  that
sensation arose from feelings in the mind, which produce action in
the body.  I attempted to show that the more simple actions arose
independently of sensation or of the actions of the nerves; that the
nerves, from their specific actions, only become the cause  of many
actions, but are not the principle of those actions; that  from their
termination in the brain they produce sensations  there from which
is formed mind, and that they also give rise  to the will, and form
the basis of reasoning.  I showed that the mind becomes the cause
of many involuntary actions in  the body, as reason  becomes  the
cause of the voluntary; and that thus the actions of  life,  of  the
nerves, of  the mind, and of the will arise from impressions being
made on each so as to affect their principles.
   In  speaking of the general principles  of disease, I divided  the
living power into susceptibility of impression, impression, dispositions
arising in consequence of such, and action consequent  on disposi-
tion;  all which I observed were immediate or primary.  But there
is a secondary susceptibility, disposition,  and action arising from,
or in consequence  of, all, by necessity, called sympathy; actions,
as it were, playing amongst themselves, each becoming a stimulant
to the other, or each being affected by the other.
   By this  principle of action, called sympathy, an  action  arises
without an immediate  impression in a secondary way,  either acting
in conjunction with the part immediately impressed, or  taking  the
whole action on itself.   This action without immediate  impression
is one of the most complicated principles  in the animal body, espe-
cially the more complicated animals, because it is the compounding
of actions.
   Sympathy may be divided into two species: 1st. A local with a
local  disease;  2d.  A  universal  with  a  local.  The  first may be
called local sympathy;  the second  universal.  But all  sympathies
must  arise from  a local  cause.   Sympathy is not confined to  the
same actions of the  same person, but  is' transferable from  one
person to another.*
   In  the investigation of this subject, we  shall find all  the princi-
ples of  action in an animal, even in the most complicated, have a
connexion  with one another ; for instance, the living principle,  the
action of the nerves, and the mind:  and that  the same principle in
one part shall be affected by the same principle in another ; and  this

  * [For some curious examples of this sort, see Dugald Stewart's " Elements of
the Philosophy of the Human Mind," p. 153, et seq., and Edin. Med. and Surg.
Journ., vol. iii. p. 434, et seq., respecting the  mode in which  some convulsive
diseases were propagated in Scotland.  A strong collateral argument may be de-
rived from this species of sympathy in favour of that opinion which makes the
intervention of the sensorium commune a necessary condition to the existence of
sympathy.  See Whytt's WTorks, p. 140, and Dr. Alison  in Edin. Med.-Chir.
Trans., vol. i. p. 165.   That  the nerves, however, are capable of a  reflex action
through the medium of the spinal marrow as well  as through the  brain, is ren-
dered  certain by  the experiments of Dr. Marshall Hall and by many morbid
phenomena.  See Med. Gaz., vol. ii., 1832-3, p. 769.] 
OF SYMPATHY.
107
is the simplest kind of sympathy I can conceive.  Thus, the living
principle of one part sympathises with the actions of life in another
part, as must be the case in all  animals which  have no nerves.*
The nerves of one part sympathise with the actions  of the nerves
in another, which may produce sensation.   The  mind sympathises
with the mind,  which of course  can only take  place in  animals
that have mind,  and perhaps not in all of them; and  it is more than
probable that such minds as are capably of sympathy are capable
of  other complications  of  affections.  Probably what might be
called  the  disposition to action of one  principle in one part may
produce action of another principle in another part.  Thus sensa-
tion in another  part may be  produced, while simple  life  only is
affected in  the part immediately impressed.   This would appear to
be owing to the nature of the sympathizing part.  Thus, if an injec-
tion is thrown into  the urethra in a man,  it shall not give pain in
the urethra, not even the common sensation  of the part, yet the
stomach shall be affected and sickness  produced, which last  is a
sensation.   I have known a stimulus  in the rectum, which did not
produce pain in  the part, produce sickness and  pain in the  small
intestines, and even  stop digestion.  Such pain certainly arises from
action in the part.   On the contrary, simple pain in  the finger shall
produce a  greater action  of the living principle in another part, as
making the heart beat oftener.
  The principle of sympathy itself I shall call a genus, of which the
above  make three species, namely, sympathy of  the actions of life,
of the  nerves, and of the mind.   Each of these have  their varieties
in action, each being susceptible  of varieties of  impressions, affec-
tions,  and  actions, and all being  capable of sympathizing with one
another.
  It may admit of dispute,  and probably will be  difficult to settle,
whether there is sympathy between sensation and sensation simply ;
for sensation must arise from some impression made on a  part, or
some  action of  nerves  similar  to those arising from impression.
Therefore every sympathy which only produces sensation must still
arise  from impression on, or action  of, the nerves;  and the same
with the sensation in the sympathizing part.   Sensation is only the
natural consequence of such action, for  sensation is only the intelli-

  * [What the real conditions of  the organization are on which sympathies de-
pend are unknown, although there seems every reason to ascribe this agency
solely to the  nervous system.  To ascribe it  to the living principle is merely
eluding the question by a sort of abstraction.  The difficulty still returns—what
is the  intermedium through which distinct and dissimilar parts are thus asso-
ciated 1 Some intermedium there must be; and as  to the difficulty respecting
those beings which have no  nerves (p. 54, note), the same is equally  felt in
regard  to the higher animals, in which the most powerful sympathies  exist, al-
though no  anatomical  connexion is to be  traced between  the parts, nor any
relation of function or structure  observable.  Indeed, those structures, such as
fascia?, membranes, &c, which apparently have no nerves, are those very parts
which give rise to the strongest and most marked sympathies.] 
108
HUNTER'S PRINCIPLES OF SURGERY.
gence of action, either from impression or arising from  the sponta-
neous action of the nerve itself.
   I suspect that all those which would appear to be sympathies of
sensation only, without action, are a delusion of the mind, a wrong
reference of the mind to some other than  the part affected, which I
shall explain when upon the subject of delusion.
   From  what has been said above, it must appear that sympathy is
a principle in animal bodies so intimately  connected with every pos-
sible impression, affection, and action, that we cannot have a proper
conception  of the animal  economy respecting diseases without
taking this  principle into consideration.  It is one of the secondary
principles when applied to the body itself, being the  effect of some
impression, affection, or action in some other part of the  same body.
Sympathy arises  from every part of the  body being  ready to fall
into  affections and actions in consequence of an impression, affec-
tion, or action having taken  place in some other part.  Sympathy
is one part taking part in the impressions, affections, and actions of
another part.
   Sympathy is not confined to actions of the same persons amongst
themselves, but is transferable from one person to another, in whom
it cannot be called a secondary action, as it arises from an impres-
sion being made on some of the senses.
   Yawning  is a  species of  sympathy;  and all actions peculiar to
country, places, family, &c, ai'e so many sympathies.  Dancing may
be included among the sympathies,  for it is not simply an imitative
action arising from the will, but it is an irresistible impulse arising
from a state of mind produced by musical sounds.   If there were no
sounds, or, in  other words, not  a sense of hearing, there would be
no dancing: for seeing would not produce it, probably rather re-
tard it.   There is, first, sensation ; then  a state of mind formed in
consequence of that sensation;  and then the  action of the limbs ex-
cited by that sensation.
   The idea of sympathy  may be stated differently: instead of say-
ing a part sympathizes with  another, we may  say  one  part under
stimulus or irritation is capable of stimulating another  part of the
same body into  sensation, action,  &c, which I think is the most
natural idea or position.
   Sympathy may be divided into two kinds, the  natural and the
diseased. The diseased is when sound  parts sympathize with the
diseased, and probably the  diseased with the diseased, which  is
what I mean to explain.
   The sympathy of  one  diseased part  with the diseases of another
part will include the idea of  revulsion, as revulsion  consists in the
production of a disease in  one  part to cure a disease  in  another
part; which shows that this  one part, while under disease, can be
affected by a diseased action being produced in another part, or the
cessation of one action in consequence of  another having  taken
place in  another part.
   Natural sympathy takes  place more readily, and  its  actions are 
OF SYMPATHY.
109
 more strongly marked, in proportion as the powers of the machine
 are capable of repairing an injury received.  On the other hand, it
 takes place more slowly, and is less evident, as the powers of life
 are more languid.
   In many diseased states the condition of the  whole body is often
 such that it more readily falls into sympathy  at one time than at
 others*   Thus we find people at particular periods much affected by
 slight causes,  while  at other times considerable mischief received
 will hardly affect them*
   Some people are naturally more readily affected  than  others, as
 will be  evident in disease.
   Sympathy sometimes proves fatal, as  in children from teething.
 But this depends in great measure on the parts sympathizing, or the
 number of parts that sympathize.
   Sympathies  are often not reciprocal: the liver never sympathizes
 with the shoulder, nor the  urethra with  the  testis; nor  when  the
 glans penis is affected  does any irritation  pass to  the  bladder;
 but often they are,  as, for example, between  the  head and  the
 stomach.
   Sympathies  are generally simple; we hardly ever find two parts
 sympathizing with the same cause : however,  the spasmodic convul-
 sion of both hands and feet, &c, as sometimes takes place, may be
 called a double sympathy.
   Sympathy is common and uncommon.   The first is where it takes
 place more  readily between some parts than it does between others,
 as between the stomach and head, the stomach and  the  skin, the
 testes and the  urethra.   Sympathy may be called uncommon when
 parts sympathize with diseased parts that were never knowrn to
 sympathize in  health.
   A gentleman had a sore on the inside of his thigh, which  itched
 so intolerably  that he could not avoid scratching it, and  when he
 did, it always  produced  tightness  in his chest and  shortness of
 breathing, which he never had but  at these times.
   Lord  Cavendish's father always felt pain in the left arm from a
 stone in the bladder.   This  pain was the only indication of a want
 to make water.
   Sympathies  are either similar to the cause or dissimilar.  The
 similar can be  but of two kinds: where the  modes  of affection or
 action of the' sympathizer are either wholly similar  to the modes of
 affection or action of the parts diseased, or the sympathizer has one
 of its modes of affection or action similar, and which is the one that
 sympathizes.  Dissimilar sympathy may  be of so many kinds that
 it is probably hardly possible to  be completely master of the whole
 of the particular varieties.
   Sympathy may be  said to be either partial  or universal.  Sym-
pathy is partial, from local diseases, when the causes  of  action in
one part become the cause of action in a distant part, as when any-
thing tickles the nose the muscles of respiration act; or it may be
partial from a universal disease.  But local sympathy  with the
                             10 
110
HUNTER'S PRINCIPLES OF SURGERY.
constitution has its order of parts, as the stomach sympathizes with
the whole body in an incipient fever.
  Sympathy  is  either  natural or diseased.  Natural sympathy
always tends to produce some salutary purpose, as  the  breasts of
women increasing with the size of the uterus during gestation.
  As no part of the body is entirely independent of  the rest, in all
particular injuries the whole must sympathize more  or less ; but
as every individual part has a more intimate connexion with some
particular part  than  writh others, these  parts sympathize more
readily.
  Local or partial  sympathies we call continuous, contiguous, or
remote.   Continuous is only an extension of the same action, as in
most inflammations  spreading from the centre ;  otherwise, in an
injury, the part which  received  the first  impression would alone
become inflamed.  Contiguous is where one part sympathizes with
another where the parts are only in contact with each other, with-
out any continuity of parts, as  the  contents of the abdomen with
the  abdominal muscles.*   Remote is where  one  part sympathizes
with another part, though at some distance from it.
   Universal  sympathy is when the whole  becomes affected in con-
sequence of a local disease, and  is of two kinds.   One  is where
every part of the body sympathizes with any one part  stimulated,
as the sympathetic fever in consequence of local inflammation, as
also eating substances that disagree with  the stomach, convulsions
from worms, teething, &c.;  or, secondly, where particular parts,
being  stimulated, more readily produce universal  sympathy  than
 any other.
   Constitutional sympathy may arise  in many  cases from  local
 sympathy, and not from the effect of the first injured part.  This is
 very remarkable when the sympathizing part is a vital part, though
 the first  injured part be not  vital.  If the stomach sympathizes
 strongly with any part of the body, this sympathy of the stomach
 produces a morbid state of the constitution.
   In universal sympathy there appear three stages, but all  equally
 belonging  to this principle;  1st, inflammatory fever; 2d, hectic
 fever; 3d,  dissolution.  These take  their  rise  from the  different
 stages of the local disease.  There may be marked a fourth, which
 may be called nervous, spasmodic, or hysteric ; but this is not par-
 ticular to any one of the states of the local disease from which the
 others arise, but from peculiarity of  constitution, and sometimes it
 exists when the others do not.
    Local or partial sympathy is found more in old  than in  young;
 whereas universal sympathy is more in young than in old.   Sym-
 pathy is less determined in young persons, every  part  being then
 ready to sympathize with other parts under disease.  This  is re-
    * [Of this kind also are the actions of membranous muscular cavities  as the
  heart, stomach, or intestines, when their lining membranes are stimulated, and of
  the muscle of the skin in animals when the skin is irritated.] 
OF SYMPATHY.
Ill
markable in the teething of children, for in them universal sympathy
seems the first mode of sympathy arising from local irritation.
  When a local disease takes place  in a part when  the patient is
very young, it is capable of giving a general disposition to sym-
pathize, by which means symptoms become more uncertain than
in those of more advanced age, often putting on the appearances of
a great variety of diseases.
  As the child advances, the power of sympathy becomes partial,
there not being now in the  constitution that  universal consent of
parts, but some part, which has greater sympathy than the rest,
falls into the whole  irritation ; therefore the whole  disposition to
sympathy is directed to some particular part.  The different organs
acquire more and more of their independent actions as the child
grows older.
  We find in children the  symptoms from sympathy often more
violent than those of the parts  affected.   In  adults  when  cutting
teeth there is only an affection of the part, or  only a continued
sympathy, that is, a swelling of the cheek, &c.   In adults the pain
is often very great, but in children the pain is little, and the action
of the part moderate, but the action in the sympathizing parts is
very great, namely, in the voluntary  muscles.
  Sympathetic Inflammatory Fever.—In consequence of considera-
ble local injuries, as a compound  fracture, or operation of conse-
quence having been performed,  that accident or operation shall be
followed by inflammation, suppuration, &c.   In consequence of this
local injury fever shall arise in the system,  which is universal sym-
pathy, commonly called  symptomatic fever.
   Convulsions often  arise from considerable  local  injuries called
irritation.  Permanent contractions are also often the consequence
of local injuries or irritation, as  tetanus.
   If another mode of action takes place  in the part sympathized
with, namely the cure of the injury,  then the inflammatory sympa-
thetic  fever will subside.
   Sympathetic Hectic  Fever.—If parts  have  not a power to effect
a cure, the  constitution  sympathizes  in another way: it is teazed,
as  if conscious that the disease  is  incurable ;  and  this  teazing
constitutes the greatest  part of what has been called hectic fever.
But if this incurable part is  removed, the hetic fever will cease.
   I have seen a wound in the knee keep a man awake several
nights with pain and constant purging, and the  patient becoming
 hectic ; and by amputating the  part he slept well the same night
 without opium, the  purging immediately  ceased, and costiveness
 ensued.  A  man had a wound in the elbow-joint, and was  affected
 exactly in the same way,  the  pulse quick and  hard : within  ten
 minutes after the removal of the arm the pulse became slower and
 softer.
   This universal  sympathy, of  whatever  species, is greater when
 certain parts  are  diseased.  The  sympathetic fever will more
 readily take place from an injury  done to the involuntary parts, as 
112         HUNTER'S PRINCIPLES OF SURGERY.

the stomach, intestines, testicles,  &c,  than if the same mischief
had been done to the voluntary parts, as the muscles of the arm,
for instance.
   When vital parts are diseased, there is more sympathy among
vital parts than among others.
   Universal sympathy is greater  if the injury received is further
from the source of life, namely, the  heart, than near it, provided it
be a part of the same nature in both cases.
   Sympathy is similar to  sensation, action, motion, &c.: it can,
and often does, cease instantaneously-  Every sympathy ceases
after the cause is  gone, although its effects  may remain, as tume-
faction.*
   Some parts of the Body sympathize more  than others.—The sto-
mach appears to have this connexion with the body more than any
other part.   It would appear that  the stomach was the seat of uni-
versal sympathy, sympathizing with every  part of the body, and
most parts of the body sympathizing with the stomach.
   Every part of the body seems  to  have some  susceptibility of
sympathy; but although there is universal  sympathy between the
stomach and whole body, yet the stomach sympathizes more readily
with a  complaint  in  the head than with one  in  the  toe;  more
with the testicle than with many other  parts.  Also some  parts of
the body sympathize  more readily  with the stomach  than many
other parts, as  the head, skin, &c.  The skin  sympathizing  with
the stomach is often very evident, from the effect some food has
on the stomach, producing disease  of  the skin.  A glass  of cider
in some shall produce  a flushing in the face  immediately; and
spirits, in the end, we know, produce  inflammation and suppura-
tion over the whole face, called  pimples, especially on the nose.
But whether the  stomach loses  part  of this property I  am  not
certain.  It appears that other parts lose that susceptibility to sym-
pathize  with the stomach, as the  skin, for that part does not seem
to be so readily affected in the old as in the young.
   The stomach sympathizes with  the skin in many  of its affections.
Cold  or wet feet  will immediately affect  the  stomach.  But the
most  striking instance is seen in the leech when its stomach is full
of blood, by throwing  salt on it,  when, from sympathy of the
stomach with the skin, it immediately rejects all the blood.
   The intestines, especially the upper  parts, have  also sympathies
over the whole body.   Cases of  worms show  this perhaps  more
than anything.
   Observations  on Sympathies of the different Principles with one
another, producing similar and dissimilar Sympathies.—Continued
sympathy  is more commonly  similar  than tho remote, as  it is an
extension of the samo action, and commonly in a similar part which
can act alike, as  indeed most parts do in  most of their common

   • [It often happens, however, that parts acquire a habit from long-continued
sympathy, which does not cease qpon the cessation of the cause,] 
OF SYMPATHY.
113
 actions, although the peculiar actions of the part may be dissimilar.*
 Thus, chancre on the scrotum, if it was to spread to the testicle,
 would produce the same mode of action in the  testicle  as  in  the
 scrotum, though it might at the same time produce effects peculiar
 to the testicle, as stoppage of the secretion, &c.
   But the remote, local, or partial, is both similar and dissimilar,
 varying according to two  circumstances:  1st, According  to  the
 nature of the part deceased and the nature of the  sympathizer.   2d,
 According to the species of properties  in  each  part; as one pro-
 perty in the part  diseased producing sympathy in another property
 in the sympathizer: disease in one part producing increased na-
 tural discharge in another part, which makes sympathy very com-
 plicated.
   Let us take  sensation as an illustration:  although we have no
 sympathetic sensation, it being wholly delusive, yet sensation is  an
 absolute guide.  We know that the  sensations in  the brain are not
 similar to any other sensations in the body,  at least not similar to
 many of them;  also  the sensations of the stomach are  unlike to
 many of the brain, if not to the whole of them; also that many of
 the sensations of  the stomach are not similar  to  the sensations of
 other parts; also that all sensations of the stomach  are not the same;
 also that an action of one part shall produce sympathy of another,
 whose mode of action is not similar: we must see  therefore at once
 why the two modes of action become not similar, and why  the sym-
 pathy is not similar to the cause, producing by this means another
 cause of complication, and consequently a variety in the first prin-
 ciples of sensation and action respecting sympathy.  Again, differ-
 ence of  properties may produce dissimilar sympathies between two
 different principles, as the principle of life and that of action.   For
 as sensation in one part may produce sympathy  in a  part whose
 actions are dissimilar from  that other part, the sympathy produced
 will be  dissimilar, and this resulting  from  the difference in the
 properties of the principle of action.
   Also when we consider that many parts have more modes  of
 action than one, as  the stomach, which  has a variety of actions,
 and of course is capable of producing a variety of sympathies  in
 other parts,  or  can sympathize in  a variety of ways with  other

  * [To this head may be referred, 1st, Those sympathies  by virtue of  which
 parts become successively diseased in pairs, as two eyes, two similar parts of
 the skin, or two testicles.   2d, Those which give rise to disease in consequence
 of similarity of function, as ulceration of the cartilages, inflammation of the syno-
 vial membranes of joints, &c.  3d, Those which affect particular organs from
forming parts of the same general system, as disease of the bladder affecting the
 kidney, of the uterus affecting the breast, or the spinal marrow of the brain, &c.
 And 4thly, Those which arise from similarity of structure, as inflammation  of
 fibrous and mucous membranes, &c.
  We may observe, once for all, that any philosophical classification of sympa-
thies is impracticable.  Mr. Hunter has probably made his division of sympa-
thies too complex; but he has amply redeemed this fault, if it be one, by the
able manner in which he has treated the subject.]
                              10* 
114
HUNTER'S PRINCIPLES OF SURGERY.
parts, so that any one of these peculiar actions in one shall produce
an action or sympathy in  that suitable to the first action of the
disease, which of course will be similar to the action of the diseased
parts; while another action in the same part, and from the same
principle, shall produce another mode of sympathy in the sympa-
thizer ; when we consider  all these, they will  at first sight appear
inexplicable: as an  illustration, we may observe what a variety of
sympathies are produced from one mode of irritation, as teething,
or worms in the intestines.
  This connexion  of every part of the body  with the others, by
sympathy, becomes one of  the extensive principles of action in the
animal economy, indeed is  the basis of most of the compound im-
pressions, affections, and actions.
  Similar Sympathy.—Sympathy must be similar to the affection of
the part  first  affected when  between  parts whose affections are
wholly similar; similar in action when between parts whose actions
are wholly similar.
  Sympathy may be similar in disease when between parts endued
with a variety of affections and actions, provided they are endued
with the same affection or  action, as irritation in one part produc-
ing irritation in another, which thus produces inflammation, as an
injection  into the urethra producing swelling  and pain of the tes-
ticle.
  Continued sympathy,  I  believe, in all cases is similar to the
disease, at least  the action is so, even though it may spread to a
dissimilar part.  If inflammation attacks the  diaphragm, and ex-
tends to the liver from continuity, that inflammation of the liver will
be similar to that of the diaphragm.  The same also if disease ex-
tends from the testicle  to the scrotum, &c.
  Dissimilar Sympathy.—Sympathy is dissimilar when the affections
or actions of the part impressed  are not  similar to the actions  or
affections of the part which sympathizes; thus, sickness at the
stomach  cannot produce sickness any where else;  or, secondly,
where parts diseased  are susceptible  of a variety of affections or
actions of which the sympathizer is not; or, thirdly, even in parts
where both the part diseased and the  sympathizer are susceptible
of the same varieties of stimuli and modes of action, which varie-
ties  in themselves  are similar to one another, yet the sympathizer
shall not be the corresponding affection or  action to  that which is
excited in the part diseased; for  example  a  medicine  taken into
the  stomach shall produce flushing  of the  face  or inflammation,
though the stomach is liable to the same disease as that of the face,
namely, inflammation.   So that in this case  the difference does not
arise from the mode of action  being different from that of the
stomach, only that  the face does not run on the same  degree of ac-
tion as the  stomach.   In inflammation of the liver the pain in the
shoulder  is  different from  inflammation, though the shoulder and
liver are equally susceptible of inflammation.  So that many  parts
have a variety of  actions in themselves which are similar to  some 
OF SYMPATHY.                     Hfi
actions  in other parts; therefore sympathy shall  or shall not be
similar  to the  action of the diseased part, being according to the
stimulus applied to such part, or mode  of action  of the  diseased
part joined with the mode of affection.   Therefore  simple stimulus,
action, or affection shall not  only be the  cause either of similar or
dissimilar action, but both, according to  the variety of affections
and different parts that sympathize.   A stimulus in  the testicle shall
produce  sickness in the stomach, which shall produce vomiting,
which is an action; so that a double and different compound sym-
pathy takes places  from the same stimulus.
  Of the simplest  Sympathies.—In vegetables we  evidently see
actions taking place in  consequence of actions having taken place
in another part; but how far vegetables  have  a variety of proper-
ties and actions is  not  perfectly known; however, we can hardly
doubt that they have a great many, for they produce a vast variety
of effects, all these actions and effects arising from the principle of
life.  So that  sympathies of vegetables  may be complicated, and
even dissimilar, but still more simple than the most simple animal.
The succession of  motions in a sensitive plant are no more than a
succession of sympathies, or  a succession of stimuli in consequence
of those preceding. Here, then, we have an exact similarity in the
actions of the  sympathizers with the part first acted on.
  The most simple sympathy is perhaps to be found in vegetables,
these being much more  simple than the most simple animal. Vege-
tables have the same properties as animals without brain or stomach.
Take away, therefore, the  sympathies  of the stomach  with the
body, and of the body with the stomach, and those between the
brain and the  body, reducing the sympathies of the animal to the
simple properties of life, and an animal will be exactly similar to
a vegetable; and this I know from  experiments made on trees.
  The motion  of the sensitive plant I have said is produced by a
succession of simple sympathies: something like this may be found
in the more imperfect animals;  but no animal can be so simple in
all its sympathies, though it may in some.  I shall  at present  sup-
pose that every part  of an  animal  is liable to be affected by the
stimulus  of agreeable or disagreeable  sensations,  and the more
simple the animal the more likely it is to be under the same simple
sympathy.  A polypus  is the most simple complete animal, and
therefore must be  most similar  in its sympathies;  but I can con-
ceive a  child  in the womb  to  be  still more  so, being capable of
one stimulus only, namely, want in  the system; and perhaps it has
no sympathy even  with this, as  it has no  demand  on any part of
its body for the supply.  This simplicity of stimulus is found not
only in the simple  animals, but  in some degree also in the more
complicated.   The similar  sympathies  may  be compared to the
unison in sounds.
  A polypus,  though so simple an animal, is susceptible  of  four
different stimuli, disagreeable and  agreeable, propagation of the
species, and want  of repletion.  In the  last the stomach becomes 
116          HUNTER'S PRINCIPLES OF SURGERY.
 the original sympathiser, and produces action in the other parts, so
 that here  is a  sympathy as in plants, but not so simple,  for the
 stomach first sympathises  with the whole  body  when it  wants
 repletion, and afterwards by a  reflex sympathy the body is called
 into action and  its little arms are erected.
   Difference of Sympathies in the Sympathiser arising from differ-
 ence in the mode of Impression.—Difference of affection  and action
 of the sympathiser from that of the part affected does not always
 arise from difference in the nature of the two parts, but  often from
 difference  in the nature  of the  stimulant, or  mode of impression;
 for a stimulant  of one kind shall produce a mode of impression of
 its own kind in  the part, from which shall arise a peculiar sympa-
 thy, while  a stimulus of another kind will produce  an  impression
 of another kind,  which of course wTill produce  a  sympathy of
 another kind in the part that sympathises.   Thus, when the stomach
 is stimulated in a particular way, the head shall ache, which is
 often the case when something  is taken which disagrees with the
 stomach; and if stimulated in  another way the headache shall be
 removed, namely, by exciting vomiting.*  There will be, therefore,
 a  variety in the actions  of the  sympathiser, arising from varieties
 in the specific  modes of action,  created  by different stimulants,
 which may also produce similar sympathy in dissimilar parts, for
 parts very dissimilar in their  natural actions shall  be put into
 similar actions by sympathy.  When the stomach  is stimulated in
 one way, an action shall be brought on in the muscles of respira-
 tion and of the  belly for the expulsion of the irritating matter; or
 if stimulated in  another way, sweating shall be brought on in the
 skin; or if stimulated in  another way,  universal  debility takes
 place; a blow on the stomach may even kill.
   Hence it appears, that a stimulus of one kind produces sympathy
 in one part of the body, while a  stimulus of another kind  applied to
 the same part produces sympathy in another part, each mode of ac-
 tion in a particular part having other parts distinct from  each other
 which sympathize with it.
   I should  suspect that specific inflammations are  not able to give
 to the sympathizer their specific  virtues, though they may be liable
 to give them others.   In  continuous sympathies the affection is simi-
 lar, but not in the  remote.  A swelled testicle in venereal  gonor-
 rhoea does  not partake of the specific nature of the original disease.
 In a cancerous breast, the glands in the axilla  will often inflame and
 subside again, which they would not do if they were  affected with
 cancer.
  Sympathies of the Body arising from Affections of the Mind.—The
living principle  of the body sympathizes with the mind.  Strong
affections of the mind  will produce  involuntary motions, even of
those parts commonly at  the command of the  will.   This must be
  * [This illustration  is incorrect; the headache is removed, not because another
mode of stimulation, that of the emetic, takes place, but because the  original one
is removed ; thus spontaneous headaches terminate in sickness, and get°well.] 
OF SYMPATHY.
117
by means of the nerves,  for the body has no  connexion with the
brain but by the nerves.  Fear will produce action of the involun-
tary parts, as purging, discharge of urine, &c.
  I suspect that particular parts may sympathize more readily with
the mind than others; therefore in such cases sympathies may be
called local or remote, but they are,  I believe, in most cases uni-
versal.
  Sympathies of the Mind, with  the Living  Principle.—The  third
principle, mind, is capable of sympathizing with the first, or actions
depending on the living principle, for I should think that  a state of
the body often forms a state of mind;  however, it is not so readily
affect-ed by what does not produce sensation  as by that which does.
A man in pain  not only feels pain as a sensation, but becomes de-
pressed: or if the actions of life can produce sensation in any part,
then the mind becomes affected, as when the whole body is in want
of food the stomach sympathizes strongly with the whole, and the
sympathy of the stomach causes a  sympathizing mind.  This is not
sympathy immediately with the first principle,  but  sympathy with
the sympathizer, or second,  which, however, arose from the first.
There are, however, instances where the mind sympathizes with
the first, or life, for there  are many instances where the mind is de-
pressed without a sensible cause,  called hypochondriasis, and also
where the mind is light or easy without any sensible cause.  I sus-
pect  that both these states  arise from the  living  principle being
either diseased or at rest.
   Sympathy  of the mind with the voluntary parts is curious.  If
the voluntary parts are rendered useless, the will has no longer any
power over them; it produces a state of mind which prevents the
will putting the parts into action.   Thus, when the tendo-Achillis is
divided, the person  cannot put the muscles attached to that tendon
into action by the will; but  as soon as union  takes place and grows
strong, the mind allows the will to  take possession of its action over
the muscles.
  Use of Sympathies*—Sympathies are designed for very important

  * [To enumerate all the uses of sympathies in an animal body would evidently
be impossible in the present state of science.  Nothing is more certainly ascer-
tained, however, than that every part of the frame is connected in some myste-
rious manner with the whole,  and the whole with every part, in consequence of
which a sort of community of feeling is established between all  the parts and
functions of the machine.  This is most remarkably exemplified in those organs
which are associated in some common function, as, for example, in the organs of
generation, digestion, respiration, &c, which reciprocally act and react upon one
another on all occasions, in health and in disease.
  Ascending  to still higher generalities, as, e. g., to the  great centre of organic
life, the stomach, the brain, and the heart, the same relationship and dependence
is observed to exist, still more strongly developed ; while these again may be
regarded as so many primary foci, to which all the impressions of the body tend,
and from which, by a sort of reflex  operation, they radiate to the most remote
parts of the system.  A balance of power and action is thus established which it
is easy to see must be of the most essential importance to the general economy of
the animal, whereby the weakness of individual parts is reinforced by the reaction 
118
HUNTER'S PRINCIPLES OF SURGERY.
ends.  They produce a communication between the three principles
of the animal economy.   The use of sympathy is often very evident.
If there is an uncommon irritation in the  lungs or throat, the mus-
cles of respiration act with uncommon force, and the offending sub-
stance is  thrown up.   The irritation is frequently in the lungs, then
it is transferred  to the larynx, the  muscles of respiration sympathize
with the latter, and cough is excited either to get rid of the disease
or of its consequence, which is increased and morbid secretion.  In
pregnancy the breasts become swollen, preparatory to their  secre-
ting milk  in parturition.   In labor the  uterus is  stimulated by the
child, now become fit for expulsion, and the muscles of the abdomen
sympathize with the  uterus.
   Sympathy in  diseases, by becoming the symptom of disease, often
leads us to the cause, especially when the cause is in a deep-seated
part, as the pain in the knee when the hip-joint is affected.
   We find that the  sympathizer in some cases relieves the part
irritated or under diseased action,as the testicle relieves the urethra;
but there appears to be nothing gained by this, as  the sympathy is
the worse disease of the two.
   By the sympathizer often relieving the part diseased, and  some-
times even curing it, it becomes similar to a constitutional affection
becoming a local one, as in the gout; and, as  in the swelled testicle
from gonorrhoea it often changes sides almost instantaneously, it is
in this exactly  similar to gout.

of the whole, or, on the  other hand, the over-action of one  organ divided  and
 broken by participation with another.  Upon this principle it is, also, that one
disease becomes the cure  of another, and that  revulsives and counter-irritants
 operate.   This consent of  parts, or interchange of sympathy, in virtue of which
 the parts of a complex animal body vibrate, as it were, in unison, pre-eminently
 distinguishes an organized being from any work of human art, especially when we
 add to this the further fact that it carries within itself its own resources of repair
 whenever it is injured.  The full perception which Hunter had of this  extraor-
 dinary co-operation of parts led him to employ a language  borrowed from the
 operations of the  mind, as if consciousness resided  in an animal body, and was
 capable of directing its operations as  it were by anticipation.  (See pp. 29, 49,
 54, 58, et passim.)
   The prevailing opinion is, that this connexion of function is established by
 means of  the great sympathetic nerve, which is supposed to accompany the ar-
 teries in their most remote ramifications.  Whether this  is so or not is  not sus-
 ceptible of proof; we may at least venture to say that our knowledge of this set
 of nerves  has hardly kept pace  with other branches of physiology, and that  in
 fact our  actual knowledge  of the subject is  exceedingly imperfect.   In the
 greater number of cases the intervention of the brain or spinal marrow seems  to
 be an essential  condition to the  propagation of sympathy; and probably in those
 cases where this is not necessary, the same condition is fulfilled by the ganglionic
 masses of the sympathetic nerve.  Nothing certain, however, can be affirmed  on
 this subject.
   Some physiologists have excluded from their definition of sympathy all those
 phenomena which depend on obvious anatomical connexion, functional  relation,
 or continuity of structure, restricting  the terra to those cases only in which  no
  functional or mechanical connexion is to be traced.  I apprehend, however, that
  this distinction is not tenable,  and  that these  two sets  of  phenomena will  be
  found to depend on the same principle, and insensibly  to merge in one another.] 
OF SYMPATHY.
119
  Some sympathies are opposite in their action to the original action •
pain in the liver is depressing, that in the shoulder rousing.   Nature
is incapable of sustaining the former, and sets up the rousing pain in
the shoulder to continue life.
  Delusion.—A simple sensation in  the mind of a local disease in
the body which does not correspond  with the  seat of the disease
itself has, I believe, been always referred to the principle of sympathy.
Thus, sensation of pain in the shoulder from disease in the liver has
been always supposed to  arise from the shoulder sympathizing with
the liver.   The sensation of the glans penis from a disease or irri-
tation in the bladder has been referred to the same  cause.  But I
believe it is a delusion  in the mind ; for the  nerves of the part are
not the seat of the disease, and irritation could not communicate to
the mind the sensation of pain in  the  part affected, excepting they
(the nerves) take on the same action, which they must do when
they produce the sensation of pain of  that part.  But if the nerves
of the part which is the  seat of sensation in such cases do not act
at all, it cannot be called sympathy.
  That  there is such a delusive principle in the  animal  economy
we see  every day, and that it not  only exists  between mind and
body, so as to lead us astray from the real subject, but between the
mind and other bodies with which it  has no immediate connexion,
not even by the common senses.   But we must allow that certain
sensations  can form a peculiar state of mind, called a sympathizing
mind, for we are capable of transferring the sensation of another
person to ourselves, which is like a dream.  A delusion in the mind
is an object appearing to be where it  is not.
   To account for  this delusion in  sensation in ourselves may be
difficult, but we may conceive it to be in this way.   We may sup-
pose that when the seat of sensation in the brain only takes on part
of the action of sensation in the brain, it may be in this way:
   Suppose E, (PI. I. f. 3.) the brain; A B, two portions of the brain;
G H, two  nerves; F, communication  between these two nerves; C
D, two  different parts of the body.
   The nerve G is inserted into part of the  brain A; the nerve H
into the  other part B.  F is a communicating nerve between G and
H.  A  and B are the  two  parts of the brain  to which  sensation
from C  and D is  conducted.   C is the disease or part impressed.
But from the connexion between  C and D, by means of the nerves
G F H, B will become the seat of action of the nerve G as well as
of the nerve H, and the sensation be  in part referred to D as well
as to C.   For if the nerve H is stimulated, in consequence of these
connexions, to take up part of the action of the nerve G, and B is
sensible of it as well as A is of the sensation of C, then the sensitive
principle of the nerves A B is made sensible of both the disease of
the part of impression as also of the sympathizer D,  which become
the two impressions in the sensorium.  If anything stimulates G,
part of the action is communicated to H;  this goes on  with the
 action to B, so that both A and B  become  sensible  of the disease 
120
HUNTER'S PRINCIPLES OF SURGERY.
C.   If there is disease in C, the mind is made sensible of it, because
G always communicates the sense of C to A; but if a small portion
of it is brought over to H, and this nerve carries on the action to
B, B becomes sensible of it also, and B refers it not to C, but to D,
because it is to that point that it has  been accustomed to refer all
its sensations.
   I  do  not know whether this explanation may be the  true one or
no,  but  it is one mode of explaining how  we may feel both the
disease  and  the part of sympathy.   But how is it in those cases
where the sympathizer takes on the whole action, affection, or sen-
sation ?  In this case we must suppose that not only a part but the
whole of the sensation passes by the communicating nerve F to B,
and  thus  the disease appears  to  be in D only.   But it is possible
that nervous sympathy is not  affected by  the nerves communi-
cating with  one another in  the  body, but  from their connexions
in the brain;  as from the  point B sympathizing with the point
A, taking on the whole of its  action, and  referring  its sensation
to D.*
  Delirium.—It will be  very difficult to prove whether delirium is a
disease of the brain  or nerves ;  it appears equally easy to prove that
it is from one  as from the other.
  A  delirium  is a dream arising  from disease, whether the dream
is in the brain itself or  in the body; only it is worthy of considera-
tion,  as dreams arise from  sleep, and as a  delirium is  a diseased
dream arising from what may be  called diseased  sleep, whether it
may not be  first necessary to give a short definition of sleep.
  Perfect sleep is a cessation of susceptibility of  sensation,  and of
course of all its actions; the consequence of which is a cessation
of consciousness in the animal of its own existence; and also, of
course, of the  consciousness  of  the relation it bears to itself and
every other thing.   But whether this cessation of the susceptibility
of impression arises from the brain not then having power to receive
impressions of the actions of nerves, or whether the nerves are not
then capable of acting  or conveying their action to the brain in the
state of sleep, is not so  easily determined.
  Dreams are actions of the mind in sleep; therefore may be inde-
  * [Thus, if a branch of a nerve be irritated (being in connexion with the spinal
marrow), it is capable, by a reflective operation, of  exciting all those musclea
supplied  by the trunk, although if the spinal marrow be destroyed this effect does
not take place.
  Sympathies of simple sensation are probably as real as sympathies attended
with  visible action, and  to be referred to the same general law.  This appears
from  the  same cause producing one or both effects, according as the cause is less
or more intense.  Thus  toothache and tic-douloureux will  occasion pain  or in-
flammation of the face ; diseased  hip will produce pain of the knee, and, as 1
have  frequently seen, inflammation of that part; gonorrhoea will occasion pain or
inflammation of the testicle ; disease of the bladder  pain or morbid change of
structure in the kidneys.  Many other examples might be adduced  to show^that
the same cause is capable of producing simple pain or  pain accompanied with
visible effects : which is evidently inconsistent with the  opinion which ascribes
simple sympathetic pain to a misdirection of the mind.] 
OF SYMPATHY.
121
pendent of any immediate information or impression, but are always
independent  of  the relative connexion between body and mind, or
consciousness of the existence of that relationship between the two.
For the connexion between the two enables the mind to distinguish
perfectly what is sensation and what is only thought, without which
all would be a dream.   In a delirium, as in sleep, we find the sus-
ceptibility of external impression lessened.   Whilst sensation is con-
tinued sleep  is kept off; delirium may be also lessened by arousing
the mind from that particular state by external impressions;  so far
delirium appears similar  to dreams,  but it widely differs in other
respects.   In natural sleep the more the brain puts on that peculiar
state the less we have of dreaming; but the more the other state is
put on the greater the delirium.  Dreams often do arise from sensa-
tions of the body being conveyed to the brain, it being in an  imper-
fect sleep; but the consciousness of the connexion between our own
body and our own mind being cut off by the state of sleep, the sen-
sation may or may not be referred to  our own body; it may  be
referred to some other  body.*   In some cases it is  not referred to
the  part of the  body where the impression is  made: and the same
thing happens in delirium, where the connexion is cut off; these not
distinguishing between  real  sensation and thought, what the mind
thinks about appears to be real.
   But even where the mind is in full  possession  of the conscious-
ness of its connexion and relationship  with the body, we have in
some cases  this delusion, as the  appearance of the turning round
of the objects  about us whilst they  are  really fixed, and that in
consequence of our having  turned about  quickly;  giddiness from
going to a height, or from riding backwards in  a coach.   Delusion
is also an effect of intoxication and disease.   Whilst awake and in
health, impressions produce sensations,  which are conveyed to the
brain, and from these the  mind  reasons:  but suppose  the mind to

  *  [One of the most remarkable properties of dreams is, that we have no idea
of time or place, or sometimes of our personal identity; in consequence of which
we commit the most ludicrous anachronisms, imagine ourselves dead and alive,
or in two places, at the same time, or else that our spirits have transmigrated
into some other bodies.  In  consequence of the absence of external perception in
sleep, the ideas and associations of the mind acquire an overpowering vividness
which lead3 us to mistake  them for realities;  while the absence of reason and
volition permits the imagination to revel in its own creations under the simple
guidance of association.   There are, however,  many phenomena  respecting
dreams, delirium, and that variety of the former called somnambulism, which do
not admit of any plausible explanation  : the will,  the senses, and voluntary mo-
tion are still exercised, under certain modifications; whilst it must be in the ex-
perience of every one that the reasoning faculty is still also capable of exerting
itself, so as in some rare cases to engage in,  and even  to accomplish, the analy-
sis of complicated  problems which it could not  have achieved during its waking
6tate.
   There is one point in which pure delirium and sleep differ from insanity. Per-
sons may be roused by a strong impression  from the former to  a right percep-
tion of their situation, whereas in the insane  person truth and error are inextrica-
bly blended together, so that when seen side by side they are not distinguishable
by the patient ]
                                 11 
132
HUNTER'S PRINCIPLES OF SURGERY.
have lost, or as it were forgot, its former connexion with our body,
then the above false reference takes place.
  A gentleman came into  this country in 17—; his memory was
imperfect, and a  particular kind of delirium began whenever  he
was going to sleep, but afterwards continued whilst wide awake ; and
for a week before his death he was not quiet from  this  delirium a
moment, but whilst his impressions were forced on him by external
objects.  His delirium was of this kind; he  was constantly talking
of former circumstances of his life, but referring them to  the pre-
sent moment and to some  other person.   There was  a revival of
past ideas in his mind, but  from  a want of connexion between  his
mind and his body, he was not enabled, by his present impressions,
to infer how little relationship  they bore  to the  present time, or
to those persons  to whom  he referred  them  : at the same time, it
really appeared more a want of connexion between the mind and
the body than the mind itself being hurt, for he determined rightly
what should be  done in those  circumstances which he  supposed
present, and would express his sentiments in really elegant language.
That it depended more on want of connexion than on disease of
the body,  appeared, from his being sensible  of impressions, and  re-
ferring them to the part where they took place, but supposing that
to be in  any other  body than  his  own.  Thus, he would tell  his
nurse or the bystanders that they were hungry or thirsty ;  but upon
offering food or  drink, it appeared plainly by his eagerness that the
idea had arisen from a sensation of hunger in  his own  stomach.
He would show great signs of distress or anxiety, which he would
say was because his nurse wanted to go to  the close stool, but was
restrained by his presence ;  and this from his sensations also.   He
had a violent cough, in which he would sympathize with  some  by-
stander, proceeding in his story after the cough, no otherwise dis-
turbed than by sympathizing with the person whom he thought so
unfortunate as to have it.   The objects about  him were  more to
him than his own sensations.
   A gentleman who was  fond  of his bottle referred all   his Own
weaknesses and feeling, as he became intoxicated, to those around
him;  and upon his going home would insist upon undressing all
his family and putting them to bed, declaring that they  were  too
drunk to do  it themselves;  and this  happened not only  once, but
whenever he was intoxicated.  I myself once experienced what I
have  since thought  must  have proceeded from this want of con-
nexion between the mind and the body.  I was reading a remarkable
case, and reasoning with  myself upon it, when  I found the letters
and words made an impression on  the retina,  but that I was  in-
capable of affixing a meaning to them: this I thought might proceed
from want of sleep ; but that was not the case: I tried repeatedly,
but without effect, and at  last I went to bed, from  which  I did not
 move for three weeks, a violent affection of the head following this
 extraordinary circumstance.  It may not be amiss to say, that the
 case I was reading was that of the late  Mr. Foote, who was  not 
OF SYMPATHY.
123
able to command his attention to more than one action or circum-
stance at a time:  thus, if he took his snuffbox  out  of his pocket
and held it in his  hand, it was  all  very well, until he attempted
another action, such as taking a pinch of snuff out  of it, and  then
the box fell immediately out of his hand :  in fact, he was going back
into a state of second childhood, for  a child  is not capable of com-
manding his attention to more than one circumstance or action  at
a time: give him a  stick to hold, and call his  attention to another
object, and the stick will be dropped; for it is by habit we become
capable of attending to several actions at a time.   If a  person is
blindfolded and put  into a coach, he  will  think he is riding forwards
though really moving  backwards.   An  impression from any part,
either healthy or diseased, may be conveyed,  yet there may be no
consciousness of the mind from which part of the body it was  con-
veyed, the mind having full possession of the impression, and a per-
fect idea of it, but having nothing to direct it right in its reference
of it.   It must refer it somewhere, and is more likely to refer it  to
another than  to itself.   Thus, A  (PI. I.  fig. 3.) does  not refer the
sensation to C as a  cause, nor will B sympathize with A  so as  to
refer it to D.
   A gentleman, a medical man, dreamed he had given  a patient
too strong an injection for gonorrhoea, and that it had produced a
total stoppage of urine: he awoke, and found an erection  of the
penis, and that he could not void a  drop of urine.   Here was  an
impression without the consciousness, and he referred the impression
to another person.
   A  gentleman,  upwards  of ninety years old, suddenly lost his
senses, and in consequence of this there  was a reference of all the
ails which he might be supposed to feel to his wife,  who had  been
dead some time, but who he now thought to be alive, and ordering
the utmost silence to be preserved, lest by noise her illness  should
be increased.   The new-born child  has probably sensation without
this consciousness.   The  contrary takes  place  when a person
refers  the sensations of others to himself, or when the idea of sen-
sation is supposed to be sensation itself, as happens in those who are
affected by animal magnetism.   I was asked to go to be magnetized,
but at first refused,  because the spasm on my vital parts was  very
likely  to  be  brought  on by a  state of mind anxious  about any
event.  Thus, at  my country box I  have bees, which  I  am  very
fond of, and I once  was anxious about their swarming lest it should
not happen before I set off for town; this brought it on.  The cats
teaze me very much by destroying my tame pheasants, partridges,
&c, and rooting up my plants.   I saw a large cat sitting at the
root of a  tree, and was going into  the  house for  a gun, when I
became anxious lest she should  get  away before my return ; this
likewise brought on the spasm; other states, where my mind is much
more affected, will not bring it on.  Now I feared lest my anxiety for
the event should bring on the spasm, and that should be imputed to
animal magnetism.  But considering that if any person was affected
by it it must be by  the imagination  being worked  up by attention 
124
HUNTER'S PRINCIPLES OF SURGERY.
to the part expected to be affected, and thinking I could counteract
*iiis, I went; and accordingly, when I went, I was convinced  by
the apparatus that everything was calculated to affect the imagina-
tion.   When the magnetizer began his operations, and informed me
that I should feel it first at the roots of my nails of that hand nearest
the apparatus, I fixed my attention on my great toe, where I was
wishing to have a fit of the gout;  and  I am confident that I can fix
my attention to  any part until  I  have  a sensation in  that part.
Whenever I found myself attending to his tricks, I fell to work with
my great toe, working it about, &c, by which means I  prevented
it having any effect on me.
                          CHAPTER XL

              OF LOCAL AND CONSTITUTIONAL DISEASES.

Difficulty of distinguishing between strictly local diseases and local diseases aris-
  ing from constitutional affection.—Diseases constitutional;—local;—mixed.—
  The first universal, as fever;—or constitutionally local, as gout.—Local dis-
  eases.—Mixed diseases.—Diseases common or  specific.—The latter do  not
  always depend on a specific cause.—Of diseases peculiar to ages.—Effects of
  climate on diseases;—of seasons;—of temperature;—of  the moon.—Of  hu-
  mours, erroneous notions  of them ;—effects  of  substances  contained  in  the
 v blood ;—experiments of injecting medicines into the blood ;—no  specific dis-
  eases produced.—Of diseases supposed to arise from humours.—Of hereditary
  diseases ;—hereditary nature of natural  and of acquired properties ;—here-
  ditary dispositions;—latent hereditary principles ;—similarity of children to
  their parents ;—dispositions hereditary, but  not diseases ;—more  permanent
  than   accidental  dispositions;—scrofula;—gout;—supposed   hereditary.—
  Symptoms of disease local or universal ;—variation  of local symptoms ;—
  universal symptoms affecting the circulation ;—secretions ;—nerves.—Combi-
  nations of symptoms.—Irregular symptoms.—Delusive symptoms.

It may be  difficult in  all  cases of  local diseases to  distinguish
between one truly local  and one arising from the constitution ; that
is, one arising entirely in the part diseased, and  one arising entirely
from the  constitution.   For  as one can and often does affect the
other, which may be called mixed, it becomes  the more uncertain
where the disease originated.*
   Diseases may be called constitutional, local, and mixed.  Diseases
may be originally constitutional  and  originally local; that is,  dis-
eases may take place in the  same person from constitutional or local

  * [Mr. Abernethy, in speaking of the evil effects arising from the separation of
medicine from surgery, makes the following observation : "The effects of local
disorders upon the constitution have in consequence been too little attended to;
and, indeed, I  know of no  book to which I can refer a surgical student for a satis-
factory account of those  febrile and nervous affections which local disease pro-
duces, except  that of Mr. Hunter." See his Essay " On the  Constitutional
Origin and Treatment of Local Diseases."] 
OF LOCAL AND CONSTITUTIONAL DISEASES.
125
causes, and be totally independent of each  other;  but they may
affect one another.
   The first, or constitutional, is either a universal action  of some
kind, as fever, or where there is a universal susceptibility  for an
action, but the action is local.   Therefore they are divisible into two
kinds,  1st,  universally constitutional, and 2d,  constitutionally  local.
   Universally  constitutional is when there  is universal action of
some kind, as fever, where every  part of  the body is under some
diseased action, which will be according to the nature of the influ-
ence  which produced  the fever, as inflammatory fever,  putrid
fever, &c.
   Those arising from external influence will  in some degree  reduce
all constitutions to some one mode of action; and whatever differ-
ence there is between one  and the other  must only arise from a
peculiarity in constitution.
   If an inflammation is  produced in any part by violence,  it will
always be as the  constitution is.   If a man has a fever, a cut will
partake of the  disease, and the  inflammation  will be erysipelatous,*
or so on, according to the fever.  But if the fever is of some specific
kind, superadded  to  the nature of the constitution, as small-pox
fever, a cut will not partake of the specific quality of that fever, but
will be exclusive of the  specific quality.  Nor will a cut on any part
of a pocky patient be venereal.
   Constitutional diseases are of various classes, which are  known
by their effects.   A  constitutional disease is a  universal  diseased
action, as fever, every part taking on more or less of the  diseased
disposition.  Such diseases,  I  apprehend, have  no disposition for
local action, though  it is commonly supposed they have,  as  where
fever produces abscess.   This I hardly  believe,  though an abscess
may form  in the time of that fever, and is  caused  by it, or is an
effect of that fever; but it is not an act of the constitution, according
to our  third division, therefore  does not relieve the  constitution of
that fever.   What I call an act of the constitution relieves the con-
stitution, as gout falling  on a part; but  in  abscess from fever it is
only that this part has been so disturbed in the time of the fever that
it  has gone into inflammation and  suppuration.
   The second of  the  universal is the constitutionally local, that is,
when there is universal susceptibility of body to  produce  peculiar
local complaints, but not the action, till disturbed ; requiring  an im-
mediate  cause, which may at the  time be either universally disturb-
ing, as fever, or in the part only,  as an accident.  Thus the  whole
constitution may be affected with  a gouty disposition, but the dis-
ease becomes local and is cured.   We see  constitutional or univer-

  * [There are many  exceptions to this  observation, as, for instance, in  several
cutaneous diseases, gout, rheumatism,  &c.  These diseases  may exist in  an
active state in some parts of  the body at the same time that common  inflamma-
tion is produced in other  parts by accidental injury.  On  the other  hand, the
erysipelatous inflammation seems to give way to common phlegmon when in-
cisions are made into erysipelatous parts.]
                               11* 
126
HUNTER'S PRINCIPLES OF SURGERY.
sal diseased affection excite local, as fever exciting scrofula, not as
a termination  of that fever, but because the part affected was par-
taker of the universal affection, and being disturbed by that univer-
sal affection or action, it took on the  mode of  action it was most
susceptible of.  It would do the same thing on being locally dis-
turbed; therefore, as to  its  diseased action, it is the same whether
it is disturbed  as part of a whole,  or only by itself.  The scrofula
goes no further than a susceptibility for diseased action,  until it is
brought into action by the local injury or constitutional fever.
   Perhaps there is no term so vague or undetermined in the mind
as the term constitutional.  Universal action of every kind may be
called constitutional, even when arising from some local cause, which
I have called  one of the mixed; or one capable of producing local
effects, which  we have  also called  one of the mixed.  But a  true
constitutional  disease is  one arising, as it were,  spontaneously in the
constitution, partaking of the nature of the constitution itself.
   Local disease I would consider in two lights; 1st, When  it is a
natural local action, being a kind of violence on a part, there being
no constitutional local affection.   In this case the disease takes on
no specific quality of the constitution, either from  the constitution
having none, or the  disease not being affected by it, being such as
either arises from itself in  a part from a local cause, and may take
place in any constitution, or may be  produced by accident or vio-
lence where the constitution was never affected.   2d, Which will
more properly come under the head of mixed, where the local affec-
tion either affects or is affected by the constitution.
   The mixed may be said to partake of the first and second, and is
often the consequence of either, namely, original constitutional pro-
ducing local, or original local  producing constitutional;  therefore
they are often of two kinds, and such as may be called secondary
actions either  of the  constitution or part, as universal sympathy with
local disease,  yet not what generally comes under the idea of com-
mon sympathy, as sympathy of part with part.  Of the mixed, the
first kind is where original constitutional produces local; the second
where it influences local already produced.  Therefore this kind is
divisible into two species.
   It may  be difficult lo  say certainly when a constitutional disease
really produces a local;  but it may  be set down generally that there
will be a distance as  to the  time of appearance of the  two diseases.
The first of these two species is of various kinds, perhaps belongs
more to specific diseases than  to common, and  is where the consti-
tution  from its nature  produces a local  one,  and is necessarily
relieved by it, by what I have called an act of the constitution.  Of
this kind are small-pox, measles, fevers producing critical  abscesses,
erysipelatous fevers,  gout, &c, and on this is founded the doctrine
of revulsion.
   Local diseases produced by an  act of the constitution may be
illustrated, I think, by the growth of plants.  A plant or tree ap-
pears to have  a disposition and power of producing either only a 
OF LOCAL AND CONSTITUTIONAL DISEASES.
top shoot,  or a number of  shoots, called  branches,  which  are
according to the nature of the plant.  If the top is cut off, then a
new branch sprouts, and it  serves as a top;  so that the disposition
is taken up by some other  part  most susceptible of action.  The
same thing happens in those plants  which grow by branches.   So
that the removal of a part in action gives the disposition of action
to parts not before disposed  to act, but next in  order  of suscepti-
bility.                                                      v
  The second of the mixed  is where the original local  produces
constitutional, and  which  may  alter  the  constitutional  disease
already existing, or cure it.   This may be of three kinds.
  1st,  The immediate; 2d, Less determined as to time; 3d, The
remote.  Of  the first there appear to be two; of the  second but
one, though it may appear in  different forms ; of the third probably
only one.
  Of the  immediate we shall  reckon that which is called symp-
tomatic fever.  Delirium I  shall reckon the second, though it is not
always the second as to time.  The third or remote,  is hectic, to
which may be added  symptoms of dissolution, which last stage
may be the consequence of either of them, or of any other disease.
  The first of these is generally called symptomatic  fever, but I
choose rather to  call it  sympathetic  inflammatory fever.  It is
sympathy of the constitution with the first stages of local disease,
which is  the action of alarm on the constitution,  rousing up its
powers to produce action.
  The second, or delirium, appears to arise from an  affection of the
brain or sensorium, producing sympathy of action of the brain with
the nerves of the part; not sensation, as headache, but an action
producing  ideas  without  uniting  sensation,  which is  therefore
delusive.
  The remote, namely, the hectic, is a sympathy of the constitution
with local  disease, but sympathy of another kind ;  it is sympathy
with the operation of an incurable  disease,  where the  constitution
is conscious of inability of the part to  perform a  cure, by which
means the constitution is  at  last, as it were, worn out, producing
dissolution if not removed.
  Dissolution is the last stage and consequence of all, whether local
or constitutional.
  Diseases are common or specific.—All diseases are either common
or specific, but it is  more  than probable  that most diseases have
some  specific qualities.  A common disease is such as will attack
every constitution, and  perhaps every animal, and  rather appears
to  be  an   increased action,  as common inflammation, common
inflammatory fever, &c.
  Many diseases may be reckoned specific in their mode of action,
though not in their cause.  An ague  is a specific action, but its
causes are various.  Gout is a specific action, but  its  causes vari-
ous.   Cancer is a  specific action, though its immediate causes are
various ; but it is capable itself of  becoming a true specific cause, 
128
HUNTER'S PRINCIPLES OF SURGERY.
by forming a  poison.  The cause of  scrofula varies,  though its
action is specific.  The  remote cause of all is a greater suscepti-
bility of such actions.
  A specific is a  peculiar mode of action, differing from every
other mode of action.  A true specific  disease is one that probably
cannot arise but from one cause, and which probably belongs only
to morbid poisons ;  for  although gout, scrofula, ague, &c, may
be ranked among  the specific, yet they can  and do arise from a
thousand causes.
  There  seems a  specific  susceptibility for those diseases in those
that  have them.   But in poisons there must be a  specific  cause,
which may be attended  at the same time with specific suscepti-
bility of such, as some have a greater  tendency to  small-pox than
others.
  Specific diseases are such as we cannot increase,  for they always
act with the full force of the readiness in which the constitution is
at the time.  If the  constitution can be  made more susceptible of
action, the action will be increased.
  Every specific disease has two modes of action—namely,  the
common and the specific,—joined to it.  There are  specific inflam-
mations, specific suppurations ; or, in other words, there are inflam-
mations and suppurations  with specific  properties, or which have
specific properties superadded ; thus, in small-pox there is common
inflammation,  with  the  specific qualities  superadded.  Specific
diseases may  be  either universal or local; universal, as fevers of
particular kinds ;  local,  as scrofula; others are mixed, as agues,
rheumatism ;  and these admit of cure  from a variety of medicines.
  A circumstance worthy of notice  takes place with  respect to
local specific diseases; parts appear susceptible of  them as to  take
on their action so readily, that were it not for another very curious
circumstance  we might soon expect them to spread  over the whole
body; but the favourable circumstance  I refer to is  where  the
disease is spreading  very fast, affecting parts which  the disease  has
not yet touched, whilst in the centre this  diseased action no  longer
takes place.   Those parts which have already suffered  this action
appear to have lost their susceptibility  of it, whilst the surrounding
parts are contaminated  by  sympathy with  those  parts already
affected : this  property belongs to many,  as erysipelas, herpes, &c.
I have seen the same thing take place in  ulcerated bubo, spreading
over the whole belly and thigh, but healing in the centre.  Another
circumstance is to be added to what I have mentioned as hindering
the disease from extending over the whole body, which  is, that the
constitution  itself alters  or loses that peculiar susceptibility before
such an event  takes place.
  Different parts differ very much in their power of resisting dis-
eases, as well  as in the power of curing themselves, or  getting rid
of the diseased action and putting on a  curative one: this seems to
be according to the strength of the circulation  in the part;  where
this is less the power is less; thus, there is greater power of resis- 
OF LOCAL AND CONSTITUTIONAL DISEASES.       129
tance in a muscle than in  a tendon.   But in specific  diseases I
should suppose there is little difference in this respect, in conse-
quence of a difference in structure, although we know that specific
diseases affect some parts more than others, as the small-pox affects
the skin;  the measles, the skin and surface of the lungs: hooping-
cough and hydrophobia, the throat;  &c.
   Diseases peculiar to Ages.—Particular ages have their particular
diseases.   These diseases peculiar to age are  perhaps more  of the
specific than of the common kind;  and age is little more than a
natural or remote cause, there being some immediate cause  acting
so as to produce the disease, as in scrofula.  But this is not the case
with all of them, e.g. cancer, for this appears often to arise without
any peculiar immediate cause.  How far particular  ages are more
or less susceptible of particular poisons we do not know.
   The age of man may be  divided into three parts: 1st,  The age
of growth; 2d, The stationary age; 3d, The age of decline.  The
first and last are absolute, but the  second is not so easily ascertained,
it not being  very easy to say where the first ends and the  last
begins.  The young subject  and  old are more susceptible of many
diseases than the full-grown, or stationary, but they  are not  subject
to the same diseases.  The young are  more susceptible of sympa-
thy,  both universal and  local; more susceptible of scrofula than
the middle-aged, but particularly more than the old: and this scro-
fula may produce consumption, which we know is peculiar to youth.
 Children are  more disposed to have affections of the bowels, and
 worms, perhaps, from a peculiarity in their way of  life.   They are
 also more subject to water in the head than those  who are older.
 The young have few affections of the mind, excepting those arising
 from natural passions, or immediate sensations of the body.
   The middle age would appear to have but  few diseases peculiar
 to it, excepting nervous  affections and hypochondriasis, &c.  1 he
 middle age gets  into an imaginary region, a region of romance,
 which produces diseases of the  mind, and also affects the  body.
 However, it is, as it were, accidentally affected  with the diseases
 both of youth and age, with which it is gradually intermixed.  1 he
 foundations for the diseases of old age are often laid by intemper-
 ance during the middle age.
    In the old  we have perhaps as great a variety of diseases as in
 the young.   In the old the power and necessary action  are not well
 proportioned, even in health, much less, therefore, in disease.   1 his
 produces a degree of irritability often increasing inflammation, and
 terminating  frequently in mortification.   In  the  old we have the
 gout, which seldom takes places  in the young.  Cancer ^ peculiar
 to the latter part of the middle age, and  still more to the old.  Gall-
  stones are to be found chiefly in the middle-aged and  old.   Ossifi-
 cations of arteries are rarely found in young persons.  Ihe blaa-
 der becomes less disposed to stretch, and more irritable; hence oia
 people  make water oftener than young.  The prostate  gland is
 more subject to  indurations.  The mind gradually becomes  more 
130           HUNTER'S PRINCIPLES OF SURGERY.

attached to [Quaere, detached from ?] this world and the things that
are in it the nearer it approaches to a separation from it.
  Effects of Climate on Disease.—Climate in general only becomes
the immediate cause of disease; however, it isf sometimes sufficient
to produce the whole  disease.   Climates are of three kinds: hot,
cold, and temperate.  Hot climates carry on the natural operations
both of animals and vegetables with much more rapidity than either
of the others.
  It  is almost impossible to rear young  animals in cold weather;
therefore most animals bring forth their young  in spring and sum-
mer.  Animals of the same species do not grow to the same size in
cold  climates as  in warm.   It is almost impossible to fatten an
animal while it is kept in the cold.
  Warmth produces action beyond its power of generating strength.
  Parts more readily yield to any power in summer than in winter.
Mr.  Jones, the inventor  of  the machine for  correcting distorted
spines, observes that they produce more effect in summer than in
winter.
  Hot climates produce diseases in the liver, but these diseases are
more frequent in the West Indian islands than on the continent of
South America or India.*  They also produce violent vomitings and
other disorders  in the stomach; also  violent  affections of  the
bowels: and fevers and diseased actions, like the natural, are much
more rapid than in temperate climates, it being no unusual circum-
stance for diseases  to run through all their stages  in a few hours,
ending in death, which is speedily followed by putrefaction.   Heat
produces indolence in the voluntary actions, which is injurious to
health, but generally increases  the involuntary action or actions of
life, which is always hurtful.  Cold  climates retard many actions,
both of vegetables  and animals ; but cold, when  only in a certain
degree,  and continued for a certain  length of time, excites action;
but that is the action  of strength, the action of resistance or  de-
fence, not the action of luxury or ease.  Cold climates produce
their diseases, though it would appear that they have not equal effects
with warm, nor are capable of producing such variety.  Whatever
diseases are produced  by cold  are not so rapid as  those produced
by heat; and after death putrefaction does not take place so rapid-
ly.   We may observe  a curious gradation in this process; in  cold
climates, after visible death, absolute  life will remain for some time ;
the muscles will retain their power of contraction, and the blood be
kept from coagulating. But in hot climates death is  as rapid as dis-
ease ; for it is action that consumes life.   In cold the action is less:
in heat it is so great that the  body  can hardly support it, and death
comes on.   Cold climates lead to voluntary actions,  which generate
heat,  and this is much  more healthful than heat derived from exter-
nal sources.
  In  temperate  climates there is  perhaps a  greater  variety of

  * [The very reverse of this observation is, I believe, the fact; see p. 86.] 
OF LOCAL AND  CONSTITUTIONAL DISEASES.
131
diseases  than in  either the hot or the cold ;  for the temperate is a
very irregular medium, sometimes  very hot, sometimes very cold,
and often in the middle state ;  and these changes are not at regular
periods.   This irregularity produces  some irregularity in the wet-
ness or dryness,  so that in such climates we have a great mixture.
These changes] in temperate  climates give rise to  scrofula, colds,
&c, which are the forerunners of a thousand diseases.   Agues are
also much more frequent in temperate climates.
  Seasons.—Seasons which arise from the variations of heat in a
climate,  produce  diseases which will be  in some degree similar  to
those both of hot and cold, and also temperate climates ; for seasons
are, as it were, a change from one climate to another.  Seasons
have  besides, diseases peculiar to themselves;  they  produce an
increase of old diseases, arising simply from the change, and call
forth those diseases which only want an immediate cause to pro-
duce them.  The spring and autumn  are two of the most unhealthy
seasons in the year : the spring the most so, although from reason-
ing alone, without observation, it is supposed to be the most healthy,
and therefore people  do in the  spring whatever will  allow of a
choice of time,  as  inoculating,  &c.   This idea probably took its
rise from observing  vegetation, that at  this time the plants appear
to come into life  and action.  But, even in vegetables, this season
is the  most unhealthy ; blights much  more frequently take place  in
spring than in summer.  Of every disease that can be called consti-
tutional,  that is,  where  there is a  strong susceptibility for such
disease, we find spring becomes the immediate cause, exciting it  to
action; thus, scrofula  shows itself, or increases in spring ; the same
with   rheumatism and scurvy;  hence  spring  is  said  to set the
humours afloat by those who are favourers of the humoral pathology.
   I should doubt  much whether there is any diurnal influence on our
body, further than that which the habitual modes of acting produces;
consequently, I doubt  if  daylight or darkness produces any effect.
It is, however, certain that  the increase of action which commonly
takes  place  in  the day,  increases   diseased  action, producing
exacerbations in  continuous  diseases.   It is probable, therefore,
that it may  bring on the  paroxysms of those diseases which are
periodical, and may bring on  the first fit of a disease for  the same
reason.
   Effects of the Moon.—The moon has certainly considerable effects
on the human body.    We find it often become the immediate cause
of diseased actions, especially those of the mind.   Mad people are
certainly more affected  at particular periods of the moon than  at
other  times.  The full of  the moon has the greatest effect: it not
only affects those who have a natural predisposition, but also some
who have had injuries done to the brain by external violence.
   A lamp-lighter, by a fall, injured his head: upon examination I
 found a fracture  which appeared to run through the foramen mag-
num of his occiput; he recovered, but he was seized every spring 
 132           HUNTER'S PRINCIPLES OF SURGERY.

 with a phrenzy at stated intervals, and this was found to be at the
 full of the moon.
   A gentleman had an anchylosed knee and ankle-joint from scro-
 fula,  and he is always deaf at the full of the moon,  except in
 autumn, when his sores discharge plentifully.
   This effect of the moon is increased at certain seasons ; in spring
 it is greatest often.   Intermitting and remitting fevers often arise,
 recur, or become exasperated  about the  time of the full or new
 moon, more especially in  climates  fitted for giving rise to such
 diseases.*
   Of Humours.—The term humour has been applied to the animal
 body, especially  the  human,  both  literally and  metaphorically.
 When literally, it is used in two senses, either  as expressive of an
 extraneous substance existing in the blood, or as meaning the blood
 itself.  When used metaphorically it is applied only to  the mind,
 and  is therefore  more  applicable to the human  than  any other
 animal.
   Nothing  can be more vague, nothing more unphilosophical, nothing
 more misleading  in science, than to  employ the same term to ex-
 press two or more different meanings.  In whatever sense the term
 is used, however, whether as applied to the mind or the body, it
 always is meant to express the cause of an unnatural or uncommon
 action or effect.
   At present we  shall  only consider humours in their literal sense,
 in order  to ascertain how far the notion is just or imaginary.  I have
 just said  that the word is used in two senses, either as something in
 the blood,  but foreign to it, or  else  as implying a  vitiation, of the
 whole mass of the  blood itself.  Among  physical people we find
 such expressions  in common use as " the humours  are afloat in the
 blood;" "sharp humours in the blood;" "the whole humours being
 in a  bad  state;" " the whole blood must be altered or corrected;"
 and a variety of such expressions without meaning.   They even go
 so far as to have hereditary humours, as gout, scrofula, &c, and
 make us  the parents of our own humours, saying that we breed bad
 humours.  Accidents, or even the application of poultices, have been
 supposed to bring bad humours to a part, because the part in which
 the aceident happened, or to which the poultice was applied, would
 not readily heal.   Humours are even supposed to  gravitate to the
 legs slowly; and, in short, the whole theory of disease  has been
f built upon  the supposition of humours in the blood, or of  the blood
i itself being changed.  I cannot conceive what is meant, unless it be
 that a strong susceptibility to a specific disease exists; as  small-pox
 may  bring on scrofula, or  a strain the gout; if in these cases by
 humour is  meant  a  susceptibility of either of the diseases, I can con-
 ceive that  any kind of accident may bring it  on.    The small-pox
 introduced may excite action, and  so bring on  the scrofula.

   • [Dr. F.  Balfour  has fully confirmed this observation as to the effects of sol-
 lunar influence on the bilious remittent fevers of hot climates.] 
OF LOCAL AND CONSTITUTIONAL DISEASES.      133
  I shall now consider the  notion of humours afloat in the blood.
If I have a just idea of the meaning of this expression, it signifies  *
something extraneous or foreign, something that does not belong to
the blood itself.   That foreign matter is received into the blood-
vessels is  certain, and that so received it produces disease is also
certain ; but simply foreign matter being introduced into the blood,
either produces no effect or no permanent and specific disease ; the
constitution, or some part, can be disturbed only as the constitution
or part  would be disturbed from any accident.  Medicines, applied
either externally or internally, is a proof of this, for all enter the cir-
culation more or less, therefore are in the state of something extra-
neous, or of humours  in the  blood.  Indeed, chemical analysis ot
the blood shows the existence of foreign  matter, for  it  discovers
substances that form no part  of the animal, as sea-salt, iron, earths,
&c; yet these  substances produce no ill effects by their presence.
   The following experiments show the effects of foreign substances
in the blood:                                   .   ,   ,   __,
   Experiment 1.  I injected  into the crural vein of a dog, towards
the heart, a weak solution of sea-salt, which produced no effect.  1
then made as  strong a one as possible and threw that in also, but no
effect was produced.   The quantity of salt thrown in might be about

^Ex^enmen^8.'  I threw a strong solution of Glauber's salts into
the vein of a dog—about two drachms of salt.  It produced no effect.
The dog ate and drank and had his stools as before.
   Experiment 3.  Two ounces of a  saturated solution of salt ot

 ^—Tf tZ^^^X^ in  Nation

 ^Exp^n^'-An ounce of water, in which a scrapie of borax
 was dissolved, was thrown into the veins without effect.
   ExTerlen 7.   An ounce of vinegar and water, in equal pro-
 portions Tas thrown into the veins of a bitch half  gone  with pup
 S brought on an  immediate disposition for miscarriage, which
 took place in about six or eight hours.                    vineo-ar
    Experiment 8  Water, rendered about as acid  as the vinegar
 anfw'atTwlth vitriolic acid, was thrown into the veins, and pro-

 Xe—9 lldto.  The same experiment was made with

 "^t^ e^—^ ESAt substances ^



 Ipf/su^                          "ffects wh5n thr(T inth
 SX^X^tf ^m produce any  ^^«™£*£$
 bv repeating them, and increasing the quantities, a man may destroy
  hfs health, St even his life, by destroying the natural actions of the

  ^But all this is not producing any specific disease; it is reducible
                                l <* 
 134          HUNTER'S PRINCIPLES OF SURGERY.

 to the effects of local applications, which is similar to an accident,
 producing no specific or permanent disease but what an accident
 would do, nor lasting any longer than the application lasted.
   Experiment 11.   I threw  about two  teaspoonfuls of a strong
 solution of opium, two parts water with one of opium, into the crural
 vein of a dog.   The dog seemed to be very sensible of it at first, for
 he was extremely uneasy, and soon became convulsed, but did not
 lose sensation, for when  touched he started and seemed frightened,
 and drew back his face  when a hand was presented to it; so that
 irritability was rather  increased.  I  then threw in as much more,
 which made him still more quiet, and in  great measure produced
 loss of the use of his limbs, so  that he could not stand; his breathing
 became slow  and laborious, but his pulse very quick ; when he at-
 tempted to get up he reeled, and came down  as if asleep  or drunk.
   Experiment 12.   I threw into the veins of a dog two teaspoonfuls
 of common gin.  He  showed  no  sense of uneasiness,  but became
 soon vastly quiet, and not in the least irritable, showing no signs of
 fear when touched, He seemed wholly relaxed; his breathing was
 easy, and his  pulse slow. He continued above an hour in this way
 and then began to  recover.
   Experiment 13.   I threw about two teaspoonfuls of laurel water
 into the  veins  of  a dog.   The pulsation  in the vessels became
 tremulous; he seemed very  ill, and could hardly raise his head, but
 he recovered.
   From  these last  experiments it  appears obvious that many sub-
 stances, having peculiar modes of stimulus,  will, when taken into
 the  blood, produce their effects there; but this effect  will last no
 longer than the presence  of the stimulus; and we shall find in general
 that their effects in this way are similar to what,  they are when
 taken into the stomach.   We  find also, by the above experiments,
that many substances thrown  into the constitution  by the veins pro-
 duce the same local specific effects on the  intestines  with those
 produced by  the substance when taken in by  the mouth.
   Experiment 14.   I threw into the veins of a dog an ounce of
 infusion of ipecacuan, made with five grains of the powder to two
 ounces of water.  The  dog immediately became very  sick, and
 was retching  before I could untie the mouth, and as soon as it was
 untied he threw up all  that was in his  stomach.   He continued
 sick for some time, and gradually recovered.  I can hardly suppose
 that the injection had gone beyond the  heart,  or even to it, when it
 began to act.
   Experiment 15.  An ounce of infusion of jalap, made with twenty
 grains of jalap to  two  ounces of water,  and steeped  for  twelve
 hours, was thrown into the veins of a dog.  In  less than a minute
 he vomited a  little  and then seemed well.   Thinking that no more
 effect would be produced, I threw in the remaining ounce.  This
 did  not  produce any  vomiting, nor  did  he at  first seem much
 affected; but  at last he grew weak on his  legs, lay down at times,
 and then rose  again.   About  two hours after the  infusion  was 
OF LOCAL AND CONSTITUTIONAL DISEASES.      135
thrown in he had a stool, and after this another, which was loose.
He remained sensible the whole time and then got well.
  Experiment 16.   In a similar experiment the dog vomited, had
some loose stools, and in a few hours got well.
  Although many substances do  produce similar  effects  on the
stomach and intestines when thrown into the blood  as when taken
by the mouth, as appears from the above experiment, yet this is not
the case with all.  In the second  experiment, for instance, we find
that Glauber's salt had no such effect when thrown into  the blood
as when taken into the stomach.   In like manner,
  Experiment 17.  An infusion of rhubarb, thrown into  the veins
of a dog, produced no effect but that of increasing the urine, which
it did plentifully,
  Many substances  thrown  into  the  blood  produce much  more
violent effects in this way than when taken into  the stomach, and
even cause immediate death.
   Experiment 18.   I threw into the veins of a dog a little aether,
and he died immediately.   On opening the body the thorax had a
strong smell of sether.  However, this effect may depend on  the
strength of the medicine, as we shall see by the following experi-
ments that the reason why death did not take place in experiments
6, 7, 8, 9, was the weakness of the solution.
   Experiment 19.   I threw  some common  vinegar into the veins
of  a dog, towards the heart.  He died before I supposed  it could
have got to the heart.  Now vinegar, when diluted, as  we found
before, had no such sudden  effect.  In the same manner, nitrous
 and vitriolic acid, diluted, to about the  strength of vinegar, pro-
duced almost immediate death.
   Air killed immediately.   We should therefore  be very careful in
 making experiments, when we inject substances into the  veins, that
 air does not enter with the substances, and cause the death which
 we impute  to the  latter.*  The  Abbe Fontana committed many
 errors in this way :  in short, before any man pretends to determine
 what will kill, he ought to  have  killed at least a thousand animals.
 A  poor devil t was lately hanged  at Warwick upon no other testi-
 mony  than that  of physical  men  whose  first  experiments were
 made on this occasion.
   Experiment 20.  I threw into the veins of a bitch half gone with
 pup a quantity of serum, taken from the blister of a person who was
 ill of  a putrid fever, and soon  after died.   It  made her instan-
 taneously sick, and she vomited.  She soon miscarried,  but in two
 or three days recovered perfectly.
    From all these experiments we may, I think, at least  draw, as a
 probable conclusion, that extraneous  matters taken into the consti-
 tution do not produce  any specific or permanent disease, that they
   # [Air in small  quantities, introduced at  once, or even in large  quantities
 gradually admitted, is not generally fatal.  See Treatise on the Bl°°<^;J  ,
   t [Captain Donellan.  For an account of this transaction, and of Hunter s
 evidence on the trial, see Life, and the Appendix to the Lite.] 
136          HUNTER'S PRINCIPLES OF SURGERY.
 operate  as direct stimuli, producing immediate effects, and that
 when these are violent they arise from too great a quantity of the
 stimulating or irritating substance being thrown in.
   Poisons come  nearest  to the idea of humours, but still are not
 what is meant by humours, nor have ever had this term applied  to
 them. Natural poisons will act somewhat as the  substances used
 in the foregoing experiments did, that is, either stimulate the  whole,
 or part, to increased natural action; or irritate the whole, or part,
 into some unnatural action, but  which  will last  no longer than the
 poison is present.  The sting of a  bee  affecting some more than
 others demonstrates that there  is a greater  susceptibility in some
 for such actions than in others, and that it cannot be imputed  to
 humours in the blood, unless we could suppose a humour similar
 to the poison of a bee, which then might act without that cause.
  I suppose that  bugs bite everybody,  but some they do not affect
 and others they  do.
  This is not so readily demonstrable in the poisons  that enter the
 constitution, though even  they  cannot be said to be assisted by
 any humours in  the blood.  Other poisons, which  we call morbid,
 produce  a specific disease  similar to the original; but all this does
 not  come  up to the  idea of humours.  A humour is something
 which is supposed to  go on teazing  the constitution if not extracted,
 and is even supposed  to be  capable of  leaving  one part and going
 to another.
-■„ What comes  nearest this idea of a humour, but  only so in its
 effects, is a surfeit; yet though its effects may resemble those which
 are entertained of humours, we know from the mode of their origin
 that they are not caused  by a  humour.   It  is  a  mode of  action
 taking place in the skin from a  stimulus or irritation being applied
 to the stomach.   Drinking cold water when a  person is hot will
 produce it.  In a similar case, I have seen inflammation come on
 in the heart and lungs; but they being  less able to bear the action
 than the  skin, it proved fatal.
  The method of cure  of those diseases supposed to arise  from
 humours gives us no idea of the disease having arisen from extraneous
 matter in  the blood-vessels. Can  we form  any idea how  bark
 should extract humours, when it rather stops all evacuations?   And
 yet it cures many diseases.  Would  bathing in  the sea cure those
 eruptions of the  skin which are supposed to arise from humours if
 they were really caused by them 1  Can we suppose that electricity
 extracts any humours, when it cures an ague 1
  It is not easy to account for the blood  having been supposed to
 be the cause of disease, excepting from it  appearing in a bad state
 after bleeding, and this is always a secondary symptom.   Sometimes,
 when this diseased state  has not been  very great, medicines have
 been given to sweeten the blood.*

  * [In connexion with this subject, it may not be uninteresting to mention the
 following facts, which prove that the blood is capable of being greatly vitiated, 
OF LOCAL AND CONSTITUTIONAL DISEASES.
   On Hereditary Diseases.—Hereditary, in the animal economy, is
applied to properties or peculiarities communicated from the parent
to the  child.
   This principle, according to the common notions, may be divided


either by the actions  of the body or by foreign  substances being introduced
into it.
  An animal body may be divided into those parts which form and those which
consume the blood.  The former consist of those orgaus which minister to diges-
tion, sanguification, &c. ; the latter, of those structures which perform the offices
of nutrition.  Increased  action also (although perhaps always attended with in-
creased  nutrition,) rapidly induces an alteration in the qualities of the blood, and
renders  a more frequent  renewal of it necessary. Whatever, therefore, influences
the regularity of those processes upon which the formation and consumption of
the blood depend, so as to destroy their just balance, must necessarily influence
the constitution of  this  fluid.  The following observations, drawn  from disease,
serve to confirm this view of the subject.
   In the first place, then, the varieties in the aspect and sensible qualities of the
blood prove that the condition of this fluid varies remarkably under different cirr
cumstances, being either buffy, firm, soft, diffluent, tarlike, or wholly incoagula-
ble.  It is of various colours and odours ; it requires different times for its coagu-
lation ;  it putrefies sooner or later  in one case than it does  in another ; and  the
relative proportion of its constituents is very different in different cases.
   There are, however, other changes to which this fluid is subject which are not
equally obvious to the senses, but which are rendered evident by their effects on
the body or by chemical investigation.  Thus, urea has  been detected in the
blood in cholera,  in certain cases of dropsy in which the urine is albuminous, in
considerable abundance  in cases of suppression of urine, and in dogs in which
the ureters have been  tied or the kidneys extirpated ; sugar in cases of diabetes ;
and cerebriform, and melanoid matters  in persons suffering from these diseases.
The injection of putrid or ill-conditioned pus into the blood is found to give rise
to a train of symptoms resembling those which are produced by inflammation of
the veins, so as to render it highly probable that pus is  taken into the blood in
the latter cases; but as  this is an important point, I shall offer the following con-
siderations in proof of the fact.
   1st, Pus is frequently formed in  the cavities of inflamed  veins and lymphatics
at the same time that these  vessels are perfectly open towards the  heart.   2d,
Pus is frequently found  in the lacteals in ulceration of the intestines.  3d, Large
abscesses are sometimes observed  to disappear suddenly, which could not hap-
pen except the pus were taken up by the absorbents  and carried into the circula-
tion.  4th, In  inflamed veins, small-pox, and secondary inflammations, there is
reason for believing that pus is taken  up and deposited in distant organs, as if
by metastasis.  5th, Immediate relief of the constitutional  symptoms  ensues
when ill-conditioned abscesses are laid open. 6th, M. Gendnn has observed a
mucous sediment (couche muqueuse) in two cases at the bottom of the vessel con-
taining serum,  in the first of which the patient was affected with empyema, and
in the second with a large abscess of the thigh.  7th, MM. Duploy, Andral and
Rostan  have noticed other cases in which the blood, throughout the whole venous
system, appeared to  have  undergone  spontaneous  purulent decomposition, to
which  head may also be referred those cases of polypoid concretions in the ves-
sels in  which a purulent fluid is  found in the centre, generally occurring at the
same time with suppurative inflammation in some other part of the system.  8th,
The physiological fact,  that the actions of absorption and  deposition antagonize
each other, and are continually taking place in all  the  shut sacs of the body,
which is proved by  the rapid disappearance of injected matters.              -
   M. Lecanu has detected the colouring-matter of the bile in the blood £cases,Qt.
jaundice, which is well known to tinge the structures and secretions of the body
of a vellow colour,  and  to give rise to drowsiness and other symptoms,  ivi. An-
     3                              12* 
138
HUNTER'S PRINCIPLES OF SURGERY.
into two kinds: the transmission of natural properties, and the trans-
mission of diseased, or what I shall  call acquired or accidental pro-
perties.   The  last  is not hereditary in all  its causes, for it always
requires an immediate cause before  the action will  take  place;

dral  has  referred to cases in which the  principles of the bile were found  to be
accumulated in the form of depositions  in several  organs of the body.   Many
cases are related of vicarious discharges,  especially of the urine, and menstrual
discharge, when the organs which afford these secretions have been obstructed.
In cases of obstructed lactation, M. Dance observed symptoms referrible to the
absorption of the milk, of which sort is a case described by  Professor Graaf, in
which  a substance exactly resembling caseum was found in the fluid  of an
ascites, brought on by suppressed lactation, although in a subsequent tapping six
weeks afterwards no caseum was discoverable.   Milky serum, depending on the
presence of oleaginous matters, apparently diffused through  it in the form of an
emulsion, is not uncommon, while  Blumenbach  considers it as not improbable
that  the ferocity of animals during the  rut, as well as man's superior courage,
greatly depend upon the reabsorption of secreted semen into  the circulation.
   Besides these instances, there are others of a still more obscure nature, which
have chiefly been insisted  on by the humourists.  Gout  and  rheumatism, for ex-
ample, used  generally to  be  referred  to  a vitiated condition of the blood;  an
opinion which is certainly favoured by the constitutional and, above all,  the me-
tastatic nature of these diseases.  In the former there is a disposition to secrete
uric  acid in superabundance, both in the urine and in the neighbourhood of the
joints; a highly azotized principle, corresponding to  the highly azotized nutri-
ment which is known to predispose to the arthritic diathesis.  In the latter the
cutaneous discharges  are ktiown to manifest a peculiar acidity.  The formation
of calculi, the tendency to ossific  depositions, and the disease called scurvy ap-
pear to depend upon the superabundance of particular salts  in the  blood.  Du-
hamel  has related  cases of the  most violent effects, followed by gangrene and
death,  depending upon inoculation with the blood of overdriven animals or of per-
sons labouring under putrid forms of fever.  M. Gendrin inoculated a cat, and on
another occasion a dog, with the blood of a patient labouring  under a putrid fever
with eruption of gangrenous  pustules, both  of these animals soon  after dying
with analogous symptoms.  Dupuy and Leuret have  recorded many similar
instances in regard to the horse.  The following case  was related to me by Pro-
fessoi  Coleman, and  is an interesting proof of the manner in which disease may
be communicated  through the medium  of the blood.  One of his pupils having
accidentally inoculated himself whilst  dissecting  a glandered horse, was taken
ill, with a set of anomalous symptoms,  for which he was bled.  The blood which
was drawn was injected into the veins  of a healthy ass, and produced the same
disease in it as in  the horse, notwithstanding that every precaution was used to
obviate the possibility of any source of error.  Mr. Hunter has related a case in
which a child was born with the variolous eruption, and I have myself known a
case in which a woman had seven children  in  succession  (six  of whom died)
"affected  with venereal blotches on the nates a few weeks after birth, although she
herself had been married upwards often years, and during that period had never
been affected with any syphilitic symptom, although  she admitted that  she had
had the  disease previously.  These and  similar  facts  incontestibly prove that
 the  blood is capable of being vitiated  by the actions of the economy, in conse-
 quence of which it is rendered capable  of propagating disease to others as well
as of  perpetuating it in regard  to its own self.  The  following are some further
instances calculated  to show the influence of the nervous system  in producing
these effects.
   Dupuytren found that the change from  venous to arterial blood was not effect-
 ed in the lungs  when  the eighth pair of  nerves was  divided ; Dupuy,  that  the
 fibrin  was relatively diminished by the  same operation, at the same time that the
 blood was so much altered in quality  as to  give  rise to dangerous symptoms
 when injected into the veins of other animals ;  Mayer, that the fibrin and haema- 
OF LOCAL AND CONSTITUTIONAL  DISEASES.        139
therefore its cause is not similar to the first.   To produce an exact
hereditary effect, there must be an hereditary cause or causes; and
as in all  animals of distinct  sexes, in their propagation, there are
two causes acting to  produce a third, the  first and second causes


tosin had  a disposition to separate under the same circumstances, and the blood
in the whole pulmonary system to coagulate.   The coagulation of the blood in
mortified  limbs, the stagnation of the circulation in inflamed capillaries, the in-
coagulability of the blood in cases of sudden death, and the spontaneous concre-
tions which sometimes take place in the living veins, are also to be regarded as
proofs of the influence of the nervous  system.
   But the blood may be vitiated  by extraneous matters.  The existence of many
of  these substances in the blood is inferred from their effects, but  we have dis-
tinct chemical demonstration of the presence of others.  Among the former we
may reckon madder, which tinges the bones of a pink colour;  the alkalies and
acids, which correct the opposite states of the urine; ergot, which produces gan-
grene;  salt provisions, or the long-continued use of the  alkaline carbonates,
which produce the sea scurvy; mercury, which excites ptyalism ; arsenic, which
 inflames the stomach; turpentine  and asparagus, which communicate their odour,
 and rhubarb and many other substances their  colour, to the urine.   Alcoholic
 liquors pass off by the pulmonary exhalation; garlic and many other substances
 become sensible  by the same means.  Carbazotic acid and nitrate of silver dye
 the tissues, the former of a yellow, the latter of a  purple colour. Dr. Graves
 has noticed a case in which sixty leeches, successively applied to  a temale who
 had lately taken hydrocyanic acid, all immediately perished ; and Dr. Chnstison
 has related a similar case, occurring six hours after a dose of oxalic acid.   Ver-
 niere poisoned an animal with nux vomica, and afterwards a  second animal with
 the blood of the first.  These examples afford the highest presumption that medi-
 cines actually  enter the circulation before they produce  their effects on the con-
 stitution ; a conclusion which is further confirmed by observing that they equally
 produce their specific effects, whether administered by the mouth, applied to the
 skin, inhaled by the lungs, or injected into  the veins.  The following are de-
 monstrative proofs of the correctness of this conclusion :
    Iodine has been detected in the blood, saliva, sweat, urine, and milk; mercury,
 in the blood, crassamentum, saliva, and  urine; lead, in the liver, spinal cord,
 and  muscles; copper, in the liver and perspiration; camphor,  sugar oi lead, sal
 ammoniac, verdigris, and  hydrocyanic  acid, in the blood ; sulphur, in the skin,
 &c.   The authorities for these and many similar facts may be seen in Dr. Unns-
 tison's admirable work " On Poisons."
    That medicines should enter the circulation, and thereby produce their effects
  upon the constitution, is  what we should expect; the extraord.nary effects how-
 ever, of certain poisonous  substances excite  our  astonishment   S:r WilHam
  Herschel has shown in regard to common matter that a power 50,000 times the
  power of gravity is generated by alloying mercury with Tn^f°rnJ;
  The same or greater effects  follow the introduction into the^"o^ °f wrtaw  »n
  finitesimal atoms of organic matters.  Thus, the Woorara and Ticunas poisons
  the  poisons received in dissection of recently dead bodies;  of -hydrophob a
  svnhilis  and  small-DOX ; of vipers and other venomous animals, and tnai pro
   L^ing ffom eTalaKs from tne surface of the earth or fXii^A.we'^S
  produce effects which, in reference to their causes seem infinite  Asweawnot
  able to point out the distinguishing  characters d*™**^^^^^
  presented to us in a concentrated state, it cannot be demanded that we .should
  adduce direct proofs of their existence in  the blood   *™*™?^W™
  sistibly conduct to this conclusion, as we   as the ^t that the blood  »" ™>J}™
  these cases, is altered in its sensible qualities, is ^^JPS^^^SS
  death, and speedily putrefies after extravasation,  ^e following are additio
  impediments  to the discovery of extraneous matters in the blood.
    1st, The rapidity with which they pass off by the secretions, 2d,  lheir 
140
HUNTER'S PRINCIPLES OF  SURGERY.
  ought to be exactly similar in all their dispositions and  powers of
  action, or  else the hereditary effect must be a mixture of both, either
  in equal proportions, or one side  may preponderate more than the
  other.  And this we find to be the case.   A true and perfect heredi-
  tary cause is such as will produce its effects under all circumstances
  of  life, not requiring  the influence of any external circumstances
  whatever.   It  is hereditary  for  every animal to  produce its own
  species, which  may be reckoned  the first hereditary principle.  It
  is hereditary for every animal to produce the proper sexes, whether
  hermaphrodite  or of distinct sexes.   Of  these  distinct hereditary
  species we have varieties; and if the varieties, whether original or
  accidental, are such as can be communicated to the young, they are
  then hereditary qualities.  Of this kind we may reckon shape, both
  of the whole  body or of parts, the varieties of which come nearest to
  the original hereditary principle of shape.  Size is a  similar princi-
  ple, as we see it is common for tall or short persons to have children
  of their own stature.   Colour is another  of these  varieties,  for we
  find this may become  part of the principle of propagation,  though
  not so permanent as  some others.  This property belongs to  the
  epidermis, with all its  appendages, as hair, nails, &c, which is sub-
  ject to greater  varieties perhaps   than any other  part: and  those
  hereditary susceptibilities for certain dispositions and actions of the
  mind  are perhaps as much hereditary as any  other property  in an
  animal.
     These  are what we may call permanent hereditary principles,
  becoming  part of the  constitution, and as  subject  to  be  pro-
  duced in the offspring  as any effect in nature.  They  are such as
  will take  place under every external influence, as season, climate,
  &c.   It is from these varieties  being hereditary that we  have a
  continuance of them  from  parent to  child.   When both parents

  sion through 15 or 20 lbs. of blood ; 3d, Their disposition to locate themselves in
  particular organs ; and, 4th, Their actual chemical union with the elements of the
  blood.   Mr. Hunter indeed doubted of the possibility of this latter circumstance
  taking place; but, not to mention  the presumption which arises from other cir-
  cumstances, the following experiment by Dr. Christison puts the matter beyond
  doubt.   He injected eight grains and a half of oxalic acid into the veins of a dog,
  which  was  sufficient to kill the animal in 30 seconds ;  but  although  the  blood
  was immediately tested after death, no traces of the oxalic acid could be  disco-
 . vered.
 \  Whatever may be thought of these facts as proofs of the humoral doctrines,
  they plainly establish the fact that the blood is capable of considerable vitiations.
 » In general,  I believe, these vitiations ought to be regarded as effects, and  not as
 * causes, of disease.  I conceive, however, in many cases the  real cause of disease
 **■ primarily exists in  the blood, and is  in that sense truly constitutional; and
  although we should regard these vitiations of the blood in other cases as merely
., secondary effects, yet we must admit that they will react on  the original disease,
  and in  this  point of view be well deserving of the consideration of the practi-
  tioner.   It is not unreasonable to expect that modern chemistry will throw con-
  siderable light on this subject, and discover some general principle by which the
  scattered facts which now exist relating to the blood will be connected and
  explained.  In the present actual state of science these facts are  practically
  useless.] 
OF LOCAL  AND CONSTITUTIONAL DISEASES.
are  constitutionally alike,  they will  produce  children  like one
another, and also like themselves, though this is not absolutely
certain, for a less marked hereditary principle may arise so as to
produce children very unlike the parents.   But if the disposition to
produce similarity in the children to the parents be different in the
two parents, it is impossible to say what the produce may be like.
  Hereditary varieties will often  last for some generations, and
then become extinct, seeming, as it were, worn out.  A large nose
shall be continued in  a family for  several generations, and  then
cease.   A peculiar gait, the turning in of one or both feet, shall in
the same way continue hereditary for some generations; and it is
very possible that if such  children were to intermarry with one
another, the hereditary disposition would never be lost.
  There are latent hereditary dispositions, which pass over  one or
two generations, and start up again in the second or third.
  Children are  generally more like one  another than like either
parent,  because they have the united principles of the parents, which
are dissimilar, but united will produce  the  same results.
  Parents  may not be at all  times disposed to form children alike.
This difference seems to be owing in some degree to time between
the births of the children;  for we may observe that twins are more
like each other than like those born a year or two apart, and these
latter more alike than those born at the distance of several years.
  If the varieties, as white, black, &c, are not original, they must
be monstrosities; and then we  may say that the disposition  to pro-
duce  monsters  continues  and  becomes  hereditary.   The  white
negress, who may be called a monster of the black variety, being
supposed to be  born  of black parents, and  being herself white,
with woolly hair, is a remarkable instance of the different disposi-
tions  of parents at different times.   This woman married  to a
white man, and had three children, one quite black and the others
tawny.
  A gentleman  had two children, both born with  a  disposition to
exostosis;  the son showed it earliest, and had exostosis on  each
thigh-bone, and  indeed  an increase of every bone  in his body.
The girl was little better  off.  Neither  of the  parents  had any
disease  of the kind, but gave  the  disposition to their children by
joint operations.                                            .  .
  Of the acquired Hereditary Principle.—In these cases the-princi-
ple is such as to require  accident, or some external cause, to pro-
duce the disposition in  such as have the susceptibility.   In this case
the susceptibility only is hereditary; but the disposition and action
require  the application of external influence before they will appear,
and are therefore accidental.   The  action in this case is generally
some disease.
  As the susceptibility is in some degree hereditary, the immediate
cause has been in some degree overlooked, and the disease has
been called an hereditary disease; but it is impossible for a  disease
to be hereditary when one of its causes cannot be hereditary.  It 
142          HUNTER'S PRINCIPLES OF SURGERY.
may be hereditary for a man to be irritable, one man'may be more
readily put in a passion than  another, but no man goes  spontane-
ously into a passion, there must be some violence  committed  on
the mind;  and  so various  are  our minds, that some  shall be put
into a violent passion at a circumstance which would only slightly
or perhaps  not at all, excite another.
  The natural  susceptibility  for diseased action is so  strong  in
some as  to require only a slight secondary cause to put it into
action; in  others so weak, that it requires great violence as  an
immediate  cause to bring on the effects.
  All hereditary dispositions  must be more prominent than those
that  are  acquired or accidental;  therefore people who have  an
hereditary  susceptibility for any diseased mode of action will  in
general have it  constantly, at  least it will not vary so much as some
others.  It will not  be  of that kind which has a great tendency  to
disease at  one  time and  not  at another; such fluctuating disposi-
tions cannot be hereditary.
  Scrofula is one of those diseases  which is supposed to be here-
ditary; but it is only the  readiness to  fall into this peculiar action,
when properly  irritated, that is  hereditary: and when  such a cause
does not exist we find no scrofula.
  Gout is another disease which is supposed to be hereditary, and
there is often great reason in  appearance for supposing that it is so.
This is a diseased action which perhaps every one is susceptible
of; but some fall into it  much more readily than others, and this
readiness may  be hereditary.  But  this readiness  never takes on
action of itself; it  must  have  the  immediate cause  to  excite  it,
which is a stimulus of a  particular kind.  We find  gout attacking
people whose parents for many generations have not had it, and
often never.  We see it starting up in  countries where  luxury is
introduced, where  it was  never known before.  However, there
are many instances where it would appear to be  hereditary, as  in
the case of young  men  of fifteen, the sons of gouty men.  But I
suspect that this does not arise  simply from the father's having had
the gout, but from  the circumstance  that most  people who have
had  the  gout  severely have deserved it, and that children have in-
herited the disposition for the  way of living as well as the suscepti-
bility for the disease, and will  therefore  be more liable to fall into
the disease than children at large.
  On this  principle of the hereditary nature  of diseases, if it  be
just, every disease under  the  sun will  be  hereditary: but many
diseases having a stronger visible cause has made  the  hereditary
susceptibility in them to  be overlooked.  Thus, the small-pox is  as
much hereditary as scrofula  or gout, but from  its arising in  all
cases from poison  communicated, and evidently not  in  a sponta-
neous manner,  is the reason why the  hereditary susceptibility has
been overlooked.   But on our  principle the small-pox is  as heredi-
tary as any other,  only requiring the  immediate cause  to act  to
produce  it as  in any other  disease.   We may make  the  same 
OF LOCAL AND CONSTITUTIONAL DISEASES.
observation with regard to the venereal disease, for we see some
persons much more susceptible of this disease than others are, and
suffering more severely from it when they get it.
   I do  not  know that we have an instance  of observation which
proves that the circumstance of a person's having had the disease
renders him more  liable  to communicate that susceptibility to his
offspring than if he  had only  the susceptibility  for  the  disease,
without the action  having taken place.   If it was a fact  that the
parents having simply had the disease, in some degree entitled their
offspring to it, the  human species wrould soon become extinct in
those places where  such diseases arose: and  if the parents having
had the disease  increased the  susceptibility  in the  offspring, both
small-pox and lues would  have become incurable  by  this time.
So that the immediate cause, whatever this may have been, does
not in consequence of its having  had its full effect either give or
even add to the disposition for such  action.
   The only difficulty I find, in  stating this as a universal doctrine, is
in the case  of madness.   This  is allowed  to be hereditary, and is I
believe as much so as many, yet I cannot find the immediate cause
in  many cases.  It would appear that the  disposition to produce
action is so strong as to go into action without the application of an
exciting cause.   It would be worth while to  see whether people in
a state  of nature ever go mad: if they do not, then the state of mind
in the civilized state is the immediate cause.
   A gentleman  informed  me that he had paid particular attention to
the diseases of Indians, and that he never heard of an  Indian going
 mad.
   On the Effects of Mind on Diseases.—When on the animal econo-
 my, I observed that the mind was formed by the senses, as also the
 will; that the will  produced the voluntary actions, but that the mind
 produced actions both of the voluntary and involuntary parts, which
 actions are often very irregular and undetermined.  On the state of
 the mind, therefore, the  latter will depend,  or  at  least they  will
 change with it, and even the former may be  affected by it;  indeed
 there is not a natural  action in the body, whether involuntary or vo-
 luntary, that may not be influenced by the peculiar state of the mind
 at the time, and every particular mode of the mind  has  some parts
 that are more readily influenced by it  than others.  The skin is
 affected by the feeling  of shame ; the secretion or even the  non-
 secretion of the testicles takes place under certain states of the mind.
 Palpitations  of the heart and quick respirations  are brought on by
 some states; purging and increased  secretions of  the  urine by

  }  In voluntary parts  we can also perceive the influence of the mind.
 It often produces actions independently of the will, especially when
 these actions are begun by the will, and when the mind is affected
 by a recollection of them; or even contrary to the will.  Thus, tear
 produces a vibratory contraction of all the voluntary muscles, while
 the will is doing all  it can to stop it.  Since the  mind  has  sucn 
144
HUNTER'S PRINCIPLES OF SURGERY.
power over the natural  actions of the body, we might suppose it
would have considerable effect in disease ; and this we actually find
it has, especially in those who have a  strong susceptibility for such
actions as the mind can most easily affect.  We  should naturally
expect  that it  would be [diseases principally connected with  the
nerves that the mind would most affect, though we do find that there
are other diseases, with which they appear to have little connexion,
that are much affected by the state of the mind;  and I believe  that
it is principally those diseases in which the alteration is in the action
of parts, not in their structure.
  Minds which are particularly irritable are most subject to such
diseases, having the acting parts more under the control  of the mind,
and less under  that of  the will;  also the involuntary  powers  are
more under the influence of the  state of mind, as the heart,  &c.
These diseases are called nervous, and  more peculiarly belong to
women, who being less acquainted with the real properties of natu-
ral things, are more apt to imagine preternatural ones;  and their
reasoning powers not being so strong,  they indulge  the actions of
the mind more, and allow it to take possession of the body; for the
mind can often prevent diseases of such a nature as are contrary to
health, and depend on voluntary actions, of which take the following
instance.   A woman, aged forty-six, of a good-natured disposition,
had been troubled  for some years with a drawing of the neck to one
side, by the contraction  of one of the mastoid muscles : this  it was
always in her power to  prevent, by contracting the opposite muscle,
when she  sufficiently recollected herself.   The right  muscle,  the
one affected,  did not contract of itself, unless by some accident  she
of her own accord contracted  it a little, after which it  continued
contracting till  it  produced  its full effect.  When her mind was
agreeably engaged she  seldom felt it, or when conversing with an
intimate friend or reading; but fear and every other unpleasant state
always produced  it.  If she expected to see any stranger before
whom she was particularly anxious to  hide her  defect, she  had it
always more  violently than usual.   This circumstance of the mind's
continuing action when  it has once taken it up, is  remarkable in
hiccup, which is often produced by laughing; thus hiccuping, which
is an involuntary action,  is produced by laughing, which is a volun-
tary one.  But as the  state of the  mind is thus capable of producing
a disease, another state of it may effect a cure: so the hiccup may
be cured by producing fear.  There are other diseases which a state
of the mind may cure, though they have not  been brought on by it,
as agues have been cured by charms which have been  used with a
thorough conviction of their being a sovereign remedy.   I am   apt
to suppose that a spider's web, when taken for an ague, cures in the
same way, at least in one case;  for on giving it without the patient's
knowledge, it had  not the slightest effect; but by persuading  the
patient that it was a spider, the effect was produced, at least the disease
did not return.  Even tumours have yielded to the stroke of a dead
man's hand. 
OF LOCAL AND CONSTITUTIONAL DISEASES.
  It often happens that  there is a suspension of some actions in an
animal body, and those actions return again.   Thus we have  epi-
lepsy, which is a suspension of the  sensitive principle's  actions:
sometimes we have suspension of the heart's actions.  It is perhaps
impossible to know the cause of these suspensions, and equally so
the cause of their return.  I am apt to suspect that suspension of
natural action becomes the stimulus to the powers to put themselves
in action again; or, in other words, the suspension becomes by its
continuance a force imposed on parts to act, and they act to relieve
themselves.   Thus, by stopping respiration we have such a stimulus
raised in consequence that we can no longer live without the action,
and the action takes place.
  I  suspect that opium often  produces  a  struggle  between  the
necessity  of action and the consciousness of the preternatural
suspension,  which rather rouses.   Death, which is the  ultimate
suspension of all actions, seems to explain  that, as a person seldom
dies without a struggle or convulsion.   Convulsion appears to me
to be an  action arising from a consciousness of debility ; as if there
was an endeavour to act to preserve life, but not being able to  pre-
serve it, they give up the contest.
  Of Symptoms.—A  symptom is  a sensible effect of a  diseased
action.   The first mode  of sensation is  when the disease is shown
directly, without the medium of any other reference, and is known
only to the patient; of this kind is pain.  The second is where it is
given by a reference to some other sense, as that of touch, smell, &c,
and is common to the patient and others; of this kind is the swelling
of tumours, the redness of inflammation, &c.    The third  arises
from a deficiency of sensation, and can be known only to the
patient himself.  It is by description and the second set of symptoms
that the practitioner receives his information.  Local disease may
produce only the first mode of intelligence, as pain; or it may pro-
ceed to the second, as inflammation ; or the second may be produced
without the first, as indolent tumour, not known till  felt by  the
hand.
  Pain is a simple sensation  which is common to many diseases-,
and is divided into several kinds, as sharp, sore, numbing, heavy, &c.
The sharp pain is that produced by cutting with a knife ; the sore,
from inflammation and ulcers ; the  heavy,  that which takes place in
rheumatism ; the numbing, from pressure on a nerve.   The  sharp
and  sore depend on what I shall call vibration of pain, particularly
the latter.  The heavy seems to be a  continual pain, or where the
repetitions are so quick as to appear continued ;  but probably all
of them are owing to a succession of actions of the nerves.  We refer
all the sensations we can to those senses which give us the greatest
intelligence.  We call them sharp pains from their giving the sensa-
tions of any thing that biles, or stings, as bees, or acids on the tongue;
heavy, from their giving us the sensation of bearing a weight on
the part.   A gentleman who had a hemiplegia, said his sensation 
146
HUNTER'S PRINCIPLES OF SURGERY.
was similar to an acid on the part, that is, to that feeling on tho
tongue.
  We have often a bad taste in the mouth, or a bad  smell; this is
not always a sign that the saliva or mucus is altered in its qualities,
as it is in salivation from  mercury, which appears to be from the
taste and smell of the mercury, but it is sometimes produced  by a
morbid action  of the nerves.   We have these symptoms, together
with ringing in the ears, commonly in the beginning of diseases, and
probably they  arise from the actions of the disease in the nerves of
the  part.
  Neither susceptibility nor disposition for diseased action can pro-
duce a symptom; it must  be preceded by action;  though I believe
that there  will  sometimes be an unnatural  feel in  a part before
action has taken place, as before a fit of the gout attacking the foot
an indescribable sensation is sometimes felt,  and when the action
takes place the constitution is relieved.
  Symptoms are either local  or  universal.   Local, as chancre,
cancer,  &c.;  universal, when  they accompany universal diseases,
as fever.  Local symptoms may produce universal ones, which is
a means either of increasing the local symptoms  or of curing the
disease.  Local  symptoms will vary according to the nature of the
disease; its violence or its situation, as  inflammation, will produce
different sensations in different parts.  Universal diseases will pro-
duce some  of the following symptoms:  affection of the pulse, which
arises from the heart's sympathizing and partaking of the disease;
the alterations are very various, as full, strong, weak,  small, &c.
The secretions are altered, as in fever; the tongue becomes covered
with its own secretion, at first white, afterwards  brown, or some*
times black, which last colour arises from blood being mixed with
the secretion.   The tongue also contracts in size, and we have often
thirst without  its being dry, and sometimes, as in  low fevers, very
dry without thirst, which last is owing to a diminution of sensation
in the nerves,  and is an unfavourable symptom.  The urine is  high-
coloured, without sediment, owing to its being retained  long  in the
bladder, from  debility of that organ or from blood being mixed with
it.  The respiration fails,  from debility in the lungs.  The heat of
the skin is  altered from too great or too little action of the vessels.
The colour of the skin in  some diseases changes, as from white to
yellow in a very short space of time, not from jaundice, the white
of the eye  not being changed; nor  could jaundice be so quick in
coming and disappearing; it is probably a change in the rete mu-
cosum of the skin, such as takes place in the chameleon and  some
other lizards;  veins of the skin are enlarged  by any tumour seated
beneath them  ; as in hydrocephalus, tumours of the breast or of the
uterus during gestation, the veins of the head,  chest, or  belly will
be  found enlarged.
   The feeling of the part is the first mode of intelligence.  Suppose
a stone in the kidney; it may produce three  symptoms : 1st, Pain
in  the part;  2d, Vomiting,  which is  symptomatic ;  3d,  Bloody 
OF LOCAL AND CONSTITUTIONAL  DISEASES.
147
urine.  Now these symptoms may occur in  other diseases, inde-
pendently of stone ;  if they  are  combined, they afford  a  pretty
certain diagnosis of the  presence of stone, but any one or two of
them leaves it doubtful.   These symptoms attend the passing of a
stone  through the ureter, as well  as  when  in  the kidney ; and
when a stone gets  from the ureter into  the  bladder the symptoms
abate, and a different pain is felt,  and this change occurring  con-
firms us in the opinion we had before formed of the existence of a
stone.
  Anomalous Symptoms.—These are not immediately expressive of
the disease, but make  the  diagnosis  doubtful.   They are very
numerous, taking in  all the symptoms which occur from dentition,
worms, &c.  Many  of them  are  from  sympathy, which we men-
tioned before.
  Delusive Symptoms respecting Sensation.—This delusion of the
senses makes disease seem where  it really is not, from the different
seat of the  symptoms and of the diseased part.  Thus, diseases of
the liver  are referred to the shoulder, of the testicles to the back,
of the hip  to  the  knee,  and  even in  some cases, as was  before
observed, they  are  referred to some  other  person.   When the
trunk of the nerve is injured, the pain is referred  to the termination
of it, as,  after amputation of the leg, pain  is  felt in the toes.  When
pressure  is made on  a large nerve, the most acute sensation will be
at some distance below the part pressed on.
   A gentleman complained of a pain in the hip, running down the
outside of the leg and foot.  Supposing  it  rheumatism I gave him
James's powder, Dover's powder,  and volatile tincture of guaiacum,
but with no good  effect.  A liniment of opium to the leg and foot
gave some  relief.   He  at last perceived  a tumour by the os ischii,
just at the  posterior  edge of the  gluteus maximus.  This tumour
increased,  and the person died.   The tumour was found to fill  a
part of the  pelvis, and  had made  its  external appearance  at the
foramen  magnum  ischii, being filled with coagulated blood ;  but the
pain in the limb seemed to have been produced  by its  pressing on
a great branch of the nerve, but chiefly perhaps from the great
ischiatic  nerve being stretched very tight over the upper surface of
the tumour.   Here  that happened  which may often be observed;
that is, the impression made on the trunk of the  nerve gave a sen-
sation as if it had been  on the extremities of the nerve.  The first
action of a nerve is  at its extremity, and  the last in the brain; and
this last in the brain refers the sensation  receiving the first impres-
sion ; and if, after the brain has  become accustomed  to refer any
sensation to the extremities of the nerves, any impression be made
on the trunk, the brain  receives the impression  in the  same  point
where it was accustomed to receive the  impressions made on the
extremity of that nerve, and therefore the mind refers the sensation
to the same spot, that is, the extremity of the nerve.  This happens
when the part to which the sensation is  referred does not exist, as 
148
HUNTER'S PRINCIPLES OF SURGERY.
 a person, having had an amputated limb, will for a long time refer
 his sensations to the fingers or toes.
   In diseases the general character of the patient should be known,
 which is essentially necessary before we can judge of every symp-
 tom ; for besides what we can know  by the symptoms of a disease,
 yet peculiarity of temperament, &c, will occasion great differences
 in the character of the disease.   For  our being informed by the
 first mode of intelligence, the patient's sensations, the patient must
 be in his right senses, otherwise he may be deluded, and delude us.
 But  even where the patient is perfectly sensible, many symptoms
 may appear to the physician which the patient is not sensible of, as
 wild looks, quick pulse, &c.   The brain may not be conscious of
 them, and a false conception of their  feelings is then present; and
 this  may be called half-delirium.   A complete delirium is an action
 of the mind directed by no  sensation  whatever.   But we do  not
 know how to distinguish  between these  two deliriums, the former
 being an action of  the  mind from sensation, but which sensation
 is incapable of  directing its influence to the senses, and refers it to
 other parts or  other objects.   These should  be well understood in
practice, as in half-delirium the patient will have the sensation,  but
will  direct it to some one else, or to  the wrong part, which if we
know we may be able to  afford them the relief they want.  The
history of  every thing  relative to a  disease  should be known, as
 symptoms  alone are  often  not enough to direct  us; we  should,
therefore, get the history of it and of prior diseases, of peculiarity
of constitution, manner  of living,  &c.
                        CHAPTER XII.

              GENERAL PRINCIPLES OF INFLAMMATION.

Frequency of inflammation;—nature of;—enlargement of vessels ;—several spe-
  cies ;—simple or compound ;—three results  from  inflammation in a healthy
  constitution :—adhesion,—suppuration,—ulceration.—Adhesion ;—nature  of
  the uniting medium ;—partakes of the quality of the diseased solids ;—its uses.
  —Suppuration;—differs in degree accordingto the exciting cause.—Ulceration ;
  —its  uses.—Exciting causes of inflammation ;—accidental or specific.__Re-
  mote  causes of inflammation.—Comparative  susceptibility of parts to inflam-
  mation.—Effects of inflammation on the constitution.—Of the pulse;__varies
  with the states of the constitution ;—varieties of pulse ;—causes of the varie-
  ties.—Effects on the constitution according to the state of the inflammation ;__
  rigors.—State of the blood in inflammation ; colour, heat, coldness, pain of the
  inflamed parts.—Declension of inflammation.—Ecchymosis ;__varieties of-__
  termination of.

The operation in the body called inflammation is  one of the most
common and most extensive in its effects, and requires our greatest 
           GENERAL PRINCIPLES OF INFLAMMATION.        149

attention. It is the cause of many effects, both salutary and diseased,
producing  abscesses, fistulas, diseased bones, &c, and in many
diseases is  the first step towards a cure; so  that it becomes a  first
principle in surgery.
  Inflammation would appear to be produced by an increased action
of the vessels, but it is most probably in the smallest vessels, for it
may be confined  almost to a  point where none but the smallest ves-
sels exist.  What the particular action is, or in what it differs from
the common action of vessels, is not easily ascertained, we being
more able to judge of the effects than of the immediate  cause.
  Inflammation may be considered as a genus, of which there are
many species.  It may be divided into healthy and unhealthy.   The
healthy is  that which will always take place in a healthy constitu-
tion or part,  and is rather to be considered as a restorative process
than a disease.   Unhealthy inflammation is that which takes place
in an unhealthy constitution or part, and will vary according to the
kind of unhealthiness of that constitution or part.
   Inflammation is either simple or compound ; simple, when there
is only one mode of action in the part inflamed, as in the first stage;
compound, when there  are  two or more modes of action.   The
compound produces three great effects, namely, adhesion, suppura-
tion, and ulceration, which I shall call adhesive, suppurative,  and
ulcerative inflammation.   The last is only an effect of inflammation,
for the process takes place in a different set of vessels.
   I shall place the adhesive first in order, though it is not always so,
for with respect to priority of these effects of inflammation, it de-
pends principally on the nature of the parts, with the degeee of vio-
lence of the inflammation.  To explain this more fully, I shall con-
sider inflammation  as it affects,  1st,  The cellular membrane in
general, and  the circumscribed  cavities; 2d, All the outlets of the
body,  i.  e., the excretory outlets and ducts of glands, as the mouth,
nose, tunica conjunctiva, &c, which  have  been called  mucous
membranes, and which I  shall treat of in their proper order.
   When inflammation takes place in the first order of parts, it  is
 commonly the adhesive:  but it will be  according  to circumstances
whether the suppurative or ulcerative follows first, and probably
according to the degree of inflammation.   But it sometimes happens
that the suppurative takes place almost immediately, probably  from
two causes, either from  the inflammation exciting the suppurative
 almost immediately after the  adhesive, or from  the inflammation
 having  little or nothing of  the adhesive in it.  I suspect  that the
 erysipelatous has little of the  adhesive in its nature, no adhesion
taking place  before  suppuration, whilst in phlegmonous inflamma-
 tion of  the  cellular membrane  it does; so that  the erysipelatous
 might be  called oedematous  inflammation.   When inflammation
 occurs with violence on the  surface of the  skin, the ulcerative pro-
 cess takes precedence of the  suppurative, although m the cellular
 membrane the reverse of this is the case.  In the second  order  ot
                              13* 
150           HUNTER'S PRINCIPLES OF SURGERY.

parts the suppurative takes  place first, and the adhesive does  not
take place, unless the inflammation is carried to a great height.
  When the inflammation is in the first order of parts, the suppura-
tion  and ulceration are so many  actions superadded to the  first, or
adhesive, and  arising out of the effects produced by that which now
become new causes, especially of the ulcerative, which is an action
of the absorbents.   All these actions arise from the first irritation
or cause.
  The adhesive or suppurative, either in the first or second  order of
parts with their varieties, may have a fourth character superadded,
such, for example, as the scrofulous or venereal disposition, or other
specific disease.
  These three modes of action,  when carried on perfectly, are the
effects of a good constitution, and constitute what I would be under-
stood to mean by common inflammation.
  The union of  cavities in an animal body is  formed by a uniting
medium, which appears to be  the coagulable lymph, which, by the
inflammatory disposition  of the  vessels, is separated from  other
parts of the blood and thrown out on these surfaces.  That this is
the case appears from the  following observations.  In all  large
cavities where we can make  our observations  with  certainty, we
find when they have been inflamed that a substance similar to the
coagulable lymph when separated from the serum and red particles,
is diffused all over the sides or through the cavity.   When we cut
into an inflamed part after death, we find it firm and solid, like the
section of  a  lemon, or some oedematous tumour, where we  know
extravasation has taken place ; and this appearance arises from the
cells of the  cellular  membrane being  loaded with extravasated
coagulable  lymph.
   This mode of separation of coagulable  lymph is not peculiar to
this species of inflammation; it is separated on many other occasions
to  form tumours,* where inflammation does  not  seem  to be the
leading cause.
   It is probable that the coagulable  lymph undergoes some change
in  its passage  through  the  inflamed vessels  which obliges  it  to

  *  [As we are not acquainted with the mode in which the process of nutrition
is accomplished in its natural  state, it is not to be  expected that we should  be
able to account for those aberrations from the healthy state which constitute tu-
mours,.  If the  formation of tumours depended upon the organization  of effused
blood or lymph, we should expect to see them much more frequently than we do,
since few persons escape effusions at one time or other; and we should likewise
expect to see them differ in their incipient and in their advanced stages.  Obser-
vation, however, discloses nothing of this kind;  on the contrary, the peculiar
structure of tumours is as well characterized at first as  when they become more
fully developed : the blood or lymph which is effused in inflammation or by ac-
cident is generally absorbed, and in the great majority of tumours we are unable
to refer to any  previous injury or inflammation to account for their orio-jn.  See
 Home {Trans, of a Soc. for the Imp. of Med. and  Chir. Knowledge, vol. i.,) and
 Abernethy {Works, vol. ii.), who have advocated  the opinion in the text, and
 Lawrence {Med.-Chir. Trans., vol. xvii.), who justly, in my  opinion, objects to
 the statements of these gentlemen.] 
GENERAL PRINCIPLES OF INFLAMMATION.        151
coagulate  sooner than it otherwise would, for in those cases of in-
flamed arms, after bleeding, we  find that the cavities of the veins
are in many places furred over, and in others united by  coagulable
lymph, which must have been thrown out by the vasa vasorum, and
coagulated blood immediately.   Hence it is reasonable  to suppose
that in this separation the lymph must have undergone some change,
arising from  the vessels, and that it is not simply such  coagulable
lymph as is circulating in the blood, else it would be carried off by
the circulating blood passing through the vein.  This change I suppose
to arise from sympathy with  the inflamed vein.  The lymph seems,
however, to  retain the living principle,  and  probably in a greater
degree than under common circumstances, and is, therefore, better
fitted to become a living solid. It does not seem, however, absolutely
necessary  that coagulable lymph  should first undergo this change
in the extravasating vessels, for, as I  have before said, blood ex-
tra vasated from ruptured vessels  is perhaps equally efficacious in
this respect.*
   It does not seem necessary for both surfaces that are to be united,
to  be in a  state of inflammation, but only for one, to throw out the
coagulable lymph; nor indeed  does inflammation of either seem
necessary, for union by extravasated blood may take place without
 inflammation.
   Extravasated coagulable lymph, which produces either adhesion
 or tumours, alwTays partakes of the nature of  the diseased solids that
 produced  it; if the case is  venereal, the  new substance is of the
 same nature; if  cancerous, cancerous ;  for  the absorption of this
 effusion from  a cancerous  breast will produce cancerous axillary
 glands.
    The intention of the adhesive inflammation is in some degree to
 set bounds to or prevent  the necessity of its  own larger extent.  In
 large cavities the inflamed parts adhere, and thereby exclude or
 prevent the  other parts from the necessity of falling into the  same
 irritation.   But the chief intention is  to confine  the suppuration to
 those parts where it takes place,  for  where  the  adhesions  are
 perfectly  formed the operations of inflammation  appear to be com-
 pleted,  so that the suppurative process does not spread; it also
 serves to confine the matter to the cavities where it is  formed.
    Inflammation often goes no further than adhesion, and  then
 subsides  and goes  off, which is  termed resolution.   This cannot
 take place in all  inflammations, but only in  those where the  parts
 can be brought into contact, for if the part  in which it takes place
 is an open cavity, suppuration will take place.
    When  the  adhesive inflammation is not capable of resolution,
 suppuration takes place.  The immediate  effect of this process is
 the production of matter from the inflamed  surface,  which appears
  under such circumstances to be a leading step to the  formation of
  a new substance, called granulations, which granulations are the

       * [See note, p. 34, and Treatise on Inflammation, Part II. Chap. I.] 
 152          HUNTER'S PRINCIPLES OF SURGERY.

 second method of restoring the first order of parts to health.  But
 on all internal canals suppuration does not necessarily lead to gra-
 nulation.
   In order for spontaneous inflammations to produce suppuration,
 they must be much  more violent than those inflammations (suppu-
 ration  being equally  necessary), arising in consequence of  an
 operation or accident:  and those inflammations from either opera-
 tions or  accidents,  if they have not produced  death in the part
 operated on,  are more  violent  and of greater extent than those  in
 which death of a part has been produced.  Thus, the inflammation
 of a boil or bubo is more violent and commonly more  extensive,
 than that in consequence of a  cut, or even amputation of the leg ;
 and the inflammation arising from these  latter will be more violent
 than that from a gunshot wound on  the application of caustic.  It
 may not be easy to account for all these  differences; howrever, it is
possible that in spontaneous  inflammations the inflammation  is
 more necessary for  the ultimate effect than the  suppuration;  as in
 gout, the inflammation is the mode of carrying off the action of the
disease.  It is  curious to remark,  that  in gout nature  seems  to
 produce all the purposes and effects  intended by inflammation, but
 unaccompanied by either adhesion,  suppuration,  or ulceration; and
 although the inflammations runs much higher here  than in many
 other cases,  and although  it  is attended with all the  common
 appearances, yet no adhesions are formed here: for the  lymph is
 taken up, and chalk (urate of  soda)  is deposited in its place.   In
 spontaneous inflammation, parts are either naturally more suscep-
 tible of the inflammation, or become  so by disease.   When inflam-
 mation is produced  by stimulus of the death of a part, or of effused
 blood, the inflammation is commonly slow ; but  that from a bruise
 is  often quick and  violent, but then the injury has not produced
 death.   If  caustics  do  not act with  vigour, they will  irritate and
 inflame much sooner than if they had immediately killed the part;
 but irritating applications must be continued some time to produce
inflammation.   After operations where  inflammation must  take
 place for the union  of the wounds,  suppuration  is  more necessary
than inflammation, and we find it is soon produced.
  The ulcerative inflammation is that which takes place in conse-
 quence of  suppuration,  therefore is  not so  much the original in-
flammation as the consequence.  It is that inflammation which dis-
poses parts to absorb themselves, and which  brings  matter or any
extraneous substance to the surface to be discharged, the absorbents
removing all the parts  lying between the matter and  the surface.
This process  has been erroneously ascribed to the melting down  or
dissolution of living  solids with  the pus.
  From the foregoing general account of inflammation, it maybe said
to arise in all cases from  injury done to the solids, where either the
 natural conformation of parts on which natural actions depend  is  so
 destroyed that they are  not able to support themselves in that state,
 or from the natural actions or  functions of a  part being materially 
GENERAL PRINCIPLES OF INFLAMMATION.
obstructed, the texture not being primarily affected.  The first state
arises from causes that are visible or external, such as the application
of any irritating matter, as a blister, heat, or even cold, which acts as
a sedative when applied only in a certain quantity ; but when in too
great a quantity, the parts, finding that they are losing their action,
are roused to action beyond that which is natural, in order to destroy
the irritating cause. Inflammation may also be produced by causes not
known or suspected, or from a constitutional disposition being deter-
mined to some part, producing local effects.  I need hardly mention
that fever is thus often a cause of local inflammation.
  Inflammations from the constitution are of two kinds :  one may be
called accidental, as those arising in common fever; the other are de-
terminate, depending on the species of fever which may be called spe-
cific, as small-pox, &c.
  These inflammations are thought  to be critical, but I very much
doubt the truth of this opinion.  The small-pox and chicken-pox are
the only  diseases that can be brought in proof of it, with  perhaps the
inflammation of measles;  but even these pustules or abscesses are,
perhaps, not necessary, as critical abscesses, to carry off the fever,
for specific fevers cannot exist beyond a certain  time, though no
eruption appears;  which time depends on the nature of the poison,
and the constitution. And in these diseases we have large abscesses as
often formed as after any other; and certainly I cannot suppose those
abscesses to be critical, for they possess  nothing of the specific nature
of the preceding disease, and must therefore be common ; or, where
the constitution possesses a susceptibility for scrofula, they may be
scrofulous, but not critical; and as the preceding disease has already
been  followed by pustules or abscesses which, if any deserve to be
termed so, certainly ought to be termed critical,we shall find that these
inflammations and abscesses  depend on the state of the constitution
and part at that time, and are an effect of simple fever abstracted
from  every specific peculiarity.   Fever is at all times  a disturbed
action, which may have a specific action joined with it or not.  The
inflammatory fever is perhaps, the most simple fever; and the putrid
fever is,  perhaps,  only the  same fever occurring in  a constitu-
tion predisposed to its peculiar actions.  This opinion may be illus-
trated by what occurs in the small-pox ; two different people having
this fever from the same infection,  the effect in  one will be benign
small-pox, with only simple inflammatory fever ; in the other it will
be erysipelatous or confluent small-pox, with a tendency to putridity
or gangrene.  This difference cannot depend on the specific poison,
as this can have but one  mode  of  irritating.   Now, since  every
fever  is capable of producing inflammation and abscess, and as I have
shown that in specific diseases they have no right to be termed cri-
tical,  they certainly cannot be supposed critical in common fever.
  Inflammation  may arise from one of four causes, which may be
called remote:  1st, From accidental force applied  to a part:  2d,
From some irritation, which  does not destroy the texture of a part,
but simply the natural  actions, as friction, blisters, heat, cold, and 
 154           HUNTER'S PRINCIPLES OF SURGERY.

 often fevers of various kinds ;  3d, From some particular disposition
 in the  part itself, as boils arising  spontaneously; 4th, From the
 general state of the constitution affecting some particular part, as
 gout falling on the toe, or the irritation of fever on the lungs,  liver,
 or any other  part, producing  adhesions or abscesses;  but  such, I
 suspect, are of the scrofulous  kind, and not in the least critical, and
 therefore belonging to the  second  cause.   To  these,  I think, we
 may add  specific causes, as  scrofulous, venereal, &c, as  a 5th;
 and the  stimulus  of defect  or imperfection  of parts, especially
 cavities, as a 6th.
   Obstruction of the blood's motion in the small vessels has been long
 supposed to be a great cause  of inflammation, but is, I believe, now
 pretty generally rejected.  This was certainly too confined an idea:
 it reduced all inflammations to one species.  The only  distinctions
 of inflammations must then have arisen from the nature of the con-
 stitution; but this doctrine never could account for the peculiar ac-
 tion of any specific disease or poison.   It was also too mechanical.
 If they had said that any obstruction to the natural actions of the
 parts which could stop the blood's motion in the part became the
 cause of inflammation, they would not have been so much out as to
 a possible cause of inflammation.   In such  a  case the stagnated
 blood would cause irritation of the vessels, and suppuration would be
 produced to get rid of it.   The immediate operation of these inflam-
 mations cannot be called  disease, though their remote causes may, as
 small-pox, &c.;  for they may arise from the part being only disturbed,
 and hardly exceeding the idea we have annexed to that  of being
 disturbed.  It is the cause producing  inflammation, then, which is
 the disease and not the  inflammation,* for  all inflammations that
 can be  called diseases have specific causes; and, indeed, even these
 can be  hardly called diseases, for in small-pox, where the inflamma-
 tion goes on well,  it is merely the action of health; if  diseased, it
 would  be  erysipelatous,  &c.   Sometimes,  by  amputating a leg,
 more than simple disturbed action is produced, for it is a great loss
 to the  constitution ; but yet when the constitution is in a healthy
 state, we generally find a healthy inflammation and digestion of the
 wound  take place: it will  not go into an  inflammation which  is
 unhealthy.  Specific inflammation as well as simple  inflammation
 partake of the nature of the constitution.   Some constitutions are
 more disposed to certain  specific actions than others, and will fall
 into that specific kind of inflammation, as  the erysipelatous, the

  * [That is, inflammation with a specific character is the only  inflammation
which can be denominated disease.  The meaning of the author I conceive to be
simply that pure inflammation is a restorative action, in  contradistinction to the
actions of disease which tend to destroy (pp. 15, 97); and to this general state-
ment there can be no objection, although it must be borne in  mind  that the rule
of judging from final causes  cannot be  applied absolutely without excluding
from the  list of diseases a great many affections to which it would  be absurd to
deny this title, such as sickness, purging, increased secretions, ulceration, mor-
tification, &c, the tendency of  which on many occasions evidently is salutary, or
to get rid of  some noxious matters :  still  there is sufficient ground I think for
the general observation.] 
GENERAL PRINCIPLES OF INFLAMMATION.
155
scrofulous, &c.; and every aggravation is  an aggravation of the
specific nature of the inflammation; thus it  happens in scrofula,
cancer, &c.   But some specific irritations bring all constitutions,
to their own nature, as the plague, jail-fever, &c.  Here it is not a
specific joined with a simple inflammation, but a thorough change
of constitution, and the patients  generally die, all suffering alike.
The inflammation arising  from  these causes may  be  either the
adhesive or the suppurative.   From all which  we may conclude
that irritations either produce inflammation according to the dispo-
sition of the constitution  or of their own nature, of which  last is
the plague.
   The specific diseases will change, according  as the constitution
changes;  for instance, after receiving the small-pox, if the constitu-
tion, then healthy, should by any  means become disposed to show
putrid symptoms, the small-pox  will have the same appearance; but
if the constitution is  altered from this tendency, the  eruption will
also alter. Now the  knowledge  of this fact  is  very useful  in the
treatment  of  specific  diseases; for example, if with a venereal
chancre the constitution be erysipelatous, we may have an erysipe-
latous inflammation in addition to the chancre, which will spread
over  the whole penis.  Now, in this case, we  must make use  of
mercury against the one, and of  bark against  the  other of these
specific diseases, until we bring it  to the simple ulcerative  inflam-
mation.   Again in the small-pox, when simple, the  pustules  retain
their specific distances, but if an erysipelatous inflammation be
joined to  it, it becomes of the confluent kind.  In the irritable con-
stitution we find from continuous sympathy  the inflammation will
extend itself very far; but in general we find that considerable in-
flammations confine themselves very much.
   Some parts  are more susceptible of one kind of inflammation than
of others; some admitting only of one kind, some two, and some all
three, which difference appears to be according to the situation  in
the body  of the inflamed parts, and also according to the nature of
the parts  inflamed.  The deeper-seated parts, especially the  vital,
admit very readily of the adhesive inflammation, as  is  proved by
dissections, for we hardly ever open a human subject that has not
had considerable adhesions in the circumscribed cavities; but they do
not so readily  pass into the suppurative, which  is fortunate, otherwise
internal inflammation would oftener kill.  But if the inflammation
 comes on at  once with great violence, it would  appear  to  pass
 almost at once over the  adhesive, and to take  up the suppurative
 action, and in this case we may sometimes have the erysipelatous
 added.
    The external parts of the body are more susceptible of the suppu-
 rative  inflammation  than the internal, but they always begin with
 the adhesive.   This  greater  susceptibility of the superficial parts
 to suppuration is  shown in the passage of pins, bullets, and other
 extraneous bodies to the surface : if deep-seated, they will remain
 a long time inactive, inclosed in a cyst, and  produce no inconveni-
 ence until they work their way to the skin, when siumnm*"* 
 L56          HUNTER'S PRINCIPLES OF SURGERY.

 be  produced.  It is very remarkable of the cattle which feed in the
 bleaching-fields, and are always found after death to have a num-
 ber of pins in them.   (The stomach of a bull was shown, in which
 several pins were sticking, and which were not  known to  have
 caused any  inconvenience.)  Perhaps  this  does not  altogether
 depend on the situation of the part, but also, on the degree of irri-
 tating power possessed by  the extraneous substance: thus, metals
 and glass seem to produce  such a disposition in  the part, that it
 becomes satisfied  with  the adhesive  inflammation.  A gentleman
 had a piece of glass in  his hand for many weeks, which produced
 no  pain, except on pressure.  This insensibility of deep-seated parts
 to extraneous substances, depends on a sac being formed around
 these substances,  possessing  a peculiar  degree of insensibility.
 Nature acts here with her usual care, preferring the least evil by
 securing the  extraneous substance  in a  part possessing  peculiar
 insensibility, rather than calling up the  vital powers  to  produce
 suppuration, which must be considerable to reach the surface, and
 might  expose  parts which would  be attended  with considerable
 danger;  but  when they become external, then she chooses the
 other, to get rid  of them as soon as possible.
  In my division of parts, as regards inflammation, into two orders,
 I have made  a distinction between  the  cellular  membrane  and
 circumscribed cavities on the one hand, and the ducts, canals,  and
 outlets which are lined with what has been called a mucous mem-
 brane on the  other.  In the first order of parts, inflammation  pro-
 ceeds in this order; adhesive, suppurative, ulcerative ;  but in the
 second  order  of parts, the  order of inflammation  seems to be
 inverted  as regards the two first, as may be seen in internal canals.
 In  these, if the  inflammation  is but slight, the suppurative takes
 place almost immediately, not being retarded by the adhesive going
 before ; as we  see in gonorrhoea, catarrh, &c.   It has been  said
 that these discharges are  not purulent,  but  in  my  opinion they
 certainly are; the  purulent matter  being  only a change in  the
 natural secretion,  and its  thickness or thinness depending on the
degree of the  inflammation.   If the erysipelatous inflammation
 should come on in these  parts, then the movement takes  place from
the  suppurative to the ulcerative.  In the mucous membrane ulcer-
 ation will take place, probably from the violence of the inflamma-
tion having produced  coagulable lymph, which acts as  a stimulus,
 and the parts having been weakened, are unable to support them-
 selves : this is sometimes  the  case in the mouth, from salivation ;
in the tongue, &c, in scurvy; in  the  intestines, in dysentery, &c.
 Mr. Hunter endeavoured to produce adhesive inflammation in the
vagina of an ass.  He  first,  by  moderate  stimulus, could only
 produce suppuration, but by a very active stimulus, as a solution of
 corrosive sublimate, he produced the adhesive, causing coagulable
 lymph to be  effused, which afterwards became  membranous  and
 inseparable, as was seen in the preparation of the  parts which he
exhibited.
  Strength and weakness of the constitution, or of the part affected, 
GENERAL PRINCIPLES OF INFLAMMATION.
157
will produce very different effects in inflammation.   Strength pro-
duces good effects, and renders  the disease more manageable, for
it lessens  irritability.   Inflammation is most manageable in parts
in the following order: muscles, cellular membrane, and skin, and
the more  so the nearer the source of circulation.  In other parts,
as bones,  cartilages, ligaments, &c, which have but little power in
themselves, it  is less  manageable, though the constitution be good,
for the constitution feels conscious of the weakness of these parts,
by which affection of the  constitution they become  further weak-
ened.  In  vital parts, inflammation  also  is very  unmanageable,
though  these  have  power in themselves; but  in consequence of
their  being affected,  the universal  health is destroyed,  and hence
the disease is  less  manageable.  If  the stomach is  inflamed, no
operation of the  body can go on well, the powers of  restoration
becoming  weaker than ever; hence the greatest danger is to be
apprehended.
   Sti'ength of the constitution and parts affected, when under inflam-
mation, produces the following effects :  viz., a more  ready and
quick termination, whatever  it  be.  Thus, a  wound in a  healthy
constitution unites more  readily by the  first intention; adhesive
inflammation more readily terminates by resolution.   If inflamma-
tion have got beyond the first stage, it  passes sooner on to the
suppurative inflammation; nature going  through  her operations
with greater facility and despatch in such a state of constitution.
   Weakness of the Constitution and Parts.—When a wound is made
in a  person  of  a weak habit, the union is more difficult, and the
inflammation  is  more likely to  continue;  and this  not  from there
being a greater disposition to  inflammation, but from want of  a
power and disposition to heal, nature needing greater  and longer
exertions  to produce the intended effect.
   In this state of the constitution and parts we often find that parts
seem hardly  capable of  taking on either adhesive or  suppurative
inflammation  : and in some of these habits inflammation will hardly
even follow a  solution of continuity.   As in dropsy,  I have observed
that the  puncture  made  by  tapping or  scarifications  will hardly
heal; a degree of inflammation does take place,  but not  sufficient to
procure a healing of the  wounds or suppuration, but mortification
soon comes  on.  If in such a constitution a wound is made, the
blood not  coagulating sufficiently to heal it  by the first intention,
 dies, and becomes an extraneous substance, causing irritation: sup-
purative  inflammation succeeds, and  often  mortification, which
 mostly proves fatal.
   Effects of Inflammation on  the  Constitution.—The sympathy of
 the constitution upon an act of violence to the parts, is probably the
 most simple  act of a constitution.   But this will vary in different
 constitutions, because all  constitutions do not sympathize equally.
 It will vary according to the stage of the inflammation, and accord-
 ing to  the disposition of the parts inflamed.
   We find the effects of inflammation on the constitution as various
                               14 
158          HUNTER'S PRINCIPLES OF SURGERY.
as any other circumstances, which appear to arise from the follow-
ing causes ; first, from the nature of the constitution ; secondly, from
the nature of the  inflammation,  whether common or  specific ;  if
common, according to the stage of the inflammation, whether adhe-
sive, suppurative, or ulcerative ; if specific, according to  the kind,
although I believe specific irritations do not produce  much variety
in the constitution, except the plague, which entirely changes it, and
such as by their long continuance weaken the constitution, as lues,
when Of long standing; but this will  be  similar  to any lasting
disease, for at first it certainly does not affect the constitution so as
to alter the disposition of a wound made on any part: thirdly, from
the nature of the part  inflamed,  whether vital  or otherwise : and,
fourthly, from the different situation of similar parts, as of the muscles
or cellular membrane in the legs or arms, &c.
  In inflammation we have seldom more than the continuous or the
universal  sympathy, but sometimes  the  remote.  The continuous
causes the inflammation to spread.  The general is when the con-
stitution  becomes  affected.   The remote  is seen in  pain of the
shoulder, from inflammation of the liver.
  As the effects which inflammation has on the constitution are by
sympathy, they will be in proportion to  the readiness it has to  go
into that action; and this is much greater in some constitutions than
in others;  moreover, every constitution sympathizes more readily
with some parts than others.  The kind of constitution least affected
is generally the most healthy where sympathy hardly  takes place,
the surrounding parts even seeming hardly to feel what is going on
in those nearest them.
   The nature of the inflammation  produces, I believe, but little varia-
tion in these effects : for, of whatever kind, the sympathy will be in
proportion to the violence of the inflammation,  and  its rapidity.
Hence as the  inflammation which produces healthy  suppuration is
more rapid, it generally  produces more violent effects  on the con-
stitution than  any  other.
   The effects which inflammation has  on the vascular system, and
which are chiefly discoverable by the pulse, are very  remarkable.
In considering the peculiarities of the pulse, it is always  necessary
to remark that there are two powers  acting to  produce it, viz., the
heart and the arteries.  That one part of the pulse belongs to the
heart, another to the  arteries, and a third is a  compound of both.
The stroke, which is the pulse, (as  regards the number of strokes
in a given time, the regularity or irregularity as  to  time, and the
quickness of  these strokes,)  belongs to the heart.   The vibratory
pulse and slowness of the systole, with the fulness  and smallness
of the pulse, belong to the arteries.
   As the pulse arises from the actions of the solids on the machine,
 it is of  course according to the nature  of  the  machine at  the
 time;  therefore is capable  of being in one  of two states,  natural or
 diseased.
   In most diseases of the constitution, whether original or  arising 
GENERAL PRINCIPLES OF INFLAMMATION.
in consequence of diseases of parts  in  which  the  constitution
becomes  affected by sympathy,  the  pulse  is altered from  the
natural to  the  diseased  state which  is  according to  those affec-
tions.
  The varieties of which the pulse admits are numerous.   It may
be increased or  diminished in the  number of strokes:  regular or
irregular as to  time; quick in its stroke, or diastole, and slow in its
systole ; or it may be hard  in its diastole.  In  all cases probably,
when the constitution is in a state  of irritation, the pulse will be
quick and  frequent in its number of strokes in a given time, and
the artery being hard, from  the constant contraction of its muscular
coats, will give a feeling of hardness to the touch: besides which
the diastole of  the artery is not uniformly  and regularly the same,
but there are a vast number of stops or intermissions, which are so
quick as to give the feeling  of vibration, or what we call thrill.
In such a disposition  the pulse may be either full  or small.   These
two opposite effects do not  seem to arise from the difference in the
quantity of blood, as  might  at first be supposed; but arise,  I rather
suspect, from the difference in the degree  of  strength and quantity
of irritability that the patient  possesses at the time, which when
joined,  give an antidiastolic disposition to the  arteries, so that when
the arteries have a full power of contraction and are  in a state of
irritation at the same time  this  effect will  always take place.
   It is certain that arteries in  such a state of constitution do not
dilate so fully and freely as  at other times; and as this varies quickly
as  the state of the constitution varies quickly, it is more reasonable
to  suppose that the effect is immediately from the arteries than from
an increase or decrease in  the quantity of blood.  If this  is really
the case, we should naturally suppose that the motion of the blood
in the arteries would be increased in proportion to their diminished
size, unless we should also suppose  that  the systole  of the heart
should be diminished in the same proportion, which I think is pro-
bably the  case,'as we find the blood forsakes the surface of  the body
 in such a state of constitution, which must therefore be collected in
the larger veins  about the heart.  But if the heart were to throw out
 its whole contents at each  systole, the velocity of the  blood in the
arteries would be immense, and must be then forced into the small
vessels on  the surface of the body, which  it certainly is  not.  A
quick hard vibratory pulse is generally attendant on inflammation.
 The  fulness  or emptiness of the pulse  depend greatly  on the
 parts that are  affected,  which either increase or  decrease  the irri-
 tability.
   Different Parts produce  different states of the Pulse.—In inflam-
 mation of common parts, as the skin, cellular  membrane,  muscles,
 &c, the pulse will be  full and strong, and  the  symptoms  acute,
 especially if near the heart.  Ligaments, cartilages, tendons, and bony
 parts produce symptoms which are  less acute; the pulse is not so
 full, but quicker, there being in these cases a  greater degree of irri-
 tability.   In the vital  parts of the second order, as the brain, the 
 160          HUNTER'S PRINCIPLES OF SURGERY.

 pulse is soft and slow;  but in the stomach and parts with which it
 sympathizes greatly, as the testicles, upper part of the intestines, &c,
 the pulse is small, quick, and contracted.
   Of the sensations arising from inflammation in  different parts.—
 When  the injury is in the head, the  pain is often dull and attended
 with sickness; when in the heart and lungs, the pain is more violent.
 When in the stomach or upper part of the intestines, it is a heavy
 depressing pain, and attended with more or less of sickness.   When
 in the colon it is more acute, but attended with less sickness. When
 the liver, ligaments, or bony parts are affected, the pain is much the
 same as when the stomach is affected, that is, heavy and depressing :
 the pain is acute and rousing when the skin, cellular  membrane, or
 muscles are inflamed.
   Inflammations in vital parts do not all produce  the  same effects
 on the constitution, which would seem  to arise from their greater or
 less sympathy with the stomach; but it is  certain  that  a given
 quantity of inflammation in a  vital part or its sympathizer will pro-
 duce much more considerable  effects than a greater quantity in
 another part, and the blood will be more sizy.   When the  heart is
 inflamed, its actions are irregular;  if the lungs only are inflamed,
 the heart still seems to  sympathize, and is irregular  in its actions,
 as well  as weak.   If the stomach is inflamed, the patient feels a de-
 pression and a defective action in the heart as well as in every part;
 simple animal life, or the living principle, seems then to be depressed,
 as the sensitive from inflammation in the brain, and the pulse is low
 and weak.   In inflammation of the  uterus the pain  is very acute,
 and the pulse quick and low, the stomach sick, &c.  When inflam-
 mation  occurs in these parts the symptoms come on very quickly;
 and if  it proves fatal, it runs  through  its  stage very fast;  debility
 beginning very early.   All this may depend on the stomach being,
 as it were,  the central seat of sympathy, whence the  actions of life
 are interfered with.   However, universal sympathy soon takes
 place here, and the sympathy being similar  to the  first action, a
 fever of a depressing kind is produced, and death  soon succeeds.
  Inflammation of parts not vital, of such violence as to  affect the
 actions of life by general sympathy, render the pulse full and strong.
 The constitution in  this case is strong  and not irritable;  for when
 weak and irritable, the pulse is quick, hard, and small in the begin-
 ning, as it  is in inflammation of vital parts, and the  blood though
 sizy is loose in its  texture.
  Difference from different nerves.—One cause of the difference  in
 the inflammation of vital parts seems to be the different systems  of
nerves by which they are supplied.   In all those parts  supplied by
 the par  vagum, inflammation  affects the patient with  lowness from
the first, these nerves supplying the parts of involuntary motion, and
therefore possessing the living  principle  in  the  highest degree ;
whence  an inflammation of these parts becomes peculiarly depressing.
  Situation of ihe blood in the commencement of diseases.—In some
diseases the blood at first forsakes the skin, extremities, and lips, and 
GENERAL PRINCIPLES OF INFLAMMATION.
161
 the parts shrink and diminish in bulk; this is particularly evident in
 the eye, and arises from want of power in the constitution, all the
 powers being called to  the citadel, or source of power, and the
 outworks left. This happens in fainting, agues, hectic, &c.,and does
 not seem to arise from  debility at first, but from a novelty of action,
 and a consequent  inability to  perform  it.   In putrid  fevers the
 external parts first loose their living power from having a less re-
 sisting power.
   Of the Effects on the Constitution from, different stages of Inflam-
 mation.—The constitutional effects arising from inflammation, inde-
 pendent of  the difference of parts, situation, nerves, &c, are more
 or less according to the stage of the disease.   When inflammation
 is in the adhesive stage, it has but little effect on the whole system,
 and that effect  is  generally an  increase of animal  actions.   This
 stage is the one which  should be considered as truly inflammatory,
 as in it the  constitution  appears to be more regular, more deter-
 mined, and  more  at ease, for it is more  steady, more  capable of
 continuing the time of  action than in any other, hardly  any varie-
 ties taking  place in the time of this stage of  the disease.  When
 the  suppurative stage comes on, the effects on the constitution are
 much more considerable and more various.  Cold fits or rigors are
 generally felt on the commencement of suppuration; but they are
 not  lasting, and are often succeeded by hot fits, both being more or
 less according to the greatness of the present inflammation and the
 suppuration that is likely to follow, as indeed with the nature of the
 parts, and their situation, whether vital or not,  &c.
   Cold fits show plainly the commencement of  some new action,
 as the  beginning of fever, the  absorption of poison, or even from
 simple  irritation, as pricking the finger with a clean needle.   They
 may also be produced by disagreeable sensations and disagreeable
 states of the mind.  These rigors are  probably dependent on the
 stomach, which being the seat of simple animal life and  the seat
 of sympathy, takes part in every constitutional alteration, and we
 observe how much this  viscus is  affected by loss of blood, disa-
 greeable sights, &c.  What nature intends to effect by this sym-
 pathy with  the rest of  the body it is hard to say, but it is worthy
 inquiry whether she may not intend to relieve herself by rousing
 the actions of life  by means of vomiting.  Rigors seem to be the
 effect of any new action  in the constitution,  and not at the com-
 mencement  of a disease only, for even at the close, changing from
 a diseased action to a healthy one will cause  rigors to take place.
 In a strong  constitution, where rigors occur in  consequence of a
 well-formed fever, the consequent actions of a hot fit and sweating
 go on regularly; but in a weak  constitution  there is much loss of
power by each  rigor, and they will not  be  followed by a hot fit,
but only perhaps by a little sweating.
   A boy was attacked  with rigor, followed  by sweating, and he
afterwards  continued getting sensibly  worse and  worse: pulse
quick and full, blood sizy,  tongue  white.  He was worse every
                             14* 
162           HUNTER'S PRINCIPLES OF SURGERY.

other day.   After being ill a fortnight, he was again attacked with
rigor, hot fit,  and  sweating, which,  contrary  to my expectation,
who supposed  these would be repeated, carried off the disease with
that  single fit.   I think I have  seen other cases where Nature  has
attempted something like this, but has failed.
  In many cases the  rigor is  the first apparent symptom, and is
followed by a  hot  fit, and then sweating, and  when these whole
actions of the  disease have  taken place the patient becomes well;
but this is  not the case where,  from weakness, &c, the whole
regular  actions do  not take place, but, as at the commencement of
the boy's case above related, the hot  fit does not succeed the rigor,
and  he  continued  ill  afterwards  until Nature  again took  on  the
rigor, and he was able to go through the stages regularly, and  one
fit carried off  the disease.  The boy above mentioned was also a
striking instance of the crisis of a disease being like its commence-
ment.
  Rigors from a local affection are  seldom followed by a hot  and
sweating stage, and the bark in such cases  can be of little service.
  The ulcerative stage seldom affects the whole system ; but that
rigors take  place on  the commencement of ulceration is, I think,
certain, although it cannot be well perceived in all cases, for  ulcera-
tion  will follow so  close on suppuration in most cases that it  will
be difficult to distinguish which was the  cause of the rigors.   But
when suppuration  has taken place, and the abscess been opened,
(so that the act of suppuration is finished,)  yet not so opened as to
afford a ready outlet to  the  matter, the  pressure of the  matter
against the most depending part of the abscess will cause  ulcera-
tion, and thereby rigors will take place ; but these rigors will not
take place for some time after  the first opening, for the first opening
will  for a time remove  the disposition for  ulceration all over the
surface of the  abscess ;  but when it finds this opening not sufficient
to take  off the pressure, it then sets to work to  make another,  and
the rigors return.   Many have supposed from these rigors that new
matter was forming.
  Exacerbations are  other symptoms, which have a great  affinity
to the foregoing, and  are  common to most constitutional diseases,
and  to some local  ones.   They are repetitions of the  first  attack,
but seldom so  strong as the first.  These have  been supposed to be
owing to the disease acting on the constitution  at stated times ;  but
we  must search for some  principle in the  animal economy to
account for this, for we cannot suppose  an  increase and decrease
in the cause of disease to aceount for it.  Agues exist in the con-
stitution as  much between the fits as in them.   If the constitution
is strong, the exacerbations are regular;  if weak, irregular.  These
may be partly owing to the fact that an animal cannot exist for
long together in the same state; life cannot always be affected in
the same way.
   Of the state of the blood in Inflammation.—It is reasonable to  sup-
pose that the blood is affected  in the  same  manner with the con- 
GENERAL PRINCIPLES OF INFLAMMATION.       163
stitution, and that disease has nearly the same effect  on it that it
has on the body, because the same living principle runs through the
whole.  We find this to be really the case ; for till the disease  has
affected the constitution the blood continues  the same as before;
but as the constitution becomes affected the blood also  becomes
affected, and undergoes changes which are probably owing to con-
tiguous sympathy between the vessels and the blood.  So that we
shall find that the changes in the blood are  often as  expressive of
disease as  in any other part  of the body.   When  the  action of
the solids  is  of  the inflammatory  kind, or  what is perhaps  the
same thing, when there is too great action of the solids, the  blood
under such a disease more readily admits of a separation of its com-
ponent parts (see p. 32, note) ; the red particles subside more to
the bottom of the coagulum, and the  coagulation  of the lymph,
though more slow, is firmer; the upper part of the coagulum being
of an opake white, in which state the blood is said to be  sizy.  It
is not easy to say whether this  change in the blood is not the  first
produced, and that the constitutional is not an effect of the change.
I have before said that I can conceive  the death of the  blood to
take place independently of the solids, and it appears to me that the
diseased state of the blood is capable of coming  on as suddenly as
 the corresponding state of the solids.
   A man received a stab in the abdomen.   I saw him a  little time
 after the accident, when there  was no degree of fever or constitu-
tional affection, but he complained of considerable pain; I therefore
 took away some blood from him, which was entirely in the natural
 state : in about a quarter of an  hour constitutional disturbance came
 on, and the blood appeared very sizy.
    Whether the disposition for inflammation and the change produced
 in the blood arise from a real increase of animal life, or whether it
 is only an increase of the disposition  to act with the power  that
 the machine is already in possession  of, is  not  easily determined:
 but it appears certain that it is either  the one or the other.  How-
 ever, some circumstances incline me to  suspect that it is the last,
 because we often have inflammation when the powers are but weak,
 where there  appears  to be only an exertion of very weak powers,
 arising from some irritation produced.  This appears to  be equally
 the  case  in local  inflammation and inflammatory fever,  or the
 symptomatic fever.   On  the other hand, there are some  reasons
 for thinking it may be a real  increase of animal  life, for women
 who are  breeding, and who  are in perfect  health, have yet sizy
 blood: and this  is the case with all animals in a similar situation.
 Now it would appear necessary for  an animal, when  put into  a
 situation  where  greater  powers are  wanted, that these powers
  should be increased.   In breeding females there is a process going
  on which,  though  natural,  is uncommon,  and which  requires  a
  greater quantity of power than usual; therefore we have  greater
  powers produced. 
164
HUNTER'S PRINCIPLES OF SURGERY.
   If these observations are just, the blood should not be inflamma-
 tory blood, but blood whose powers of life are increased.
   On the other hand, where  there is great debility in  the solids,
 where the powers  of preservation are less, and therefore action
 weak, where the body must therefore have a tendency to dissolution,
 we find the very reverse of the former appearance in the blood; there
 is no distinct separation, but the whole mass continues mixed.  This
 effect takes place in those who die instantaneously, and  I suspect
 that the  blood dies  first, and instantaneously.
   When the pulse is quick and hard, and has a  kind  of  vibratory
 thrill, we generally have  sizy blood.  This  may arise from fever,
 or such inflammation, &c, as affects the constitution or  the vital
 parts, these being diseased, so as to keep up a constitutional irrita-
 tion, which will always be an attending symptom.
   But when we have  neither a quick nor hard pulse, but  rather
 small, no visible fever nor inflammation, but perhaps some strange
 and undetermined  symptom,  such as  pain, which is  moveable,
 sometimes in one place and sometimes in another, yet seeming to
 impede no natural function, we shall nevertheless, on bleeding, find
 the blood sizy, as happened  in a gentleman who had severe pain
 shifting about, with a  small slow pulse :  he was  blooded, and the
 blood found sizy.   After the bleeding the  blood  became fuller and
 harder, and did so after every bleeding, which, on account of this
 circumstance and the continuance of the pains, was repeated several
 times.   Something  like this is observable when an oppressed pulse
 becomes liberated by bleeding ; but what was remarkable  here was
 its increasing in hardness.  We may even have  the blood contract
 so strongly in these cases  as  to  cup.   So that  the pulse and the
 appearance of the blood do not always agree with one another.
   The manner  in which inflammation  begins is  generally from  a
 point.  It afterwards spreads from this in proportion to the violence
 and the disposition of the  surrounding parts.  This is the case in
 accidents ; the accident is limited, but the inflammation arising
 from it is not; it is  most violent in the first point  and gets weaker
 and weaker as it spreads from this until it is lost insensibly in the
 surrounding parts.   This extension is owing to sympathy; and
 hence, according to  the  susceptibility  of sympathy  will be the
 spreading; and from the difference of disposition  to sympathy will
 result great differences as to the diffusion of inflammation ;  the more
 healthy the less the  sympathy.
  Swelling of the parts in inflammation, like the inflammation itself,
 is  greatest in the middle, and gradually  lessens  from that till it is
 lost in the surrounding parts.   It is owing to the extravasation of
coagulable lymph and some serum being squeezed out as the coagu-.
lable lymph thickens, and  is deposited around the inflamed part,,
causing cedema, which is less in proportion as the parts are healthy.
  Of the  colour of inflamed parts.—The colour of an inflamed part
is visibly changed from the natural hue,  whatever it was, to reds
 This red  is of various hues, according to  the nature of the inflam-. 
GENERAL PRINCIPLES OF INFLAMMATION.        165
mation;  if healthy, of a  pure scarlet red;  if less  healthy, the
colour is rather more of a purple, and so on till it shall be of a
bluish purple.
  This  increase of red would  appear to  arise from  two causes;
first, dilatation of the vessels, by which a greater quantity of blood
is sent into those vessels which naturally admit only serum or lymph
(an example of which we have  in the conjunctiva of the eye when
inflamed);  and secondly, the formation of new vessels in the extra-
vasated uniting coagulable lymph.   From which  circumstances
there is a greater quantity of blood in the part than  in a natural
state, according to that law of  the animal economy, that where a
part has more to do than to support itself, red blood is thrown into
it in larger quantities.
  The true inflammatory colour is scarlet, that colour which the
blood has in the arteries ;  hence we should suppose that the arteries
were chiefly dilated, or if the veins are equally distended, that the
blood undergoes no change in such an inflammation in the passage
from the arteries into  the veins, which last I think most probably
the case.
  Heat of the  inflamed part.—The  inflamed  part  is  hotter than
common; but this is most obvious in the skin, from its being a part
most disposed to carry  these sensations to  the brain.  Heat, I
imagine, is a sign of strength and power in the constitution, though
it may often arise  from increased action in weak constitutions or
weakened  parts.  It is  an immediate  action, while  cold  is  the
reverse, and often arises from a diminished action of strong parts.
It  has  not been considered whether an animal has this  power
equally in  every part  of  his body, though from what is  generally
advanced on this subject, it is probable that it  exists in every part.
Nevertheless,  I am inclined  to suspect that there  is a  principal
source  of heat, though I do not think with many that this source
is in the blood, but rather that this is affected  by the source of the
blood being near to the source of heat.
  That this principle resides in the stomach is probable;  at least of
this I am certain, that affections of the stomach will produce either
heat or cold.  Eructations often give  a sensation  of heat,  but
whether this is increased heat, or only a  sensation,  it is difficult to
say.  Certain substances  taken into  the stomach produce a  glow.
Certain affections of the mind  also produce a glow.   This would
appear to contradict  my opinion, but I suspect that the stomach
sympathizes with the mind.
   We find that inflamed  parts become hotter; but let us see how
far the increase goes.  From all  the observations I have made, I
do not find that a local inflammation can produce local heat  above
that which is natural to the  animal; and when in parts  whose
natural heat is inferior to that which is at the source of the circula-
tion, it does not rise so high.  A man had the tunica  vaginalis laid
open for  the  cure  of hydrocele;  I introduced a  thermometer into
the wound, and placed it in contact with the  testicle, and it stood 
166          HUNTER'S PRINCIPLES OF SURGERY.
at 92°;  by night it had risen to 98|°, a rise of 6J°: but this is not
greater  than the heat of the blood at the source of the circulation.
A wound was made in the belly of a dog, and the bulb of the ther-
mometer immediately applied to the diaphragm, which gave 101°,
and did  not increase above that.  Another dog's rectum gave 102°,
and when inflamed very much, which it was by injecting  a solution
of corrosive sublimate, the heat was not increased a degree.  The
rectum  of an  ass, 98°, was  injected with  a strong infusion of
mustard and ginger several times repeated, but without increasing
the heat at  all, nor did a strong solution of corrosive  sublimate
have this effect: at last  a much stronger one was injected,  which
brought on  a  very violent inflammation, but the heat  was only
increased to 100°.  A similar experiment was made with nearly
the same result on the vagina of the same ass.  Also a wound was
made deep in the gluteus muscle of the same ass, and in no stage
of this wound  did it raise the thermometer above 100°.  A wound
was made in the belly of the same ass, and an injection of a strong
solution of common  salt thrown  into the  belly, which  produced
violent inflammation, and even symptomatic fever; yet the heat of
the part was very little altered.  From all which observations and
experiments I do not find that a  local  inflammation  can increase
local heat above the natural heat of the animal;  and when in parts
where the natural heat is inferior to that at the source of the circu-
lation, it doce  not rise  even  so high.  Yet, that in some instances
the heat of the parts may be increased beyond its  natural degree
in those parts which have the greatest natural heat, is certain from
the following experiment; the bulb of the thermometer being held
in the stream flowing from the abdomen of a man tapped for dropsy
raised the mercury to 104°.   In most of the above experiments
there seemed  a difference of 1° between the heat at night  and in
the morning, and this difference seems to exist in the natural state
of the body.
   I suspect that the blood has an ultimate standard of heat in itself
when in health, and that nothing can  increase that heat but some
universal  or constitutional affection, and that the whole power of
local  inflammation is only to  increase it a little in  the part, but
cannot  bring it  above the standard  heat of the constitution, nor
even to it in parts far from the source.
   Of Cold.—The production of  cold certainly is  an  operation
which the more perfect  animals have a power of performing. (See
p. 82, note.)
   I suspect that  coldness in disease arises from weakness of  the
whole constitution, joined with a peculiar mode  of  action  at  the
time.   That universal or constitutional cold arises from the stomach
is evident, for whenever we are made sick universal coldness takes
place.   This is best proved by producing sickness in animals that
we can kill while under the influence of the affection of the stomach.
I threw three grains of  emetic tartar  into the stomach of a bitch,
and repeated the experiment with a grain more: she vomited and 
GENERAL PRINCIPLES OF INFLAMMATION.
strained very hard, and  brought off a good  deal of froth, that is
mucus, from the stomach, mixed with air in coming up.  I opened
her body, and, contrary  to what we generally observe, I found the
intestines, liver, and heart not warm.  I  have  known people who
had affection of the stomach say that they had plainly a feeling of
coldness in  their belly.   I knew a  gentleman who  said, whenever
he threw wind off his stomach it felt cold even  to his hand.
  Affections of the mind also produce general  coldness, but such
effects arise  from  the  sympathy of the  stomach with the  mind,
producing  there such  a sensation  as we mean by the expression
" turning the stomach with sickness:" the  sensation proceeds to
the shoulders, which, with the rest of the body,  are  put into motion
by  wrhat we term shuddering.
   Of Pain in Inflamed  Parts.—The immediate cause of sensation
is an  alteration in the  natural position of the solids, arising either
from  violent action or mechanical or  chemical  effects,* joined
with its being produced  in a given  time; for this alteration  may be
produced so slowly as not to keep pace with sensation, as in many


  * [It must be confessed that we are very much  in the dark respecting the
proximate cause of pain ; for being ignorant of the  ultimate distribution of the
nerves, as well as  of their mode of action, we cannot say in what manner they
may be affected; indeed, we cannot positively  say that pain depends  on the
nerves at all, for those parts which are most painful when inflamed  have the
fewest nerves, and these do not enlarge in consequence of inflammation in the
same manner that the vessels do.
  Pressure is a well-known cause of pain, and therefore has been assigned as the
cause of pain in  inflammation, for not only are the minute vessels distended
from within and pressed upon without, but the natural sensibility of the parts is
exalted by the increased vascularity.  This is further confirmed by the exquisite
pain occasioned by inflammation when it occurs in any unyielding texture, as the
teeth, the bones, the periosteum, the serous and fibrous membranes, &c, as well
as by the relief which is afforded by such  means as tend to diminish the tension
of the inflamed parts,  as bleeding, scarifications,  fomentations, &c.   It may,
however, be urged on the other side, that  the pain  is not proportioned to the
quantity of nerves, as in fibrous membranes, bone, teeth, &c; nor to the quantity
of effusion and consequent swelling, as in serous membranes ; nor to the quantity
 of  inflammation present, as in gout, rheumatism, &c: that the difference in the
quality of the pain is inconsistent with any mechanical explanation, which would
 occasion differences in degree but not in kind ; that it is irreconcileable with the
 sudden transition of pain from one part to another, as in metastasis ; that chemical
 substances cannot be supposed to act in this way ;  and finally, that pain often
 occurs without its being possible to assign any probable source of pressure as a
 cause, as in colic, tic-douloureux, tooth-ache, and many  other forms of nervous
 disorders.
   It seems, therefore, most  probable that pain depends on some peculiar action
 of the nerves with which we are unacquainted, but to which  pressure  stands in
 the relation of an exciting cause.
   Pain is the most general symptom of inflammation.  What other purpose does
 it answer besides that of inducing the patient to repose the inflamed parti Does
 it answer any direct purpose in the economy ? Intense pain occasions increased
 vascularity  of the affected part, and if continued, excites inflammation.   This  is
 seen in tooth-ache and tic-douloureux, which inflame the face, and in  disease  of
 the hip, which occasions inflammation of the knee ; on the other hand, whatever
 diminishes the pain diminishes the inflammation also.] 
168
HUNTER'S PRINCIPLES OF SURGERY.
indolent  tumours; or,  on the other  hand, this alteration  in  the
natural position of the parts may be so quick as to exceed sensation.
(See p. 56.)
  Pain is not the same in all the  stages of inflammation.  In the
adhesive stage it is  generally but inconsiderable, especially if it is
to go no further, and is perhaps  more a heavy than an acute pain.
But when  the inflammation is  passing from the  adhesive to  the
suppurative, the parts  are  undergoing greater change, and  the
pain gets more  and more acute  until  it becomes very considerable
and becomes pulsatory, being increased during the dilatation of the
arteries.   The  nerves, too, acquire a  degree of irritability which
renders them much more susceptible of impression than in a natural
state.  When suppuration has taken place, the pain in some degree
subsides; however, as ulceration begins, it in some degree keeps up
the pain, and this more or less according to the quickness of the
ulceration.  The pain  attending ulceration gives more the feeling
of soreness.
  Of the Subsidence of Inflammation.—Whatever  disposition it is
which produces inflammation, and whatever the actions  are which
are produced by this disposition, yet when  the disposition arises
either from the constitution or part, it  can be removed, and of
course the actions raised in consequence of it cease.
  If the disposition for inflammation has taken place, and the vessels,
which are  the active parts, should have dilated thoroughly, they will
allow the blood to enter them, so that the part shall look red; but no
hardness or fulness shall be observed, and the whole will subside
before adhesions have taken  place: or if  inflammation  is gone so
far as to produce swelling, which is the adhesive state of the disease,
yet by certain methods it can be assuaged, and suppuration be pre-
vented from taking place, and then the parts will fall back into their
natural state, which is called resolution.  And as the first symptom
of inflammation is  pain, the first symptom of resolution  is  the
cessation of pain.
  Why an inflammation of any kind  should  cease after it is once
begun is very difficult to explain, or even to form an idea of, unless
it is on the principle of what I call custom that the parts adapt them-
selves in time to their present situation ; and therefore, in order to
keep up inflammation, it is necessary that the cause should increase
in proportion as the parts become reconciled to their present circum-
stances.   But this  will not  account  for  their returning to their
original state when this increased irritation ceases.  We may sup-
pose that the removal of the original  cause is sufficient to stop the
progress of inflammation; and when stopped, the parts  cannot
easily remain in the inflamed state, but by their own efforts begin to
restore themselves to health, like a spring which is bent by a weight,
but the moment the weight is removed the spring returns to its former
state.
  Restoration of injured parts.—All alterations in the animal frame
arise from a disposition to act,  and these  preternatural actions, in
consequence of injuries, may be caused,—1st, by a disposition to 
GENERAL PRINCIPLES OF INFLAMMATION.
169
restoration, in consequence of injuries, which is the most simple ; 2d,
by a disposition of necessity, as thickening of parts,  ulceration, &c.'
which is  rather  more compounded: 3d, by disease,  which is the
most complicated (p. 97.)   There are a great many  cases requiring
the assistance of a surgeon  but  which  cannot be strictly called
disease,  but are injuries  done to  the  body.    In  disease  there
is a disposition to wrong action, which goes on until the disposition
is worn out, or is put a stop to by remedies ; but the actions in con-
sequence of accident are widely different, for here, by reason of the
stimulus of imperfection in the injured part, a disposition to restora-
tion is excited, and action, different from the former comes on.   In
disease the restoration to  health is produced by a prevention of the
continuance of diseased action ; in injuries, or alteration of structure
by violence,  something is  required different from the ordinary and
natural actions, which will differ in some respects according to the
nature of the violence and of the part;  and this alteration  is of the
most simple nature, being  the action  in consequence of a disposition
to restoration, and consequently if it requires any  assistance from
art, it is of the most  simple kind.  The affections  from accidents
may be divided  into two  kinds, those which take  place in  sound
parts, and those  in parts  before  diseased.  The first I shall only
treat of now.  Accidents, then, may be divided into two kinds ; first,
those which do not communicate  externally, as  bruises, sprains, rup-
tured tendons, simple fractures, ccc.; secondly, those which have
also an external  communication, as compound fractures,  wounds,
&c.;  yet these may be, and often are, brought under the first head.
Bruises, which have  destroyed the life of a part, might  be con-
sidered as forming  a third head.   The first class, when in  a simple
state, requires a most simple treatment; but they may be  so com-
plicated as to require our  utmost exertion.  The most simple of these
is the bruise, when the continuity of parts is not broken through;
here the parts have nothing to do  but  recover themselves.  The
rupture of a small vessel  is next, the blood being effused  into the
cellular membrane ; but the vessel must not be in a part of any con-
sequence to life, or the extravasation may kill, as in the arteries of
the brain.   The  cure  in  this case will be  next  in  simplicity, the
vessel being  closed by the contraction  of  its muscular coats,  and
the union effected by means of coagulable lymph, and the  extrava-
sated blood  being taken up by the absorbents.   The differences in
these cases wiir arise from  the  magnitude of the injury  and the
nature  of the injured parts.  Some  accidents of the first  class, as
fractures, will require the aid of a  surgeon to restore the  parts to
their  natural situation, and then nature falls to work and completes
the business.  Sometimes the quantity of blood  extravasated is so
large  as to  prevent  nature from going through  these processes
directly, and forms a tumour called an  ecchymosis.  Ecchymosis
may be said to be of two kinds ; one is where the blood coagulates;
the other where  it does not.   That  which  coagulates commonly
subsides gradually, from  the blood being absorbed, and gives but 
170
HUNTER'S PRINCIPLES OF SURGERY.
little trouble, which is likewise the case sometimes with those in which
the blood does not coagulate, though not generally. I have seen where
a small wound has led to the cavity containing the coagulum, which
not being meddled with, the sides of the cavity have gradually con-
tracted, and have as gradually squeezed out the coagulum.
  A woman fell with the labium pudendi on the edge of a pail.   I
found a very  considerable tumour, which I thought was of blood ;
there was evidently a fluctuation.   I bled her, and ordered a poul-
tice, but did not open  it, as I thought the presence  of the extrava-
sated blood might serve to stop the orifice of the vessel.  In a little
time the tumour burst,  with a small opening, and on examining with
a probe I found  the coagulum filling a  space the size of a goose's
egg.  The cavity grew less  and less, but always kept exactly filled
with coagulated blood ; and thus it continued diminishing  until the
orifice healed.  Thus the blood being allowed to remain in the cavity,
and not acting there as an extraneous body, nor even allowing the
stimulus of an imperfect cavity or  inflamed surface to take place,
the cavity continued to contract all round the blood until the  whole
had disappeared.  Now what would have been the consequence if
I had followed the old method of laying open the tumour, scooping
out the blood and dressing the internal surface with turpentine 1  I
should have had a sore of the whole extent of the tumour, and given
considerably more trouble both to the patient and  to myself.
   The  second species  of ecchymosis, or that where the blood does
not coagulate, does not always terminate so well as  the former.
 It has often the appearance of an encysted tumour, but from being
 the immediate consequence  of some accident to the part its  nature
 is understood.   The cause of this blood  not coagulating must arise,
 1 conceive, from some peculiar mode of action of the vessels arising
 from the injury, for I apprehend that in such cases the blood dies
 as it is extravasated, or in the act of extravasation, like the menses.
 This species of ecchymosis happens very commonly to children in
birth under  the  scalp.   In such cases nothing should  be done but
 to wait with patience, and the whole  will be absorbed.  In many
 cases  the  accident has been so violent  as to deaden  the cellular
 membrane under the  skin,  or as to produce inflammation  in  the
 surrounding parts; these sometimes resolve, but they are seldom
 allowed to do so ; for  surgeons  are led to open them  early, from
 seeing  the inflammation and feeling fluctuation, two strong entice-
 ments to use  the lancet when  all circumstances  are not  well  at-
 tended to.  But in such cases I should wait until I saw the signs of
 suppuration, viz., thinning of the skin over the matter and pointing
 of the contents, which are the only true marks of the formation of
 matter and of its approaching the skin.
    Sometimes ecchymoses are removed  by pressure, which without
 this would remain.  Parts cannot bear pressure, so that the extra-
 vasated blood being  pressed  against the sides of the cavity,  the
 absorbent vessels are under the necessityof absorbing it.
    When  ecchymoses  are not absorbed,  but suppurate, abscesses
 are formed,  which must be treated as  abscesses in common, only 
GENERAL PRINCIPLES OF INFLAMMATION.
171
waiting with a little more patience than when wholly the  conse-
quence of inflammation.  In  many of those cases of accident not
only the  skin shall be  deadened, in consequence of which it will
slough and leave a sore, but often the skin  shall preserve its living
powers, and only the cellular  membrane underneath shall be dead-
ened  and slough,  and produce  an abscess, which was not at first
expected.  In cases where the skin in one part is killed by a blow,
and the cellular membrane in another part, while the skin  over it
will remain sound, the deadened skin will come off, granulate, and
heal kindly ; but  then  inflammation shall take place, perhaps, an
inch or two from it, where  the  cellular  membrane was  deadened,
and an abscess shall be produced.
  If these  injuries are not very great, little effect will be produced
on the sensitive principle, no sympathy or irritation taking  place ;
but sometimes the accident will, by its irritation, produce  another
action of the parts, causing inflammation, the end of which is either
adhesion of the divided parts  or suppuration  for getting rid of the
substances become extraneous.   The most simple accident may be
attended with such circumstances as will prevent the more simple
process of nature  from taking place; such,  for instance, as the
magnitude of the  vessel ruptured, or a fractured  rib wounding the
lungs, &c.
  The second division I made  was where wounds communicate exter-
nally.—These are subject to greater variety than the former, yet
often admit of the same  mode  of cure.  A wound may be either
simple or compound.  The simple, which is what I  mean to speak
of now, is a solution of continuity in a part, which must be made
with a cutting instrument.  In  such cases a number of vessels are
always divided, blood is effused, and the cells of the cellular mem-
brane exposed, as well as other internal parts.  The  former class
required  only rest, but in these there is a  necessity for replacing
the divided  parts.  The present class admit of both a natural and
an artificial cure.   By the natural is meant union by the  first inten-
tion ; when this  cannot be obtained, a new  bond  of union takes
place—adhesive inflammation ;* and if this is lost, a third  mode—
granulation.   In that by art we have to imitate the  natural, we are
to bring  the divided surfaces into contact;  the living  extravasated
blood being then retained and coagulating, unites them ; the mouths
of the  vessels shut, and  the remaining blood  is absorbed:  the red
globules  are  indeed  absorbed, and  only the coagulable lymph
remaining  becomes the bond of union.t  This  is  an imitation of
  *  [Union by the first intention and adhesive inflammation are in the present
day generally considered to be synonymous.]
  f [It has been before observed that the blood does not become vascular, but
only the coagulable lymph which is  subsequently effused.  The blood at first
serves the  useful purpose of uniting  the divided parts ; but beyond this it unques-
tionably is an impediment to union  by the first intention.  Wherever, therefore,
union by the first intention is desired, the incised surfaces should first be cleansed
of adhering blood previously to their  being put into apposition.  This rule of
practice is universal.] 
172
HUNTER'S PRINCIPLES OF SURGERY.
nature ; but  surfaces cannot always be brought to unite  in this
manner, and  the blood in some parts  loses  its living principle, and
then it becomes a source of irritation, exciting inflammation, which
is the case sometimes in simple fractures, and which I shall call,
for distinction's sake, simple compound fractures.
  The best time of replacing the divided  parts is perhaps  during
the time that the extravasation continues,  but it may also be done
when the  discharge of coagulable lymph  in the adhesive or first
stage of inflammation takes place.  Sometimes the inflammation
runs so high as to get into the suppurative stage; the extravasated
fluids may lose their living principle, and become a stimulus exciting
inflammation.
  By adhesive inflammation different parts of the body may  be
united to  another by coming into contact; but the most extraordi-
nary union is that of removing  parts from one body and  uniting
them  to another.  Here is  the testicle of a cock, separated from
that animal, and put through a wound made for that purpose, into
the belly of a hen; which mode of turning hens into cocks is much
such an improvement for its utility as that  of Dean  Swift when he
proposed to obtain a breed of sheep  without wool.  The hen was
afterwards killed, and the testicle was found adhering to the intes-
tines, as may be seen in this preparation, where the  parts are pre-
served. Here is  another preparation, in which the spur of  a cock
has been  inserted into  the comb of another;  and  here a  human
tooth, inserted into the same part, and united by means of vessels,
which you see injected, from one to the other.   These living bodies
thus applied to each other produce adhesive, not suppurative  inflam-
mation.  In the  same manner, the eggs of one animal laid in the
flesh  of  another do  not excite suppurative inflammation.  This
would not be the case if the inserted  body did not contain the prin-
ciple of life, for the part would run into suppurative inflammation,
as would be the case with a  pea so introduced.  While  the guinea-
worm is endowed with  the  living principle it gives  but little trou-
ble; yet if killed  it gives the  stimulus  of an extraneous body, which
produces suppuration through its whole length.
  In this preparation you see a maggot  deposited,  just below  the
skin, on the back of a reindeer: here the  first stage of inflamma-
mation took place only; coagulable lymph was poured out, which
has formed a  chamber in which the insect resided. A similar power
is observable  in vegetables.  Here is an oak leaf, which I  picked
up in my garden; you observe on it seven or eight protuberances,
exactly circular and uniform.  These have been formed by  the in-
sertion of  the eggs of an insect into the  leaf; and I  cannot  but
think the process would have been different  if any substance not pos-
sessed  of the  vital principle had been inserted.   It is on this  princi-
ple  of  union by the  first intention that the union of parts by suture
has been recommended, which has  been  found the best practice
where it  can be done.  The dry suture in  superficial wounds
answer very well, the quilled is  sometimes useful,  and the inter- 
OF ADHESIVE INFLAMMATION.
173
rupted  is very often  useful.  The  two  last are properly  called
sutures.   In many cases it is improper to keep the surfaces together,
as when the wound has been attended with considerable contusion,
which generally occasions  sloughing of the parts.  When much
blood is extravasated, suppuration becomes  necessary,  in  conse-
quence  of the blood acting like any other extraneous body; but
when laceration only is present, union by the first intention may
take place, especially when  on the head and  over other superficial
bones, as Mr. Cline has  observed.  The machine is not  at all dis-
turbed by this most simple operation; there being perhaps even no
local action except the  contraction of the vessels, the  union being
performed by the blood only.
                       CHAPTER XIII.

                   OF ADHESIVE INFLAMMATION.

Natural tendency of inflammation.—Definition of inflammation.—-Seat of inflam-
  mation.—Adhesive inflammation ;—why limited, and  how ;—its tendency ;—
  arisino- more easily in some parts than others;—lymph affected by the state of
  the parts secreting it;—appearances of inflammation ;—redness ;—swelling;—
  pain.—Adhesive inflammation;  its  use, in  large cavities;—in the cellular
  membrane;—in the  lungs ;—compared with erysipelatous inflammation ;—
  sometimes  imperfect;—consequences  of this  imperfection ;—constitutional
  effects of this inflammation.—Of resolution ;—cases  in which it is supposed
  to be improper;—modes of by constitutional  means;—by  weakening;—
  by temporary  weakness ;—by lessening irritability.—Venesection ;—medi-
  cines ;—local applications.—Treatment of adhesive when about to end in sup-
  purative inflammation.

Although inflammation is an action produced for the restoration of
the most simple  injury in  sound parts that exceeds union by the
first intention, we must still look upon it as one of the most simple
operations of nature.  It is to be  considered  only as a disturbed
state of  parts, which require a  new but salutary  mode of action to
restore parts to that state in which  the natural mode of action will
be necessary.  But this same operation can and does vary, and is
often carried much further than union,  according to circumstances:
and is often  attended with disease, and  that of various kinds, by
which means  it becomes more and  more complicated.  It becomes
therefore necessary to begin by  describing it in its most simple
form, and with its most general effect,  and to  particularize further
as we go on.
   I shall call  everything inflammation that produces the following
local effects, viz., pain, swelling, and redness, all  depending on one
cause, and occurring at the  same time.  Out of inflammation arise
many other local effects, which may be called secondary; such as
                               15* 
174
HUNTER'S PRINCIPLES OF SURGERY.
adhesions, suppuration, ulceration, and even death or mortification
in the part, and universal affection, such as sympathetic fever, and
universal death.
  The act of inflammation is, as I have said, most probably in the
smaller vessels.  What the action is, or in what it  differs from the
common action of these vessels, is not easily ascertained; for we are
better able to judge of the immediate effects than of the immediate
cause.
  Hitherto I have only shown that this inflammation takes its rise,
and  is capable of uniting parts,  when preternaturally divided, but
we shall find that it is capable of arising from very different causes,
and  that it is capable of producing adhesions in whole parts, or in
natural separations,  such as common cellular membrane, large
circumscribed cavities, joints, &c, and these effects will be found to
answer very important purposes.
  As the adhesive inflammation precedes the suppurative in every
part excepting the  outlets, and the suppurative the ulcerative, the
propriety of following this order of nature in treating of them will
appear evident.

  Adhesive Inflammation.—If the actions of adhesive inflammation
were allowed to extend  themselves,  ft would prove more hurtful
than any good  that  could arise from it; hence there are natural
obstructions to its extending,  which we shall first consider.
  JVatural Causes of the limiting of Adhesive  Inflammation.—I have
already observed  that exposure of internal  surfaces becomes the
immediate cause of inflammation; that when it extends further than
the exposed surface it is by continuous sympathy ;  and that when a
whole cavity is wholly exposed, the whole would take on inflamma-
tion. We may now observe,  that whenever a cavity is  opened,
the simple contact of its  sides, or even the simple con-tact of these
with any other living part, will set bounds to  the immediate cause,
which is the exposure.
  To explain this further, we  may observe that there is no such
thing in an animal as an  empty space  in any of the circumscribed
cavities of the animal body, exclusive of the outlets or reservoirs,
which are imperfect, not being circumscribed.  Every other part
of  an animal is  either connected by the cohesion of one part with
another, or by simple contact.  This holds good too in the  cellular
membrane as well as the circumscribed cavities: for if a wound is
made into either, we find that the surfaces of both, beyond  the cut
edges, are entire, and generally in contact with one another.
  To explain this position, let me instance a  case.  If wc  make a
wound into the cavity of  the belly, in a  sound state of those parts
we shall find every viscus is in contact with some other viscus, and
that the whole inside of the peritoneum is in contact with the viscera
so that no space is unfilled.   If this wound is not allowed to heal by
the  first intention, still we find that no inflammation will take place,
or  extend further than the  attachment  of those parts to  the cut 
OF ADHESIVE INFLAMMATION.
175
edges, excepting what is owing to continuous  sympathy.  If this
were not the case, every part of the cavity must inflame, because
every part  would be  equally exposed;  and if the  contact were
removed at  the time of receiving the wound, or at any time after-
wards, the whole cavity must inflame, every part being in the same
predicament as regards exposure.
  The same thing would happen in the cellular membrane, if those
cells were not in a natural state in contact, and inflammation would
as readily extend over the surface  of each  cell as air does when
blown into part.
  Inflammation, then, takes place at the edges of the  exposed parts
in order to preserve this contact, as  well as to serve  as a basis for
future operations:  and in cases of spontaneous inflammation of cir-
cumscribed  cavities, we  find that where this contact is completest
the inflammation and its consequences are the least; as in the belly,
in cases of  peritoneal inflammation, the  inflammation is greatest
in the angles between the viscera, where the parts are not so well in
contact.
  The effect of simple contact, in  excluding  the irritation  from
extending, was well illustrated in a  woman who had the  Caesarian
operation performed.  After the child was  extracted, the wound
could not be brought together well, therefore so far gave rise to
peritoneal inflammation; but the belly closing and falling in on its
contents,  the whole came in  contact as before.  The woman  lived
twenty-six hours, which gave time for the inflammation to take place.
After death  it was found that the intestines were united to the  peri-
toneum all round the  wound, for above half an inch in breadth, and
the surface  of the intestines, which lay unattached at the bottom of
the wound, was inflamed, while every  other  viscus, as also the
peritoneum  beyond the adhesions, were free from inflammation.
  The adhesive inflammation seems to be nearly of the same nature,
whether it arises from the constitution, from a particular disposition
of the part, or from some violence inflicted on the part; the  final
intention being  nearly the same in all these cases, for  in all it is an
effect that has a tendency to repair an injury, as is evidently shown
in many cases of violence,  though it may not in all.   Its  utility is
most  obvious in those  cases  which arise from  the constitution, or
from  disease in a  part.  When the adhesive inflammation arises
from  the  constitution, it  may be from some disease of that  con-
stitution ;  and,  if so, it may be supposed to be  of  service to it,
especially if it should be supposed to be the termination of an  uni-
versal irritation in a  local one, and by  that means relieving the
constitution  of the former, as  in gout.   But where it is only a simple
adhesive inflammation, I am rather apt to think that it  is more a part
of the disease than an act of the constitution, or termination of the
disease.   When it proceeds from a disposition in a part, it must be
considered to arise from a disease of that part.
  Although  in all cases and in all parts the adhesive inflammation is
not absolutely necessary and preparatory for the suppurative inflam- 
176
HUNTER'S PRINCIPLES OF SURGERY.
mation, yet if it is in the cellular membraneor a circumscribed cavity,
then its effects will prove salutary.  It  may  indeed  be considered
absolutely necessary  to  prevent  greater mischiefs, for very bad
consequences wouldarise without it.  The object of it in these parts
is to unite the parts together for their future benefit by  means of the
coagulable lymph and serum thrown out, by which the  extension of
the suppuration will be limited.
  It would appear from observation that some surfaces of the body
have a much stronger disposition to  throw out coagulable lymph
than others; or we may view this effect in another light, that some
surfaces of the body  do  not so readily unite by exudation of the
coagulable lymph as others do, and therefore on such surfaces there
is  commonly a  much larger quantity  thrown  out  than probably
would have been if union would have readily taken place.  Thus
we see in inflammations of the heart that the coagulable lymph is
thrown out on the external surface in vast quantities, while at the
same time the  heart  shall  not adhere  to the pericardium.   This
extravasated matter is always of the same nature with that of the
parts which produced it, which is a curious fact.  If the disposition
of the part is cancerous, the extravasated coagulable lymph is  a
poison, for on being absorbed it contaminates the absorbent glands,
producing cancer; and probably the same takes place  in  every
poison that  is  capable of irritating to  inflammation and  extra-
vasation.
  Appearances of Adhesive Inflammation.—The part  inflamed be-
comes redder than common, and redder and redder  as it advances;
the red being of a scarlet hue when the inflammation is healthy. The
part becomes apparently  more vascular than in a natural state, and
most probably is really so, both from new vessels being set  up in the
old parts, and from  the  adventitious uniting substance becoming
vascular.  These new vessels  become  of use both  in  the  state of
adhesion and of suppuration; in the first to give powers of action to
this new substance which assist  in preventing  suppuration, in the
second to form a basis for the future granulations.  In  consequence
of this extravasation the  parts swell, which is generally in pro-
portion to the inflammation, the swelling being probably most where
the inflammation  is greatest, that is, at the point of irritation, and
it is gradually lost in  the surrounding parts.   The whole  swelling
appears like a part of the body a  little changed, without containing
any  extraneous matter,  and indeed  is simply  formed by extra-
vasation of fluids, without  their having  undergone any   material
visible change.
  Such inflammations as approach to the  skin often produce vesica-
tions, which are filled with serum and often coagulable  lymph, both
which are sometimes  tinged with  red blood.  This arises from the
violence  of the inflammation producing  an apparent degree  of
weakness, approaching to a death, in the connexions  between the
cuticle and cutis, the  life being in this part very weak, for  in the
beginning of mortification and of the putrefaction of dead bodies it 
OF ADHESIVE INFLAMMATION.
177
is produced.  This connexion of  the  cuticle is  more or less des-
troyed in every  inflammation of the skin.  We seldom see  an
inflammation attack the skin but the cuticle comes  off  sooner or
later.   We generally observe it peeling off in  flakes  after the in-
flammation has subsided.
   The pain attending inflammation would  not appear to be in all
cases  very acute, for many have  very visible inflammations which
do not give very much pain.   However, this will vary  according
to the  violence of the  inflammation,  or rather according to the
quickness of its progress and its approach to suppuration; for when
there is a  quick dilatation of the  vessels, and rapid  extravasation
of the juices, the sensations arising from such will  be increased ;
but in cases where its progress is slow,  as  from indolent tumours,
the mind  is hardly sensible of its progress.  That it must sometimes
be very trifling is shown by the fact that on opening dead bodies
we often  find strong adhesions where the friends of these persons
had never heard during life of a  single complaint.  We also see
cases  in which this inflammation arises from violence, where it
gives  very little pain.  A  man shall be shot through the abdomen,
and, if none of the contained parts are materially hurt, the adhesive
inflammation shall take place in all the internal parts contiguous to
the wound, yet no degree of pain is felt from this process.   In many
bruises and in simple fractures  the pain from  the inflammation is
very trifling, although there may be much laceration of the parts.*
   Of  the  Uses of Adhesive Inflammation.—This inflammation may
be said to arise in  all  cases from  a state of the parts which they
cannot remain in; therefore an  irritation of  imperfection  takes
place.  It may be looked  on as the effect of wise counsels proceed-
ing from  a consciousness  of imperfection:  nature is taking all the
defensive precautions possible, for in  all cases we shall evidently
see  it  answer  wise purposes, such as checking  the suppurative
inflammation, by  making  parts  adhere which must  otherwise fall
into that state; and where  this  effect does not  fully take place, it
acts as a check to the extent of it, as we see in circumscribed cavities.
In the tunica vaginalis,  after the operation  for hydrocele, the parts
often collapse and unite to other parts of the same sac by adhesive
inflammation, which prevents the  suppuration  extending over  the

  * [Redness, heat, pain, and swelling may each of them exist independently of
inflammation ;  and when they  arise from inflammation, they may exist in every
possible relative proportion among themselves.  In judging,  therefore, of the
presence or degree of inflammation, it is necessary to look at  the whole symp-
toms collectively.  The redness and heat are generally in proportion to the origi-
nal vascularity of the part conjoined with the momentum of the circulation ; the
pain is greater in proportion to the denseness and inextensibility of the inflamed
part, added to the acuteness of the attack and the quantity of nervous supply;
the swelling is generally greatest where the reverse of these circumstances ex-
ists.   Structure, however,  is not the only circumstance whieh modifies these
symptoms ; they depend greatly on the specific nature of the inflammation': the
sting of a wasp produces infinitely more  pain and swelling than an attack of ery-
sipelas.] 
178           HUNTER'S PRINCIPLES OF SURGERY.
sac, so that partial collections of water again take place.*  In still
larger cavities, as the abdomen, where partial inflammations often
take place, as after child-bearing or wounds of this cavity, we find
this adhesion takes place, which either prevents suppuration altogether
or unites the parts around it, and as the abscess enlarges the ad-
hesive inflammation spreads, and thus excludes the general cavity.
The same thing happens  in  inflammation of the pleura or surface
of the lung.   The cellular membrane everywhere  in  the  body is
united exactly in the  same manner; the sides of the cells, as it were,
sweat out the uniting matter, which, coming into contact with the
opposite surfaces, joins them into one mass.
  The lungs  are subject  to two  modes of action in inflammation;
being so  circumstanced as to partake  of the character  of both
orders of parts, the circumscribed cavity, and the secreting surface
or outlet.  The cellular  membrane of the  lungs readily admits of
adhesive inflammation, like  the cellular  tissue elsewhere; but the
inner surface of the air-cells, like the urethra, passes directly into
the suppurative inflammation, and the matter which is thus formed
is obliged to  be coughed up.  It is, perhaps, impossible to produce
inflammation of the  one  without  the  other, which is, perhaps, the
reason why  inflammation of these  parts  is treated with  such bad
success.
  We cannot give a better illustration of the  use of the  adhesions
arising in consequence of this inflammation than to contrast it with
the erysipelatous.  How far this disease is to be ranked amongst
inflammations I  will not at present say;  but it has some of the
characters,  as swelling,  redness, pain, &c.   The swelling arises,
not from extravasation of coagulable lymph, but from  serum: and
it has other peculiarities, as being generally superficial, and spread-
ing along the surface with an abrupt edge, which is, perhaps, owing
to its specific character being always confined to the part affected.
It has nothing of the adhesive character attending it which was not
necessary; because  this  inflammation, being confined  to the skin,
seldom produces  suppuration.   But it sometimes happens,  when
erysipelatous inflammation attacks deeper-seated parts, that it sup-
purates ; and when it does so, it appears often  to be a forerunner
of mortification.
   A  man was attacked  with an inflammation on each side of the
anus.  It had such  an appearance as might  have  been expected
from the suppurative and erysipelatous inflammations joined ; it had
an oedematous appearance.   He was bled, and the blood appeared
very  sizy: he took physic, and was fomented.  The next  day the
inflammation had reached the scrotum, where a fluctuation, with a
gurgling of air, was  felt.   I now made an opening near the rectum,
and in the scrotum, and let out a quantity of dirty-coloured matter.
It continued to spread over the loins, scrotum, bottom of the abdo-

  * [The old operation is here referred to, in which the tunica vaginalis was ex-
posed by incision, and suffered to suppurate.] 
OF ADHESIVE INFLAMMATION.
179
men, &c, where I made openings, and out of which the cellular
membrane hung like wet tow.   In this  case, the suppuration was
diffused for want of the adhesive process preceding or accompany-
ing it, by which means it would have been limited.
  Adhesive Inflammation sometimes imperfect.—Sometimes it hap-
pens that the adhesive inflammation is so  imperfect that it cannot
set bounds to itself, and  still less to the suppurative.  This may be
owing  to two  causes; first, the violence of the inflammation  and
quickness with which  suppuration  ensues,  that  is, before the parts
have sufficiently united; secondly, the inflammation may be, as I
suspect it is, of the erysipelatous kind, especially when there  is a
tendency from the beginning to mortification.   This mixture of the
suppurative with the  adhesive, or hurrying on of the suppurative, I
have often seen in the abdomen of women who  have been attacked
with peritoneal inflammation  after child-birth; and when these cir-
cumstances become the  cause of death, we find matter mixed with
coagulable lymph, as if  formed together.
  The adhesive inflammation also  takes place in cases where  it is
impossible it should produce  the same good effects; as in wounds
which are not allowed to heal by the first intention, as a stump after
amputation, and many other parts.  But it is one of those fixed and
invariable principles of the  animal  machine, that, on all such irrita-
tions, the uniting process should be produced, although,  like many
other principles in the same machine, it cannot  always produce the
same salutary effects.   So that although the wound is not allowed
to, or cannot, heal  by the adhesive inflammation, yet the parts go
through the common actions consequent upon being wounded; first,
they throw out blood, as if to unite the parts by the first intention;
and then, the vessels contracting themselves, coagulable lymph, with
serum, is thrown out, which has the effect, even in such wounds, of
preventing  a great extension of the inflammation, while the  con-
traction of the vessels prevents the  inflammation from running along
their inner surfaces.*
  Effects of  Adhesive  Inflammation  on  the Constitution.—These
effects are very slight, even when the inflammation arises from vio-
lence ;  but the effects of those inflammations which are indolent in
their progress are still more trifling in the constitution.   This arises
from the slowness of the  alteration  produced in the part,  as it
were, insensibly stealing on the constitution.
   We know that one effect of adhesive inflammation is the uniting
of  parts not intended by nature to be united, and which must thus

  * [One of the most remarkable good effects of the adhesive inflammation con-
 sists in the gluing of parts together previously to the discharge of hurtful matters
from the body, as gall-stones, fasces, urine, &c, which are frequently discharged
 in this way;  the ulcerative  and adhesive processes proceeding pari passu to
effect the discharge, at the same time that the latter always keeps a little ahead
of the former.   If it were not for this beautiful provision of Nature, the great
cavities of the body would frequently be exposed to fatal inflammation from such
causes.] 
180           HUNTER'S PRINCIPLES OF SyRGERY.

be made less moveable on one another: in fact, they must at first
have little or no motion on one another, as  occurs in the cellular
membrane and circumscribed cavities: but it happens that motion
is again obtained after a time by the elongation of the connecting
part, which is  effected by the repeated endeavours for motion.
These uniting media are seen to become vascular.   They are per-
haps often the cause of many indescribable sensations, which cannot
be called pain.   In  the heart they are the cause of palpitation, &c.
  On the Resolution of Inflammation.—Since an animal body can be
made to act improperly by impression, we can see no reason why,
when acting improperly according to  such  impressions, it should
not be made to act properly by the same mode, namely,  by impres-
sion.
  The cure of inflammation  is resolution, and an attempt towards
it, when  in  the  adhesive state (for this is intended to prevent sup-
puration taking place), must  be in general made only under the
following circumstances, namely, when inflammation arises consti-
tutionally, or from disease of the part.  In cases of accident where
there is  no exposure, as also where  there is, but that exposure  is
removed in time by bringing the parts into contact, and where the
life of the parts has not been destroyed, in  all such  cases we find
that resolution will readily take place.
  It is commonly supposed that there are a great  many local in-
flammations which should not be  resolved.   An  inflammation
arising from a preceding indisposition in the constitution, commonly
called critical, has  always been classed amongst  those which are
not to be resolved ; it has  been insisted on  that the inflammation
should rather be encouraged, and suppuration produced.  But in
such treatment it  is always  under the idea that the inflammation
is in such parts as will readily admit of cure when suppuration  takes
place; for if the disease is otherwise situated, the cure of the con-
stitution by suppuration will be a mode of cure which  will reflect back
another  disease on the constitution, under which it. will sink; there-
fore resolution  in such situations should, if possible, be  brought
about.   Many deep-seated  inflammations, if allowed to  suppurate,
will, of themselves, most certainly kill: gout also, in the head or
stomach, should always be resolved, and left to settle in some other
part less connected with life.  If inflammation is really a concentra-
tion of the constitutional complaint,  and if, by not allowing  it to
rest there, the  same disposition would really be diffused over the
whole animal again, and would be liable to affect some other  more
important part, it would certainly be  better  to  encourage it when
in a proper part.  Still  it  does not appear necessary that it should
suppurate, for suppuration is  only a consequence of inflammation;
not an immediate effect of the original constitutional disease,  but a
secondary one.   As suppuration, therefore, is  only a  thing super-
added, and as we shall generally find that inflammation subsides as
suppuration comes  on, I see  no reason why inflammation should
not in the present case as well subside by resolution as by suppura- 
OF ADHESIVE INFLAMMATION.
181
tion.   It may, however, be supposed, that as this suppuration is not
a natural or immediate effect of the disease, yet as it is a continued
local action, that it is capable of diverting the disease to the part.
I hardly know an instance where inflammation from violence  may
not with propriety be resolved, and prevented from going into  sup-
puration, except where  it relieves the  constitution from any prior
disease.   Thus, Mr. Foote was cured of a violent pain in his head
by amputation of his leg;  but he afterwards  died  with  a different
complaint in his head.  Might not the first diseased action in the head
be altered in this case, and an  action of a different kind induced,
which proceeded to the degree of effecting his death 1
  Of the Resolution of Inflammation by Constitutional  means.—If
the inflammation is of the true adhesive kind, the only thing to be
done is  to  lessen  everything that has  a  tendency to keep it up,
because  we know of no  method that  will entirely quiet  or  remove
the inflammatory disposition, or mode of action ;* there is no  specific
against inflammation that we are  acquainted with.  Whatever will
lessen the power or disposition will lessen  the effect.
  There appear to be three methods which tend to remove inflam-
mation :  first, by weakening; secondly, by producing  temporary
weakness ;  thirdly, by lessening or soothing the irritability.
  That which absolutely weakens is bleeding, purging, quietude,
and  low diet.  The temporary weakness  is produced  by sickness
at the stomach, faintness, &c.  The soothing effect may be produced
by sedatives,  antispasmodics, &c, such as  many sudorifics,  ano-
dynes, &c.   The first will have the greatest, most immediate, and
most  lasting  effects; the  second and third act  as  auxiliaries;
the  second probably  will  come  nearest  to  lessening  the cause
while  the other will assist so far as  irritation is a cause ;  they
should go hand in hand, for wherever we  lessen the  power we
should at the same time lessen the disposition for action. But nei-
ther bleeding, sickness, nor purging can possibly lessen the original
inflammatory disposition :f by lessening the power of action of any
disposition you only lessen  or protract the effects, which, however,
will be of singular service, as less mischief will  be done, and will often
give the  disposition time to wear itself out.
  Bleeding, then, at first may be necessary;  but this must be done
with some restriction.   If  inflammation arises from real powers,
then bleeding freely is absolutely necessary;  but if from too great
action of weak parts, bleeding should  be no  more than what will
just lessen the violence of the blood's  motion,  or remove the feeling

  * [Mercury and colchicum are perhaps exceptions to this observation ; at least
they certainly subdue inflammatory action with extraordinary rapidity in  many
cases.]
  \ [In this instance the author has  allowed reasoning and hypothesis to  usurp
the place of observation and fact. It is certainly not  uncommon to witness the
almost complete destruction of an inflammatory attack by a single copious  vene-
section.]
                               16 
182
HUNTER'S PRINCIPLES OF SURGERY.
in the part inflamed of too much to do.  The  quantity, therefore,
must be according to the symptoms and other  circumstances, that
is, according to the visible indications.   The indication for bleeding
is, first, according to the violence of the inflammation, joined with
the strength of the constitution : secondly, according to the disposi-
tion to form blood ; thirdly, whether the disease is in a vital part:
fourthly, its situation, whether near the heart  or not; fifthly, ac-
cording to the  duration  and the extent to which it has affected the
constitution.*
  With respect to  the first kind, in which the constitution is strong
and the inflammation is violent, bleeding largely is proper, and in
many cases  bleeding near the  part will answer better than from
the  general habit; less may be taken  away in  this way with an
equal effect on the  part inflamed, and of course with less effect on
the constitution, as bleeding from the temporal artery, or the jugular
vein, for  complaints of the brain, or cupping or applying  leeches
near the part, as, for example, to the temples in inflammation of the
eyes.
   The same mode of practice is to be followed with regard to the
second, third, fourth, and fifth.  It seldom  happens that one bleed-
ing  will be  sufficient in  a considerable inflammation.   The  first
blood taken affords a symptom of  the disease; if it is buffy, thick,
and considerably cupped, future bleedings may  be used with  less
caution.  On the other  hand, there may be indications for bleeding
sparingly;  first, from there being  too much action with  weakened
power;  secondly,  from a  disposition  to form  little blood; thirdly,
from the part  being far from the source of the circulation.
   A gentleman had a violent inflammation of the eye;  the blood
was sizy, but  though sizy the coat was exceedingly tender, and so
slight as not  to bear  its  own weight  when raised  up.  He  was
blooded plentifully several times without any good.  Here was not,
then, much power, the blood putting  on the sizy appearance in
consequence of there being increased action in the vessels of this
part of the body.

   * [The  propriety of blood-letting is indicated  by many other  circumstances
besides those pointed out in the text. I shall only mention three of these at pre-
sent : the first arises from the structure of the part affected.  Thus, serous and
fibrous membranes require  and bear venesection to an extent  which would be
perfectly unwarrantable in  regard to mucous  membranes.  The second arises
from the probable demands  which will be made on the constitution during the
future progress of the case. It would be extremely imprudent, for  example, to
bleed a patient with a severe compound fracture to the same extent which would
be perfectly justifiable in  inflammation of the eye.  The third is derived  from
the act of venesection itself, as whether the blood flows freely and the state of
 syncope is easily induced ;  for it has been justly remarked that those inflamma-
tions which most require venesection support the constitution under considerable
 losses of blood,  and enable it to bear them much more easily than it could  have
 done in a state of health.  In most cases of acute inflammation it is advisable to
 take such quantities of blood at first as shall make a decided impression on the
 constitution ;  one effectual  bleeding being of infinitely more service in checking
 the disease  than a number of successive bleedings to a smaller amount, at the
 same time that the powers of the general system are much less reduced.] 
OF ADHESIVE INFLAMMATION.
183
  A lady with inflammation of the tonsils was blooded; the blood
was sizy, but loose; and after three bleedings the blood became so
loose that the bark was given, which did service.  The disorder
returned again, and the same  mode was used;  the blood was sizy
only in the first bleeding;  the bark was obliged to be again given.
  In such cases bleeding  is very seldom necessary.   Where it is
necessary, it should be as  near the part as possible, in order that it
may have the greatest effect on the part with the least damage to
the constitution-  If local bleeding be used, leeches  will answer
best, because but little  inflammation  follows their bite;* however,
this can only be put  in  practice in inflammations which are pretty
much external.   In many cases we cannot take it immediately from
the part, and must be content to go as near as we can, as in bleed-
ing from the temporal  artery or jugular vein, in affections of the
head.  Sometimes of course  even this will be  impossible,  as in
inflammations of the liver and stomach.
  Too much action writh  small  powers may often, if not always,
be classed with the irritable, and bleeding here should be performed
with very  great caution.   When  inflammation is  far from the
source of the circulation the same precaution is hardly necessary,
as in general it can be taken away from  the part.
  We cannot depend on  sizy blood alone as a proof of the pro-
priety of repeating the bleeding; we must take into consideration
also the strength of action.
  The pulse is  a great  indication for bleeding in inflammation, but
is not always to be relied on.  In inflammations that are visible,
the knowledge  of  the kind of  inflammation  is  in some  degree
ascertained, in  which cases it has been  supposed that we  go on
surer grounds in our indications for bleeding.  But all inflammations
are not visible: therefore we require some other  criterion.   If  we
could ascertain the pulse peculiar to certain appearances in visible
inflammations,  and were sure  that  universally the  same pulse
attended such appearances, we  should then suppose we  had  the
true indicative criterion to go by, and  be able to apply it to invisible
inflammations,  and judge of  these by  the pulse.  But when  we
consider that the same kind of inflammations in every part of  the
body will not produce the same kind of pulse, but  very different
pulses  not  according to the  inflammation, but according to  the
nature of the parts inflamed, and many of these parts are invisible,
we see that we  at once lose the criterion of the pulse as a  guide.
There may be  every symptom of inflammation and the pulse be
soft, and not quicker than  usual, and yet the blood when taken
away will be sizy and cupped.
   A lady had this kind of pulse (soft and not  quick), and at  the
same time had a violent cough, with tightness  of the chest and
stitches  in the side;  bleeding was ordered, when the blood was
found sizy, &c.; nor did the illness subside till the sixth bleeding.
  A hard quick pulse is generally an indication for bleeding, being
  * [Cupping will generally be found  more effectual where it is practicable, on
account of the blood being more rapidly removed.] 
184
HUNTER'S PRINCIPLES OF SURGERY.
frequently accompanied with sizy blood ;  but even  these  signs are
not always to be depended on as furnishing a criterion.   The kind
of blood is of consequence to be known, for although it  should be
sizy, if it is not firm in its texture, but lies squat in the dish, bleed-
ing must be performed very sparingly.
  As the pulse simply, independently of all other considerations, is
not an absolute criterion to go by, and as a sizy and strong coagu-
lum  is only  an  afterproof,  let  us see if there are any  collateral
circumstances that can throw some light on this  subject, so as to
enable us to judge, c\ priori, whether it is right to bleed where the
pulse does not of itself indicate it.
  When speaking of inflammation of various parts, I took notice
of the pulse peculiar to each part, which I may now be allowed to
repeat.   First, I observed in inflammation of parts not vital, or such
as the stomach did  not sympathize with, that if there was great
power and  not much  irritability, the  pulse was full, frequent, and
hard.  Secondly,  on the contrary, in inflammations of  the same
parts,  if the constitution  was weak,  irritable, &c, that then the
pulse was small, frequent and hard, although, perhaps, not so much
so as when-, thirdly, the  inflammation  is in a vital part, as the
stomach or intestines, or some part with which the stomach readily
sympathizes ; then the  pulse is quick, small,  and hard.
  Now in  the  first  of these  dispositions  bleeding  is  absolutely
necessary; but in the second, where the pulse is small and frequent,
bleeding should be performed with great caution :  though the per-
son may be of strong constitution, yet in inflammations of these
parts the constitution  appears to be more irritable, and  to have a
greater sense of  weakness. We should bleed to two or three
ounces by way of trial, which could do no harm.
  The urine will throw some light on the disease; if high-coloured,
and  not  much in quantity, it may be presumed,  with  the  other
symptoms,  that bleeding will be of singular service; but if pale
and copious, though  the other indications may be strong for bleed-
ing, it ma)r be necessary to do it with caution.
  Bleeding, however, is a remedy of so  much importance that  it
should be employed in all cases  with great caution; yet  not more
than appears really necessary.
  I cannot perceive  why  bleeding should have such an effect on
inflammation as it often has. We cannot account  for it simply on
the mechanical principle of lessening the quantity of blood, because
this can never remove the cause of inflammation.
  Medicines.—Medicines which have the power of producing sick-
ness lessen the powers of life universally, because every part of the
body sympathizes with the stomach; and when they are intended
to produce  this effect they should not be  given in doses  sufficient
to produce anything  more than sickness, for  the act of vomiting is
rather a counteraction  to that effect, and I believe has rather the
effect of rousing, as few are so weak as not to be able to bear sick-
ness.   Purges have been much recommended, under the  idea that
there were humours to be carried off;  such practice  answers best 
OF ADHESIVE INFLAMMATION.
185
in the cases in which bleeding is useful.  In irritable habits, where
inflammation becomes more diffused, greater caution is necessary,
as nothing tends to weaken the habit more.  A single purge  has
been known to produce death in dropsy.  In such cases bark may
be required to bring  the  constitution  into a proper state, either for
resolution or suppuration, by increasing the powers and diminishing
the action;  and thebaica may be a good assistant as a soother or
sedative with the bark.
  Modes of Resolution by external applications—Whether  we have
any external applications which have really a tendency to resolve
an inflammatory disposition, is not well ascertained.  We are in
possession  of  many that can weaken, so as to lessen the powers
(most of which appear to be of the soothing kind), and thus lessen
the action, though the cause may still exist; by which means the
effects are lessened,  and the  inflammation is either cured or pro-
tracted, until the disposition wears itself out.   Perhaps cold is  one
of the greatest weakeners, but it should not be used too freely, as it
may produce a worse disease, which is indolence.   Lead is sup-
posed to have considerable effects in  this way; but I believe much
more is ascribed to it than it deserves.   Its properties appear to be
to lessen the powers,  and therefore  it should not be used except
when the powers are too strong.   Applications to weaken should
not be applied to irritable parts ; on  the contrary, the parts should
be strengthened, which can only be done through the constitution.
  Whatever power external  applications possess, they must act in
one of  four ways:  first, which  is the  immediate or truly local;
second, by repulsion; third, by revulsion  and derivation; fourth,
by sympathy, which  is probably the  same  principle in the animal
economy as revulsion and derivation.
   The first, or local effect, may be of two kinds: 1st, simply such
as is an antidote to the  action of the part, as cold,  sedatives ; 2d,
such as destroys the first irritation, by exciting a  second.  This is
most applicable to specific diseases, as the  action of mercury  in a
venereal sore:  but all  specific  diseases will not allow of it; a
gonorrhoea in a scrofulous habit  is an instance of this.  In some
cutaneous  affections  this mode of cure is very useful.  Sedatives
are less useful as local applications than counter-irritants, but both
of them may have another effect, viz., repulsion or derivation, which
must be from a constitutional  affection, such  as  I have  called an
act of the constitution, as in gout.   If the constitution is determined
toiiave a local complaint, by which she throws off a constitutional
disposition, then these revulsions do not rid the constitution of  the
disposition.  It is difficult to say  what will  merely repel and what
will cure.   Repulsion, however, is a cure of the part, whatever
effect  it may have on the constitution. Surgeons were formerly
greatly afraid respecting repulsion.   They were even  afraid ot
curing a gonorrhoea, lest they should drive it back into the consti-
tution and produce a pox; but they  did not  consider that it does
not arise from the constitution, and has nothing to do with it.
                              16* 
186          HUNTER'S PRINCIPLES OF SURGERY.
  Revulsion and derivation appear to me to depend on the same
principle in the constitution as sympathy, and, like the latter, have
the greatest effect in habits which are irritable or nervous, and in
diseases which are nervous, as  cramp;  not in such  as change the
structure of parts.   I knew a nervous girl cured of  pain  in one
arm by rubbing the other.  These terms were used under the idea
of removing humours by inviting them from other parts, as making
an issue to remove eruptions.  They probably act by causing an
irritation in one part to cease when an  irritation  in another is
excited; and this latter may be  made greater  than the  original one
though in a part less dangerous, and where it can be  more easily
cured, as burning the ear cures the tooth-ache;  vomiting, the
swelled testicle; blisters,  pleurisy, &c.  In some of these, as the
vomiting to cure the testicle, no  new disease tis excited, but only
the action of the part.   The cures performed by these modes are
in many cases preferable to those by means of local  applications,
and they will succeed where the others fail; thus vomiting will cure
hernia humoralis, when other applications have had no  effect.  The
cure by revulsion, or sympathy, is in some  respects the reverse of
that by derivation, yet it is  probably from the  same consent  of
parts, but from  a  different action.   In these a remedy is applied
to a sound  part to  cure a diseased, which is either  contiguous,
continuous, or remote, and the action is either similar or dissimilar.
The cure of continuous parts by similar sympathy is by the applica-
tion of such remedies as we suppose would  cure if applied to the
part.  That of remote  parts by dissimilar modes of action, is by
stimulating a part in such a way  as that the sympathy shall act in
the same way, and yet the action in the diseased part  be not at all
similar to that  in the sound part: suppose, for instance, a  part in
any mode of action, a medicine applied to it  would increase that
action, but by applying it to  another part it will remove the  first.
The contiguous is different from the two former, and  can  only be
applied to surfaces, as a blister to the  scalp to remove headache.
These may be either stimulating or  soothing, or specific.
  Treatment of adhesive  Inflammation when Suppuration must take
place.—The treatment must, in some measure, be the same as in
the foregoing  in accidents where the powers are very great, and
the inflammation violent, namely,  bleeding, purging, sickness, &c.;
but when the constitution is irritable, bark, &c, as before directed.
In cases where there is considerable sympathy, sudorifics, as Dover's
powder,  seem  desirable, as they tend  to  keep up the harmony
between the skin and the stomach.   Opium in peculiar constitutions
increases irritability; but in others, where there is not this peculiarity,
it is highly useful in  soothing and  diminishing  irritability.
  Different applications have been made to the inflamed  parts, as
fomentation, washes, poultices,  &c.   The  mode of  applying  heat
and moisture by fomentation  appears more efficacious than in the
form of a fluid ; it certainly gives ease at the time of the application,
but the symptoms generally recur between the times of using it,
and with nearly the  same violence.   How far the application of a 
OF  SUPPURATIVE INFLAMMATION, ETC.          187
medicine for fifteen minutes out of the twenty-four hours does good
I hardly know.
  Washes are  fluid  applications, and are more  commonly used to
inflamed internal surfaces than to the common integuments.  I am
afraid we are  not much acquainted with their true specific virtues,
the use of them being very vague.   For inflammation of the eyes
we use astringents, as alum, vitriol, &c.   For inflammations of the
throat we gargle with  port wine, vinegar, &c.; yet how  absurd it
would be, in the opinion of any surgeon, to use the latter applica-
tions to  the  eyes;  and yet if the two  inflammations are the same I
do not see why we should not use the same remedies to both parts.
These, like  the former, have  only temporary effects.
  Poultices  are constant applications, and may be  either simple or
medicated;  their effect is greatest locally, but it  extends  likewise
to surrounding parts, by sympathy.   They may be medicated with
lead, opium, &c.  Simple poultices are the best application where
we have no particular object in view.
                        CHAPTER XIV.

  OF SUPPURATIVE  AND ULCERATIVE INFLAMMATION ; GRANULATION,
            SKINNING, HECTIC FEVER, AND DISSOLUTION.

Suppurative inflammation ;—difficulty of tracing the chain of causes leading to
  it;—not arising from the access of air ;—nor from external violence ;—occurs
  most readily in canals.—Peculiar pain attending  it;—rigor;—diminution of
  the inflammation.—Cure of suppurated parts ;—abstraction of matter by ab-
  sorption, or by external opening;—granulation;—cicatrization.—Of pus;—its
  formation ;—gradual changes from lymph to pus;—breach of substance not
  necessary to its existence ;—erroneous notions of its formation and uses.—Of
  absorption of the whole or parts of the body, in consequence of disease.—In-
  terstitial and progressive absorption.—Interstitial of two kinds;—1st, wasting;
  —2d, complete removal.—Importance of the latter;—and of progressive ab-
  sorption.—The two sometimes mixed.—New parts most subject to be removed.
  __Causes which render parts liable to absorption.—Relaxing process of the
  skin over an abscess.—Absorption with or without suppuration ;—Ulceration ;
  —progressive and interstitial absorption combined ;—almost always accompa-
  nied  by inflammation ;—seldom affects the constitution.—Whitlow.—Granu-
  lation ;—not always attended with suppuration ;—does not appear till abscess
  has been opened ;—arises on one surface ;—nature and structure  of granula-
  tions ;—colour an index of the state of the parts and constitution ;—contrac-
  tion  of granulations;—followed by cicatrization;—an assistance  to this
  process.—Of skinning.—New skin generally arising from old skin;—economy
  of nature in forming new skin.—Hectic ;—when arising; causes numerous;
  —symptoms ;—erroneous  notion of cause.—Treatment;—incurable ;—when
  from local disease in removeable parts, they are to be removed.—Dissolution,
  definition of the term;—when occurring;—symptoms ;—incurable.


When  an  inflammation exceeds the adhesive state, and has got
beyond  the power  of resolution, and when the adhesive has set 
188
HUNTER'S PRINCIPLES OF SURGERY.
bounds to the suppurative inflammation, the suppurative begins;  or
in internal  surfaces, where the adhesive cannot take place, the
suppurative begins.  The irritation which is the immediate cause of
suppuration  is  the  same,  from whatever cause it may have been
produced: it is a similar process, going  through the same  stages,
whether it takes its rise  from external violence, or from the consti-
tution, or from  disposition for disease in a part, if all other circum-
stances are equal.  It is very difficult to give a true and clear idea
of the whole chain of causes which lead to suppuration.  Irritation
simply is not always sufficient; it often only brings on the adhesive
inflammation.   Violence done to a  part is one of the great causes of
suppuration, but this alone is not sufficient:  it must be with a pre-
vention of union by  the first intention, or by adhesive inflammation;
it must be attended with death in the part, as in bruises.  The appli-
cation of air to internal surfaces has generally been assigned as a
cause of inflammation, when it happened in consequence of destruc-
tion of a  part; but air has certainly no such effect, for a stimulus
would arise from a wound were it even contained in a vacuum;
nor does it get to the parts forming circumscribed abscesses, which
yet suppurate, in consequence of inflammation, as readily as exposed
surfaces.  In many cases  of emphysema, where the air is diffused
over the whole  body, we have no  such effect, excepting there is
produced an exposure of some internal surface for the air to make
its escape by,  and then the wound inflames.  In birds  we find the
cells in their bones communicating with the lungs, so that they have
at all times more or less air in them, although they  never inflame ;
but if these are exposed by a wound, the stimulus of imperfection is
given, and inflammation begins, and suppuration may succeed.  The
same observation is applicable to a wound  made in the abdomen
of a fowl, for  there the wound  inflames and unites the intestines,
to make the cavity perfect again;  but if the union  is not allowed,
to take  place,  more  or  less of  the abdomen  will inflame and
suppurate.   How should we account also for suppuration  taking
place in  the nose during  catarrh, since it is not more  exposed to
air then  than  at other  times 1  Air, therefore, is not the cause of
suppuration.
  We are at a loss to say, with regard to spontaneous inflammation,
whether it is a disease in which the constitution will be injured, or
whether it is a salutary process in which nature is endeavouring to
relieve herself; and it  is  evident  that  the same action may arise
from different causes.
  Suppuration does not depend on the violence of the inflammation :
for that  circumstance,  simply considered,  rather tends to produce
mortification; and we see that in  gout, which does not suppurate,
there often is more violent  inflammation than in many other cases
that do : and in true scrofula we have suppuration without any visible
inflammation:  so that this does not seem essential to suppuration.
Although  wre find  that  inflammation  and suppuration from injury
are very violent, yet that which occurs spontaneously generally 
OF SUPPURATIVE INFLAMMATION, ETC.         1Q9
exceeds it in violence.  In inflammations of the breasts in women
and of the testicles in men, the quicker the inflammation proceeds
the better; for where it is slow it gives the idea of specific inflam-
mation, as this generally proceeds slower than simple inflammation.
  Suppuration takes place more readily from the surface of canals
than in either the cellular  or investing membranes ; the same degree
of inflammation which  will produce suppurative in the first men-
tioned parts will only produce adhesive in the latter.  If  a bougie
be introduced into the urethra, it may produce suppuration;  but if
introduced into the tunica vaginalis or abdomen, it will only give a
disposition for adhesions.
  Symptoms of suppurative inflammation.—The sensations arising
from a disease generally  convey some idea of its nature.   Some
diseases give what is called a heavy, a dull, or a gnawing pain,&c:
but the suppurative inflammation gives as much as possible the idea
of simple pain, without having relation to any other mode of sensa-
tion ;  this pain is  increased at the  time  of the dilatation  of  the
arteries with the sensation called throbbing.   The part now becomes
more swelled by the greater dilatation of the vessels and a greater
quantity of extravasated fluid being poured out, and the scarlet colour
increases  from the admission of red globules into vessels, not natu-
rally conveying them,  and the formation  of new  vessels, and an
cedematous appearance, like that in erysipelas,  takes place.  One,
two, or three parts of the inflammation lose the power of resolution,
and take on exactly the  same disposition with that of exposed  sur-
faces, or a surface in contact with an extraneous body.   If it is in
the cellular membrane that this  disposition takes place, or in the
investing  membrane of circumscribed cavities, the vessels now begin
to alter their disposition and mode of action, and continue changing
till they  bring themselves to that  state which fits them to form
matter.  But as this change does not take place all at  once, some
parts  may for some time continue to discharge  coagulable lymph,
as in the adhesive state, whilst those parts which have taken  on the
suppurative action  pour  out matter: and hence, if the tumour be
now opened, it will be found to contain both matter and coagulable
lymph: in which state  it  has always been  imagined that the matter
had not arrived at  a state of ripeness by those who supposed its
purulence to depend on its confinement and stay.   It would appear,
from matter forming from the investing membranes of internal cavi-
ties and from mucous surfaces, that matter may be formed without
any breach of surface.
   There  is a  certain period  in inflammation  when  suppuration
begins, and which is discovered by new  symptoms, as shivering,
&c.; and though the change is pretty quick, time must be allowed
for the vessels to be fitted for the suppurative state.  Ihe effect ot
inflammation seems to be the producing the suppurative disposition,
or that state of parts which disposes them to secrete pus: in doing
this, inflammation seems to be carried to such a length as to destroy-
that state of parts  on which itself depends; the consequence of which
is that they lose the inflammatory and come into that disposition 
190
HUNTER'S PRINCIPLES OF SURGERY.
which fits them for throwing out matter.  That the suppurative is
very different from the adhesive inflammation is plain from this,
that if a wound in a suppurative state, yielding good matter, has by
irritation of any kind the  adhesive inflammation produced in it to
any degree, the discharge lessens,  and the wound puts on appear-
ances very different from  what it had before.  It seems a fixed and
useful law in the animal economy,  that when inflammation has gone
to the length of destroying the natural  functions of parts, so as to
prevent their returning by a retrograde motion to that state from
which they  set out, suppuration should come on to give them a dis-
position for  a second mode of cure.
   Treatment of Suppuration.—Suppuration  may sometimes be re-
moved  by producing action in other parts:  thus, I have seen a
bubo cured  by a vomit, and similar effects are producible on scro-
fulous tumours.   When suppuration cannot  be stopped or resolved,
in most cases it is to be hurried  on towards the skin, which generally
is the first step taken by surgeons.  How far suppuration can be
increased by medicines or applications I do not know, but attempts
are generally made ; hence  we have, I think, in the pharmacopoeia,
(though I do not read many books,) suppurating cataplasms, matu-
rating, &c, but I doubt if they have considerable effect in this way,
for the same applications applied to  a  sore  would hardly increase
the discharge of that sore.  However, in cases where the parts are
indolent, and hardly  admit of suppuration, by stimulating  the skin
more  salutary inflammation may  be produced,  and of course
quicker  suppuration;  but  with  true  suppuration, preceded by
inflammation, it is I  believe hardly necessary to do anything with
respect to the suppuration itself.   Nevertheless it has perhaps been
found by experience that  these applications tend to bring matter
faster to the skin, even in the rapid suppurations; only, however,
in those cases where the inner surface of  the abscess is within the
influence of the skin.  This effect, too, may arise from another mode
of action being produced than that of quicker suppuration, which is
the hastening of an ulceration.  Poultices of bread  and milk are
commonly used to inflamed  parts when suppuration is known to
have taken place : this application can have no effect,  except that
of lessening  the inflammation, or rather making the skin easy.*
  Of suppuration without inflammation.—I have hinted that thickening
of parts took place sometimes without inflammation, and also that
the suppurative inflammation might take place  without being pre-
ceded by the adhesive.  Many  indolent tumours, slow  swellings of
the joints, swellings in the  lymphatic glands,  tubercles in the luno-s,
and  swellings in  many parts of the body,  are of  the first  kind,
namely, thickening without visible  inflammation ; and the contents

  * [The immediate effects of poultices and fomentations to inflamed parts are,
1st, to soothe the pain and irritation; 2d, to augment the local perspiration ;
and, 3d, to diminish the tension.  The addition of sedatives and  narcotics cer-
tainly increases their soothing effects, and their  continued application  certainly
promotes the suppurative process.] 
OF SUPPURATIVE INFLAMMATION, ETC.
of some kind of encysted tumours, the matter of many  scrofulous
suppurations, as in the lymphatic glands, and in the joints of the foot
and hand, for instance, and in the hip-joint, called hip-cases, of the
loins, called lumbar  abscess, the suppuration of tubercles in the
lungs and in many other parts of the body, all exhibit the formation
of matter without any previous visible inflammation.  They come
on insensibly, the first symptom being a swelling in consequence of
the thickening, (which is  not the  case in inflammation, for  there
sensation is the first symptom,) and this swelling is increased by the
formation of matter.*
   The nature of the matter is another distinguishing mark between
suppuration in consequence of inflammation and that without it, the
latter being generally composed of a curdly substance mixed  with
matter.   The curdly matter  is, we  may  suppose,  the  coagulable
lymph deprived of serum, the thinner part is true pus, having the
globules and specific properties of pus, and is often as thick as the
common  pus formed  in consequence of inflammation.
   All parts which form pus of any kind, whether in consequence of
inflammation  or otherwise, must go through similar processes to
produce the ultimate effect or cure.   The first step, in either  case,
is the evacuation of this matter, for till that is effected nature cannot
take means towards  a cure; the second step  is granulation; the
third, cicatrization.
   There  are three modes of doing the first; one is the absorption of
matter, which is very common in the scrofulous  kind, but not in
those suppurations which are the consequences of inflammation, and
which  produces  no  alteration of the part  except the gradually
creeping into a  sound state; the other modes of discharging this
matter are, either opening the abscess, to allow it to pass out, or
allowing ulceration to take place on the inside to produce its escape;
which process, in the present case, having peculiarities  different
from those arising from inflammation, it is  necessary to explain
still further.
   Ulceration in consequence of suppuration arising from inflam
mation, is very  rapid, especially if the suppuration is very rapid;
but ulceration in consequence of suppuration not the  effect of
inflammation, is extremely slow: it may remain  months or even
years before the parts give way.
   When an abscess  in  consequence of inflammation is opened, it
 immediately proceeds towards a cure, and perhaps may have gone

   * [Those singular deposits of purulent matter which  occur in the  joints, the
 serous cavities, the viscera, and the cellular membrane, during the progress of
 phlebitis and secondary  inflammations, are examples  of the same kind.  I have,
 on several occasions, found all the principal joints of the body filled with an ap-
 parently healthy pus, although during life there were no symptoms of inflamma-
 tion, nor after death any indications of increased vascularity.
   The question, therefore arises. Does suppuration ever  occur independently of
 inflammation 1  I think it does.  The formation of cartilage antecedently to that
 of bone is a parallel case, and yet  instances every now and then occur in which
 ossific depositions are formed independently of this condition.] 
192
HUNTER'S PRINCIPLES OF SURGERY.
 some steps towards a cure  before the opening.   As inflammation
 lessens, suppuration becomes still more perfect, granulations begin
 to form, &c.  But when an abscess not preceded by the common
 inflammation is opened, a very different process is first to take place;
 the  consequence is, that inflammation now takes place over the
 whole cavity  of the abscess, which  afterwards produces  perfect
 matter, like that produced when inflammation is the original disease.
 However, it sometimes happens  that they inflame before they are
 opened, in consequence of the matter distending  the  cavity acting
 like  an extraneous body, not in consequence of the cause of suppu-
 ration.   I have seen white  swellings of the  knee inflame before
 they were  opened, then ulceration  took  place, and the pus was
 brought  soon  to the skin, though  before  it had  been  for  months
 without producing the least tendency to ulceration, and of course
 none to inflammation; but the  confinement of matter  became the
 cause of inflammation.   The inflammation and  new  suppuration
 taking place in consequence of an opening into these  abscesses, is
 exactly similar to those inflammations and suppurations which take
 place in consequence of an opening made into internal cavities; and
 it is  extraordinary that often upon opening these swellings, inflam-
 mation, fever, nay death, shall  follow, but if suffered  to break of
 themselves no such effect  is produced.
   Of Pus.—The immediate  effect of the  modes of action above
 described is the  formation of matter commonly termed pus.  This
 matter is very different from what was  discharged during the  ad-
 hesive stage  of inflammation,  and also  very different from  the
 common secretion of internal canals :  yet when these surfaces form
 pus it is probable they are formed by the same vessels; if so, their
 mode of action must be greatly altered.
  In suppuration of the cellular membrane or of circumscribed cavi-
 ties their vessels are but little changed at the commencement of the
 suppurative disposition, so that they still retain much of the form
 they aqcuired by the first stage.  The discharge is at the beginning
 little more than coagulable lymph mixed with some serum ; this is
 scarce different  from the  discharge  in the adhesive  stage  of  the
 inflammations; but as the inflammatory disposition subsides, a new
 disposition is every instant altering these vessels to the suppurative
 stage; the discharge is also  varying  constantly from a species  of
 extravasation  to the new-formed matter peculiar to suppuration.
 The  matter  removes further and further from the  nature of blood,
 losing the yellowish or greenish hue, and becoming white, and more
viscid and creamy. _ By the formation of this new substance, the
coagulable lymph, which was extravasated in the adhesive state,
 and  adhered to  the  sides  of the cells, either on  cut surfaces,  as
wounds, or on the walls of abscesses, is pushed  off, and if there is a
 cavity, is pushed into it, so that  wTe  should find in the cavity both
 coagulable lymph and pus; or, if on a cut surface, it is thrown off,
 and is generally removed, along with extravasated blood, &c, with
 the dressings. 
OF SUPPURATIVE INFLAMMATION, ETC.
193
   This is the process which takes place in the first formation of pus
 in an abscess, or from the surface of fresh wounds.
   On the internal surface of canals the parts are not obliged to go
 through all these steps;  they run into suppuration almost instanta-
 neously.
   Mode of Formation of Pus.—Pus is formed by some  change, de-
 composition, or separation which the blood undergoes in its passage
 out  of  the vessels.  To  carry on  this  process, either  a  new  and
 peculiar structure of vessels must  be formed, or a new disposition
 or mode of action of the old must take place.  This new structure
 of vessels, or new disposition of vessels, I shall call  glandular,  and
 consider pus as a  secretion.*
  Dissolution of the living solids of  an  animal body into pus,  and
 that the pus  already formed has a power  of  occasioning their
 further  dissolution, is  an old opinion,  and is still the opinion of
 many.
  But if this idea were just, no sore which discharges matter would
 be exempted from continual dissolution; and I think it must appear
 inconsistent that matter  which was probably intended for salutary
 purposes should be a means of destroying the very parts which pro-
 duced it.
  The circumstance of internal circumscribed cavities, as the abdo-
 men, thorax, &c, forming pus, and where they  might often have
 seen pints of matter, v/ithout any breach in the solids to produce it,
 (which  is proved  beyond  controversy to lake place,)  should have
 taught them better; and  the prevalence of this idea certainly shows
 a barrenness of knowledge and observation.   Such an idea might
 be forgiven when it was thought that the discharge in gonorrhoea
 arose from an ulcer; but now that it is known that there is no ulcer
 in the urethra, it can only continue  from mere stupidity.
  The moderns have been more ridiculous still: they have put dead
 matter into pus, and have thought that it has  been formed into pus,
 and have thence inferred opinions similar with the former.   In this
 case they have been putting dead and living animal matter  on  the
 same footing.   But what is still further, they  might have seen that
 extraneous matter cannot be formed  into pus, by observing that in
 wounds, and in suppuration with extravasation, blood  and pus  are
 found separately in the  same cavity, and that in extravasation of
 blood in sound parts no pus is produced.   In abscesses from violence
 and erysipelas they might have seen sloughs of dead cellular mem-
 brane,  hanging like wet tow, and not melting  down into pus,
 although exposed to the action of matter for a  long time.  The same
 observation holds good with regard to dead bones, when exposed to
 the action of pus; besides, if, in consequence of the decomposition of

  * [Delpech endeavoured to  prove that pus was always secreted by a new mem-
brane {membrane puogenique) developed by inflammation;  an opinion which re-
ceived some colour of support from the appearance of cysts in old  abscesses.
 Nothing, however, is  more common than  to see suppuration from mucous  and
serous surfaces, where no trace of any such membrane is discoverable.]
                               17 
194          HUNTER'S PRINCIPLES OF SURGERY.

these parts, some of their parts are mixed with pus, it is altered in
its properties, thereby attaining a very ill smell.  But if there is loss
of substance in a dead  piece of bone, for instance, it is produced
by  absorption; in proof of which we see that the loss is on that side
where it unites to the sound parts, and where alone the absorbents
can act.
  The chemists found no difficulty in  explaining  the  formation of
pus, and this they supposed took place by  fermentation.   But fer-
mentation  necessarily implies that there  should  be something  to
ferment; and, according to this idea, there  are three effects which
contradict  the notion of  fermentation flatly.   First, internal canals,
where mucus only was formed, take on the  formation of pus with-
out previous loss of substance or  previous  fermentation, and they
leave off the action in the same way.   Secondly, internal cavities
take it on without loss  of substance.  Thirdly, abscesses already
formed leave it off.   If fermentation wras  the cause in  the first,
what solids enter  into the matter discharged 1 for the whole penis
could not afford matter  enough to form the  matter discharged in a
gonorrhoea.  And how or by what power was   the  fermentation
commenced? and how should it ever cease?  for there is the same
surface secreting its  mucus whenever the fermentation  of pus
ceases ?  In the second  case, what solids were destroyed when fer-
mentation began?  by what power is the first particle of this fluid
formed in an  abscess or sore, before anything  exists capable  of
dissolving  solids ?  And according to the  third,  an abscess shall
form  matter, become stationary, perhaps for months, and at last be
absorbed;  and what becomes of the  ferment during the  time it
remained stationary ?
  We may safely, then, discard these notions, and  say that pus is
formed from the fluids alone, by the action of the  living solids.
  Pus appears to consist, when examined by  the microscope,  of
globular bodies, such as compose cream ;* these may be white, or not
so, as we find glass appears white when powdered,  though not really
so.   The globules swim in serum, or a fluid like  serum, and  most
probably there is a little coagulable lymph mixed with it.  The propor-
tion that those white globules bear to the other parts depends on the
health of the parts which form it; and when in larger  proportion, the
matter is thicker  and whiter, and is called good pus, that  is, the

  * [These bodies were found by Dr. Hodokin to be  irregular in size and figure,
and to have  no resemblance to those of the blood ;  from which  Dr. Babington
has inferred the probability that pus consists merely of lymph, in a minute state
of division, suspended in serum.   The existence of  globules  gives to this fluid
an iridescent appearance when viewed between two plates  of glass, which was
proposed by the late Dr. Young as a test of the presence of this matter in doubt-
ful  cases, and is still considered the best which we possess.  Another test,
derived from the facility with which pus is diffused through  water, and after-
wards subsides, is applicable to a great many cases,  and is much to be preferred
to any of those which depend on the reaction of chemical agents.  The fact
however is, that pus and mucus insensibly merge in one another, which  renders
the distinction between them in transitu impossible.] 
OF SUPPURATIVE INFLAMMATION, ETC.
solids that produced it are in health, for these appearances in matter
are no more  than the consequences of certain salutary processes
which are going on in the solids, the effect of which is to produce
a disposition  on which both suppuration and granulation depend.
  Pus has a  sweetish mawkish taste, as is known when it is formed
in the mouth, and it coagulates by heat.   This is the same, whether
from an irritated  natural surface, as the membrane of the nose and
other outlets  and canals, or from an ulcerated surface.
  These discharges from canals or outlets have been termed mucus,
and not pus; and the surfaces yielding these discharges have been
termed mucous membranes.  A test has been recommended  for
distinguishing these when their appearances have been  so exactly
similar as  to afford  no visible difference, and when, as I observe,
they are in fact one and the same fluid.  This  test was the  chem-
ical solution  of the fluid in  menstrua, and its  precipitation  there-
from, a proposal which was unphilosophical on the very face of it,
and which I  treated from the first as absurd.   I did conceive that
all  animal substances when in solution, either in acids or alkalies,
were in the same state,  and that the precipitation from them would
be the same.   But as it was so slrongly asserted, and supported by
experiments  said  to  have been made, I, to  satisfy myself,  made
several experiments with animal matter, both solid and fluid; these
I dissolved in  different acids, vitriolic, muriatic, &c,  and  made
precipitates  with  several alkalies,  both fixed and volatile, but all
these precipitates appeared the same, even when examined with
the microscope, exhibiting universally a flaky appearance.
   The quality of the matter always depends on the nature of the
part secreting it: whatever specific  quality the partis affected with,
the pus will possess the same; hence we have venereal matter from
venereal sores, cancerous matter from cancerous sores, &c.;  but
though it takes on these qualities  when the part yielding it is so
affected, yet it does not derive these qualities  from the constitution
if it is so affected, unless that part is also affected.  A circumstance
which serves to show that the part which  yields it is of the same
nature  with  the matter produced, is that it does  not prove  an
irritator to the surface yielding it, though it may to another; hence
no suppurating surface can be kept up by its own matter.  The gonor-
rhoea, small-pox, &c, curing themselves is a  proof of this, for
were  not this the  case we  should have  constant pain  from the
irritation and much more difficulty in the cure.  We  do, indeed,
sometimes find that pus will irritate its own surface; but this may
be  the effect of some extraneous matter, as blood, &c, in the pus;
the intestines will sometimes produce a discharge which stimulates
them very considerably;  but this may be secreted by the diseased
surface, and prove an irritator to the sound part  of the canal only.
What I have hitherto said  refers  to natural pus only;  but when
a specific nature is added, then  the secretion is altered.  The first
alteration  is a greater quantity of serum and salts, producing  a
thinner  discharge, called sanies;  this  discharge  has sometimes 
196
HUNTER'S PRINCIPLES OF SURGERY.
appeared to affect the solids, and has thence been called corrosive,
a  property which it does  not possess,*  the  parts only receding
from the irritation;  and where this is the case, perhaps, the decom-
position and new combination necessary to  the formation of pus is
not perfect, in consequence of the  vessels  having lost that structure
which is proper for  the  secretion of pus;  and  this is probably the
case, as healthy granulations are not produced when such matter
is  secreted.  By what particular organization  matter  is produced
we can no more determine than we can the  nature of any other
glandular organization.
   Pus appears to have  a greater tendency to putrescency than the
other secretions  have, but I do not think this  is in the degree that
has been supposed.  It is brought into a putrescent state by  circum-
stances independently of the pus itself.  If  the air is admitted to it
by a small opening  in an abscess,  or it is placed near the intestinal
fasces, or some parts of the solids which have sloughed, then it will
be fetid;  or if any dead blood, as  in recent sores, is mixed with it,
it is fetid ; but if perfectly confined in an abscess it is always sweet,
and will be a long time in  putrefying.  In erysipelatous inflamma-
tion,  however, where there is an  internal inflammation, there will
be putrefaction; but this is probably from the solids themselves first
putrefying. Hence we find, in most cases of specific disease, that
the pus is offensive,  because blood  is mixed with it.  Where there is
dead bone also pus becomes very offensive.
   The final intention of this secretion of matter is not, I believe, yet
understood.  Some  say it is carrying off humours from the consti-
tution, or that it  is a constitutional disease changed into a local one,
and so discharged, or thrown out of the body, either in the  form of
pus, or with it, as in those cases called critical abscess.   Or it is
presumed to carry off local complaints from other parts, by way of
derivation or revulsion; hence sores or issues  are made in sound
parts to  allow  other sores to  be  dried  up.    But I am apt to
believe that we are not yet well,  or at all,  perhaps, acquainted with
its uses.   We might naturally suspect that it was on the surfaces of
sores to keep them moist, but thi§ will not account for its formation
on internal surfaces.
   Absorption of whole parts in consequence of Disease.—The imme-
diate effects  of absorption  of the  body in consequence of  disease
may be said to be of two kinds.   The first is only a wasting of a
part, or the whole, without any breach in the structure or form, and

  * [Pus very often  corrodes the external parts.  There seems also the greatest
reason for believing that the presence of pus is  highly deleterious in several
forms  of inflammation,  as carbuncle,  diffuse  cellular inflammation, erysipelas
aedematodes, inflammation arising from the bite of vipers, &c.  Unless free  and
early openings are made in these cases, the inflammation or gangrene  extends,
apparently from the infiltration of pus, or  that diseased secretion which  precedes
the formation of pus into the unadherent cellular membrane.  That  the pus,
under such circumstances, acquires a highly poisonous quality, is  proved by the
effects which it produces  on the  constitution when injected into the  veins
(See p. 136, note.)] 
OF SUPPURATIVE INFLAMMATION, ETC.         197
this I call the interstitial absorption; the second consists of the total
removal of a part, as if by art, and this is  the progressive absorp-
tion.  The interstitial absorption may be considered in two lights;
1st, where it leaves the part affected still a whole, though wasted;
3d, where it entirely removes it, which latter resembles the natural
process by which useless  parts are removed, as the thymus gland,
the membrana pupillaris, &c.
   The process of removing entire parts of the body, either by the
second  interstitial  or  the progressive absorption, answers very ma-
terial purposes in the  machine.   It is  by means of  the progressive
that bones exfoliate and sloughs separate, that pus is brought to the
skin, and  that while new  bones are formed old  ones are removed ;
and although in these cases the process arises from disease, yet it
is somewhat similar  to the modelling process in the natural forma-
tion of bone.   It is  this last  that removes useless  parts, as the
alveolar processes when  the teeth drop out, or when children are
shedding  teeth, which allows these to drop out; and it is by these
means that ulcers  are formed.  It is in many cases a substitute for
mortification (which  is another mode of loss of substance), for it
is a degree of strength or vigour superior to that where mortification
takes place; and in many cases  it finishes what mortification has
begun,  by separating the  mortified part.
   The  progressive is that absorption which begins  at one side of a
part to  be removed, and goes on until the whole is  removed, as in
spreading ulcers.
   These  two modes, the interstitial and progressive, are generally
going on at once, which  may be  called the mixed.   This operation
 of absorption, like many other processes arising from disease, would
 often appear to be doing mischief, by destroying parts which are of
 service, and where  no visible good appears to arise from it, as  in
 those cases where the  external covering is destroyed by ulcers or
 sores;  but in all cases it  must  be reduced to necessity, for we may
 depend upon it that those parts have not the power of support, and
 it becomes  a substitute for mortification.   In many cases  we shall
 see both  ulceration and mortification going on, ulceration removing
 those parts which have power  to resist death.
   New-formed parts,  or such as cannot be said to form a part ot
 the original animal, admit more readily of  removal than those parts
 originally formed : probably this arises from the principle of weak-
 ness.   It is on this principle that all adventitious new matter is more
 readily absorbed than that matter which forms the substance ot  old
 tumours.                                        . .
   Remote Causes of Absorption.—The remote causes of absorption are
 various.   The most  simple appears to arise from a part's becoming
 useless, as the thymus gland, the ductus arteriosus, the alveoli alter
 the teeth drop out, the crystalline lens  after  couching, the fat  ot
 the body  in fever, either inflammatory  or hectic,  all  which  are
 removed by the absorbents as  useless parts.   Another cause is want
 of power in the part to support itself under certain  irritations, whicn
                               17* 
198
HUNTER'S PRINCIPLES OF SURGERY.
may be considered as the basis of every cause of removal of whole
parts, as calluses, cicatrices;  also of parts pressed on.  From all
which it would appear that parts are liable to  be  absorbed from
five causes:  first, parts pressed on;  second, parts  considerably
irritated by an irritating substance ; third, parts weakened ;  fourth,
parts  rendered useless ;  fifth, parts  become dead.  The two first
appear to me to produce the same irritation ; the third, an irritation
of its own kind ; and the fourth and fifth may be somewhat similar.
  Immediate Causes of Absorption.—The immediate causes of absorp-
tion of the body itself must  be of two kinds respecting  the parts, one
passive, the other active.   The first  of these is  a consciousness in
the parts to be absorbed of the unfitness or impossibility of remaining
under such circumstances, the action excited by the irritation being
incompatible with the natural actions and existence of the parts,
whatever these are;  therefore they become ready  for removal,
or accept  of it with ease.   The second is a consciousness in
the absorbents of such a state of part; and both concurring to  do
the same thing, they fall to work.   When the part to be absorbed
is a dead part, or extraneous matter, the whole disposition is in the
absorbents.   Pressure from without rather stimulates than irritates,
for we find it produces thickening of parts;  but if it exceeds  the
stimulus of thickening, it becomes an irritator.  If pressure is from
within,  parts  rather  appear  to give way, and absorption  takes
place.
  Interstitial Absolution.—This is of two kinds  with respect to the
effects,  or,  rather, has two states.   The  first,  where it takes place
only in part, as in the  wasting of a limb,  where disease of the
joint has rendered it useless;  in a broken tendon ; a divided nerve
going to a voluntary part; or when it  takes place  in the whole
body  in consequence of  disease,  as atrophy,  fever, &c.   The
second, when entire absorption takes place, and no vestige is left;
and this would seem to be of two kinds, one  where it takes place
only in consequence  of another disease, and is a necessary and
useful effect of that disease, assisting infringing parts to the surface,
&c.; but the other appears to arise  from disease in the part itself,
as a total decay of the alveoli without any disease  in the teeth or
gums, as also the wasting of the testicle*  The  first of our second
division of  absorption  of entire parts  is taking  place in a thousand
instances; it is gradually taking place in that partof the body between
many encysted tumours and the surface,  and is generally slow in its
progress.
  Progressive Absorption.—The removal  of those surfaces imme^
diately contiguous to  the irritating cause, which is an absorption
of necessity, is effected by progressive absorption.  Absorption
from  pressure is the  removal of the part  pressed,  which may
either be the  surface of an abscess in  contact with pus, or  of
that part of the surface of the body in  contact with some body
constantly pressing, as the buttocks or hips of  those who  lie long
on their backs. 
OF SUPPURATIVE INFLAMMATION, ETC.          199
  Of the Relaxing Process.— Besides the modes of removing parts
above mentioned, there  is another process, called the relaxing or
elongating process, carried on between the abscess and skin.   It is
possible  that this  process may  arise in some  degree  from the
absorption of interior parts;  but there  is certainly  some  other
cause, for the  skin which covers an abscess is certainly  looser
than it would be from mere stretching;  and it is very beautiful to
observe how nature goes on in her own way  to produce an effect.
In consequence of the pressure of pus in an  abscess, Nature sets
up three processes to  let it  out;  first, progressive  absorption;
secondly, interstitial, by which the progressive is assisted ; thirdly,
the relaxing process, making the parts yield  to  distension.   In
women,  the  relaxation of parts is  very considerable  before  the
birth of  a child:  and the  old women in the country know when a
hen is  going  to lay, by the relaxation and softness of those parts.
The following cases exemplify those processes of absorption.
   A lady, after inflammation of some of the abdominal viscera,
had the belly swell;  some  time after, a kind of pointing was
observed in various parts of the belly, and on  opening the largest a
very considerable quantity of fluid (matter, I think,) was discharged;
this opening was near the   sternum, and the  ends of  the recti
 muscles were  quite  ragged.  The  patient  died.   Here was  an
instance of the effects of absorption, by which an exit was obtained
for the matter.   Suppose an  abscess to go on for a long time with
a smooth surface, yet  if any part takes  on the absorbing process
the matter will be very rapid in  arriving at the  skin, although this
 process may have taken place in the thickest part.  This process
 may be induced by an irritation in  any part  of the surface; thus,
 after opening an abscess, if matter is permitted to collect at the most
 depending part, it may bring on this process, whence a fresh opening
 will be made.
   This  preparation  [showing one] represents the front ot a chest,
 which contained  an  aneurism of the aorta;  and here on the right
 side you see an  instance of  the elongating process, the cartilages
 being  bent  outwards, or elongated, to adapt themselves  to  its
 figure,                                  „                .    ~
   This is another preparation (see  PI. III. f.  1.),—an aneurism of
 the aorta.  AA, ends of the aorta; B, the first sac, which contracted
 at C and having proceeded to d, where it met with resistance from
 the s'ternum DD, it became again contracted; but having produced
 absorption  of  the sternum  d,  E, by which  an  opening is made
 externally, the sac is again expanded.   Here are two other prepa-
 rations, exhibiting similar appearances.

                           Ulceration.

   Before I enter  on this subject  I shall make a few more general
 observations on absorption. 
200          HUNTER'S PRINCIPLES OF SURGERY.

   Some parts of our solids are more susceptible of being absorbed,
especially by ulceration, than others under the same or similar cir-
cumstances.  This is particularly the case with cellular and adipose
membrane, as we often find muscles, tendons, and ligaments deprived
of their connecting membrane by ulceration, as maybe observed  in
the opening of large abscesses.  The  skin  itself,  if affected  by
pressure  from  without, is less  easily absorbed than the cellular
membrane; hence we may  observe, that in continued  pressure
from without the skin will remain whole, although the parts beneath
are wasted by the absorption of the cellular membrane; but some-
times the  skin is  more susceptible of absorption  than the cellular
membrane; this may proceed from the skin acting  with  so much
more vigour, either in opposing any injury or in taking on salutary
action.  Although in abscesses, in tumours, and in the case of ex-
traneous bodies, the parts all round are equally pressed, yet we find
that the progressive absorption takes place  only on  that side near-
est the skin, and arrives at the skin only on that side: a very slight
degree of pressure from within will produce this effect, so slight  as
would from without have produced  only a thickening of parts.
   Bones are  susceptible of a similar process.   Absorption may be
of two kinds,—without suppuration, or with it.  The first, I believe,
is universally the case with the interstitial absorption when it takes
place alone, as in the  absorption  of  callus, of the alveoli of the
teeth, &c.; but the  second  may precede or produce suppuration
where there was  none  before, as in old  sores breaking out anew.
To distinguish the second from all  other  modes of  absorption  of
whole parts,  I shall call that absorption  ulceration which is either
preceded, accompanied, or succeeded by suppuration.  Absorption
may  be  a consequence  of  pressure under  two  circumstances,—
where the pressure is from diseased parts, or from extraneous sub-
stances.   Of the first is that from tumours,  &c.;  thus, in a case  of
aneurism, where  the coats of the  artery press against the bones,
the rib for instance, its coats begin to be absorbed, and, after they
are  absorbed, that absorption goes on in the bone, the adhesive
inflammation takes place at the same time round  it, and unites the
circumference of the absorbed parts: another instance is where
tumours make their way to the skin, without any suppuration taking
place. Of this I once saw a very remarkable instance in a soldier
in the Dutch  service : a tumour had formed between  the pia mater
and dura  mater, which gradually increased to a very considerable
size, and  had shown itself externally some time before the man
died.   Upon examination after death I discovered that the pia mater
was absorbed underneath it; but  the chief absorption  had taken
place on the side next the skin, for on this side the skull was absorbed,
and the absorption had begun in the integuments of the scalp, which
it would soon have probably ulcerated had not the man died before
Nature had finished  her  operations;  and in this  case no  matter
was  found either on  the  brain,  skull,  or in  the   integuments,
owing, perhaps, to the pressure being made  by a living part.   This 
OF SUPPURATIVE INFLAMMATION, ETC.         201
species of absorption is attended with very little or no pain, and its
effects are  as trifling on  the constitution, although it  may be  an
effect of an alteration in the constitution, as the absorption of calluses
in scurvy, &c.
   Ulceration.—I shall now take notice of that action of the absorbent
system which 1 call ulceration, and which is the second species of
our first  division, being connected with the formation of pus, either
as a consequence or as a cause;  and it is this kind which always
constitutes an ulcer.
   This  process  of ulceration  or  absorption  with suppuration, is
almost constantly attended with  inflammation, which  led me to
call  it ulcerative inflammation.   Ulceration is  generally attended
with considerable pain, which is called  soreness; but this does not
attend all ulcerations, for there are some  which are of  the specific
kind, which give little or no  pain, as  scrofula ; but even in this
disease, where ulceration proceeds  pretty fast, it often gives con-
siderable pain, wherefore the pain may be  in some degree in pro-
portion  to the quickness  of its operation.  In  those cases where
ulceration is set up to separate dead parts, as sloughs,  it is seldom
attended with pain, and it is not easy to assign the cause of this.
   It seldom or never  affects the  constitution much, although  the
process is affected by the constitution.
   What I have  hitherto said of ulceration  I  shall illustrate  by
noticing what occurs in an  inflammation of the peritoneal coat of
an intestine.  The first  inflammation  produced  is the adhesive,
which occasions an adhesion  between the inflamed part of an in-
testine and the peritoneum lining the cavity, which remains, although
the inflammation should  stop  here; but if it does not stop  here,
then the suppurative takes place,  and an abscess is produced, the
matter of which is collected into a regular cavity in these adhesions,
and is prevented from diffusion through the cavity of the abdomen
by the effects on the surrounding  parts, by the preceding adhesive
inflammation, as well as of that which accompanies it.  This matter,
by its pressure, irritates, and absorption takes place in consequence;
but  as none of the parts, except those between  the matter and  the
skin, are hardly, if at all, susceptible of this irritation, no parts  are
absorbed but such as are so situated: hence the abdominal  muscles,
cellular  membrane, fat, and  skin are removed  in preference to the
coat of the intestine. If the suppuration had at first begun in different
points, the parts between are absorbed until it becomes one abscess;
and when it reaches the skin we have the ulcerative inflammation.
It is in the  same manner that Nature  acts in all abscesses of cir-
cumscribed cavities, as in  common abscess, inflammation of the
lung of  the side  next  the pleura, of the  pleura itself, gall-bladder,
liver, &c.; also in the case of lumbar abscesses.   In the substance
of the lungs we sometimes find abscesses go on  in a different  man-
ner, and open into the cells, and this because the adhesive inflam-
mation finds it difficult to connect the  air-cells  together;  and that
the  air-cells do not take on the adhesive inflammation is evident 
202
HUNTER'S PRINCIPLES OF SURGERY.
from many observations.   Whilst a part is under the  ulcerative
inflammation, irritation will increase the  absorption on any part of
its surface.  Thus, if a large abscess forms on the thigh, opposite
the great trochanter, we shall  find that, from the  pressure of the
trochanter on  the part opposite to it, ulceration will take place
there likewise.   An irritation we have of the same  kind in milk
abscesses, from the irritation of the matter in a depending part of
the abscess, which shows how very easily, from the slight pressure
of matter, the ulcerative process may be  produced.   Ulceration is,
therefore, no more than a process by which parts are removed out
of the way of pressure.  The ulcerative process has no  effect on
the cuticle; but in general this  is so thin  as not to give any trouble,
as it easily bursts.  But on the fingers and hands of working people
it becomes so thickened as  to cause  excessive pain and  trouble in
whitloes; and as from this cause we have so considerable a sepa-
ration between the cuticle and  the  skin,  these abscesses  should be
opened early.  Poultices  in these cases are more useful than in any
other, for their moisture is absorbed by the cuticle as by a sponge,
and the cuticle is rendered  more dilateable.  After these have been
opened, or have  opened of themselves, by a  small  orifice, the  soft
parts lying under are apt to push through the  opening, and appear
like a fungus, occasioning great pain, which is owing to the cuticle
around  the  granulations  underneath.  To this escharotics have
been applied; but it would appear that there is  no necessity for
them, as  it would disappear of itself when the thickening of the
parts  in consequence of inflammation has gone off.  But besides
ulceration, the consequence of previous suppuration, which we have
been hitherto describing, we have ulceration taking place where no
reason  can be assigned  for it, except  perhaps weakness  be  the
cause, the parts not being able  to support themselves. New parts
are more susceptible of it  than old, as cicatrices, stumps, calluses,
&c.  This arises from the new parts being less firm than the old
original  ones, as in Anson's voyage, when  there  was a general
debility from  the change  of climate, &c.  The  appearances of
ulceration are different at different times, according as the process
is  going on, at a stand, or the parts healing.  The ulceration in the
small-pox is attended with death  in the parts, hence loss of sub-
stance and pitting.
   Restoration of  Parts.—We are  now to  trace the operations of
Nature  to bring  parts  back as near to their original formation as
possible.  These  operations cannot  be looked on as morbid, as they
are for a  salutary purpose.
   Granulations.—These have, I believe,  in general been  supposed
to be a  consequence of, or  an  attendant  on, suppuration ; but  the
formation of granulations is not confined to a breach of the solids
allowed  to suppurate, as from  accident,  or a breach of the solids,
produced in consequence of suppuration, as in  abscesses ; but it
takes place under  other  circumstances, and when  the  first  and
second bond of union have  failed, as in simple fractures. 
OF SUPPURATIVE INFLAMMATION, ETC.
203
  I believe no  internal canal can granulate in consequence  of
suppuration, except there have been a breach of continuity.   And
here I may observe, that when granulation does  take  place  in
such a canal, it is not on the proper coat of the canal, but on the
surrounding cellular membrane.   Few surfaces of abscesses gra-
nulate until opened, either of themselves or by  art; therefore  in
abscesses of very long  standing we seldom or never find granula-
tions.
  In most abscesses, if not in all, after they are opened, there is
one surface more  disposed  to granulate than the others, which is
the surface next to the  centre of  the body in which suppuration
takes place, the surface next to the  skin  hardly ever having the
disposition to  granulate ; on the contrary, it is sometimes ulcera-
ting when the bottom of an abscess is granulating.  Exposure is
so far necessary for granulations, even in  cases where  there is an
opening, that if the opening is only a small one, and the  abscess is
deeply seated, the latter will not  so readily granulate, which often
becomes the consequence of deep-seated  abscesses not healing.
  I have said that granulations are not confined to a breach of the
solids attended with suppuration ; for parts are capable of making
new matter internally in cases where union by the first intention
ought  to have occurred.   A case in St. George's Hospital first
gave  me this idea.
  I was called  to a man with a  fractured  thigh, and made use of
the usual means, but without success, for no union of the  fractured
parts was formed  in the usual  time ; and about the end of four
weeks the man died with another  complaint.   Upon examination
of the parts, I found that the upper end of the bone rose consider-
ably over the under, and consequently there was a great cavity in
the soft parts, the parietes of which were thickened by the adhesive
inflammation, though not so much  as if  the parts had been better
disposed  for the adhesive inflammation.  There was no extrava-
sated blood, nor matter, nor coagulable  lymph to be found, except
a few threads, which were  probably the remains of extravasated
blood.  Here the  parts  had lost two chances of being united, the
one by the extravasated blood, the other by the coagulable  lymph
thrown out by the adhesive inflammation ; and Nature had begun
a third, which was  that of forming  granulations  of new  animal
matter on the ends of the bone and the surface of the surrounding
cavity;  and adhesions,  you see, had taken place between the bones
and soft parts, by which the bones would have been united by a
bony case.   Hence we find that granulation may take place with-
out the parts being exposed, and without suppuration.*
   This  mode of union by  granulation  is,  I  believe, much more

  * [The effusion of callus in this case does not seem to differ essentially from
the effusion of callus in other cases.  It cprtainly cannot be regarded as a con-
clusive proof of the existence of  granulations without suppuration and exposure,
although these do. sometimes continue to form after cicatrization, as in burns and
eome other cases.] 
204           HUNTER'S PRINCIPLES OF SURGERY.

extensive than has been imagined; this third  bond of union taking
place where the parts have missed the first and second, as just men-
tioned.  In the exposure of cavities of abscesses we  have granula-
tions going hand in hand with, and following suppuration.  As the
suppurative  inflammation follows injuries  with exposure, it seems
that this inflammation is in general necessary to granulation in these
cases.
  Granulations are an  accretion of new  animal substance on the
surface of a wound, or a newly-formed surface composed of coag-
ulable lymph exuded from  the vessels, into which new substance
the old vessels probably extend, and entirely new ones are  formed,
so that the granulations come to  be  very  vascular, more so indeed
than any other particular animal substance.   The vessels pass from
the original parts to the base of  the granulations, and from thence
to their outer surface.   The surface of this new formation continues
to have the same disposition for the secretion of pus as the parts on
which  they are formed had; therefore it is easier to suppose that
the nature of these vessels  does  not  alter  by  forming granulations,
but they are completely changed for this purpose before granula-
tions are begun  to be formed, and that these granulations are the
consequence of the change.  They always  also are of the  same
nature with the parts on which they are formed : if a diseased part,
they are diseased ; if the disease  be  of any specific kind, they are
of the same kind and  produce similar matter.  The  surface of the
granulations is convex,  being just the reverse of an ulcerating sur-
face, which is thus, as it were, shagreened by a great many points
or small eminences: the smaller  these points  are, the more  healthy
the granulations.  The colour of healthy granulations is a florid red,
which would make us suspect that it is principally owing to arterial
blood; when they  are of a livid  red  they are most commonly un-
healthy, and have a  languid circulation in  them ;  however, this
appearance  frequently is owing to the particular position of the
parts.  I knew an instance  of this in a young man  who had a gran-
ulating wound on his  leg.   I was surprised to see it  on  some days
of a healthy scarlet, and on others quite livid; but the cause of this
he explained to me, by showing that if he kept it in a  recumbent
posture for a short time, its surface  was  then of a bright  scarlet,
but if he stood for a few minutes it would become quite livid.  This
appearance must have arisen from  the stagnation  of blood in the
newly-formed vessels, and from their not possessing sufficient strength
to resist  the  superincumbent column of blood, which  sufficiently
accounts for the difficulty  of healing sore  legs when patients are
allowed to stand or walk much.
  Granulations not only show the state of the  part on which they
are formed, but also how far  the constitution is affected in many cases.
The  chief of those which affect granulations are the irritable and
indolent habits, and, still more,  fevers, which  must be of such a
nature as to produce universal irritation in the constitution.
  Granulations have a disposition to  unite with  one another, which 
OF SUPPURATIVE INFLAMMATION, ETC.
205
is absolutely necessary to healing; and this is done, I suppose,  in
the following manner : when two granulations meet, the mouths  of
the opposing vessels are irritated, which  causes them to embrace
each  other; this junction perhaps being aided by the attraction  of
cohesion, or they may throw out coagulable lymph, and unite in that
way.  I have seen granulations from the dura mater and scalp unite
so closely in twenty-four hours as to be with difficulty separated,
and then to bleed very freely, which shows their great disposition
to unite.  When  the  parts,  and consequently the granulations, are
not sound, there is not this disposition to unite, and a smooth surface
is formed, which  continues to secrete pus.  I conceive the  internal
surface of a fistulous sore to  be of this nature, and somewhat similar
to the urethra in  gleet.   Ulcers of this  kind are cured by exciting
inflammation in them.
  Granulations have  less powers  and shorter lives than originally
formed parts.   Different animals have different periods of life, and
so have granulations, and sometimes they seem to be formed with
a short period of existence.  They often die and slough off without
any visible cause, and,  coming down to the original parts, a fresh
crop of granulations is formed, which in a certain time will again
slough off without any apparent change  in the  constitution.
  Many small wounds would perhaps do much better without any
dressing.   The blood, coagulating and  drying, forms itself into a
scab, which falls off and shows that Nature  has  completed her
work under it; the same will often happen when small suppurating
sores are suffered to dry. This is a circumstance not attended to,
perhaps, as much as it ought: even compound fractures with a small
opening, if suffered to proceed in this manner, will  often give but
little trouble.  In blisters, where the cuticle  is not removed, the
process is exactly similar.   It would be a great advantage to us
to ascertain what sores require dressing, and what do  not.  I be-
lieve  all  cutaneous  sores do best without dressing;  excoriations
and little  pimples had best be left to themselves, for often when ap-
plications are made to  any  of these, a  hundred little  pimples will
sprout up: when  this is the  case, I make it a general rule to desist
from any application.
  A young gentleman had a small pimple on  his leg, to which  a
little ointment was applied, and in  a day or two the  surrounding
parts were covered with similar pimples : these, being treated with
similar applications, spread,  until the  whole leg was covered with
them.  When I was  consulted, and  asked what was  to be done
—" Nothing."   " How is that ?"  " Can anything be easier ?"  I
said ;  " do nothing to the leg."   " Then  the stocking will  stick to
it."  " Let no stocking be worn: put the boy on a pair of trousers."
The advice was taken, and  the leg dried up and healed directly.
  Cicatrization.—Immediately on  the formation of granulations,
cicatrization would seem to  be in view;  contraction is  going on in
every part, but principally from the edges to the centre, so that the
sore becomes very small, without much  new skin.   This contrac-
                              18 
•206           HUNTER'S PRINCIPLES OF SURGERY.

tion is easiest effected on loose parts, but with difficulty when over
bones, as on the scalp, shin-bone, &c, where the granulations can-
not contract much.   This observation should  direct  us, in  opera-
tions on such parts,  to leave as much skin as possible.  This con-
traction continues until the whole is skinned over ;  but their greatest
power, or at least their greatest effect, is at first.  This contraction
can be assisted by art, which shows there is a resistance;  this is
done  by bandages, but these should be avoided at first, while there
is inflammation, and until granulations are formed, otherwise  they
might prevent the granulations rising.  Besides the contractile power
of the granulations, there is a similar power in the surrounding edge
of the cicatrized skin, which assists the power of the granulations,
and is often greater than that of the granulations;  this may  be seen
in sugar-loaf stumps, where the skin grows round  and embraces
the granulations like a ring, appearing to squeeze them out; but it
is only in the  new skin, the old being loose all round.  This con-
tractile power prevents the necessity for so much new skin, the
surrounding old skin  being drawn over the parts.   The advantage
of this is very evident, the original skin being more fit to live than
the new, and less liable to ulceration.  As the granulations contract,
the old surrounding  skin  is stretched, and  is probably elongated.
If it is elongated, it must be so by the interstitial deposition of new
matter.
   Of Skinning.—When a sore begins to heal, the old skin, which
had been inflamed, then becomes  whitish, and especially near the
 edge:  this is one of the first appearances of healing.   The new
 skin  is a very different substance with  respect to texture from the
 granulations on which it  is formed; but whether it is  an addition
 of new matter, or a change in the surface of the granulations them-
 selves, is not  easily determined.  We find new skin generally taking
 its rise from the surrounding old skin, as if elongated from it; but
 that  is not always  the case, for in very large old ulcers, where  the
 edges of the old skin have but little tendency to contract, new skin
 forms in different parts of the ulcer, standing on the surface of the
 granulations  like little islands.  These little specks  show that the
 ulcer is healing slowly, and it seldom or never takes place  the first
 time a part is ulcerated ;  but the old surrounding  skin  assists  by
 shooting towards the new.  The granulations may perhaps acquire
 a disposition  to skin from their being in the neighbourhood of the
 old skin, but  it is plain they can take on this disposition without that
 assistance.
   Skinning is a process in which  Nature is always a great econo>
 mist.  We never find that new-formed skin is so large  as the sore
 was on which it was formed.   This is brought about by the con-
 traction of the granulations, which in some measure is in proportion
  to the quantity of the surrounding old skin.  If a sore be in a part
  where the surrounding skin is loose, as the scrotum, the  contractile
  power of the granulations being not at all prevented, very little new 
OF SUPPURATIVE INFLAMMATION, ETC.
207
skin is formed ; whereas if the sore is on a part where  the skin is
tight, as the scalp, the new skin is nearly as large as the sore.
  Nature of  ihe newly-formed  Cutis. — When granulations  are
formed near a bone, the skin is at first fixed ; but it  gradually be-
comes loose, from  elongation, by continued attempts  at motion.
Motion given to the part  so affected must  be mechanical, but it
becomes a stimulus by which the parts become conscious of their
not being able to exist as they  are, therefore the  lymphatics  set to
work to absorb all the adventitious substances which prevent their
motion.  Medicine has  not  as much power  as we  could wish in
assisting this process ;  however, mercury seems to have nearly the
same  effect  as  motion, especially when  combined with  camphor,
and should be used.  When  everything else  fails, electricity may
be tried, for it has restored the motion of parts after they have been
fixed from inflammations  after strains.
   The newly-formed skin has no indentations, or lozenge-shaped
marks, on it,  like the old,  nor  has it the living principle so strong.
The  new cutis  is at first very vascular,  but  afterwards becomes
less so,  the vessels perhaps being obliterated,  or converted  into
absorbents, and so becoming white.
   Cuticle.—That formed on the new  cutis is  at first horny, but
 afterwards shining.  It is  sooner restored than the cutis, and  is
 formed at once from every  part of the cutis.
   Rete Mucosum.—This is much longer in forming than the cuticle,
 and  sometimes is never recovered, as we see in wounds,  blisters,
 &c, in blacks, their skin  in that part remaining white for ever.

   Effects on  the Constitution.—I have divided diseases into
 local and constitutional; and when on local, I observed that they,
 and especially inflammation,  had secondary or sympathetic affec-
 tions, which were immediate  or remote.   The immediate were
 considered when on inflammation, namely, the sympathetic fever.
 The remote are now to be  treated of.
    One would suppose that  the suppurative would only so far affect
 the constitution as by the preceding inflammation which produces
 it; but  the  contrary is  sometimes  the  case, and the suppurative
 will produce worse symptoms than the inflammation itself.  The
 condition which the constitution takes on after suppuration is some-
 times productive of those diseases termed  nervous, as locked-jaw,
 hysteria, spasm on  the muscles of respiration, restlessness, debility,
 &c, all of which seem  to arise from the suppurative action, and
 are not salutary effects, but harass the constitution and even pro-
 duce death.  The  locked-jaw I shall defer for the  present, and
 consider hectic or sympathetic fever.
    Hectic fever is a remote constitutional sympathetic  affection, and
 appears to have  a very different  origin  from the other remote
 sympathizing effects, though in general the consequence of a local
 disease.  It is the constitution affected  by a local  disease, pr irri-
 tation, which it is conscious  it cannot cure; for while the inflam- 
208           HUNTER'S PRINCIPLES OF SURGERY.

mation lasts, which is only preparatory to  an immediate effect of
most injuries, in those parts at least which can most affect the con-
stitution and call up her powers, there can be no hectic.
  It takes  its rise from  a variety of causes, which I shall divide
into two:  1st, From an  affection of  vital parts; 2d,  From  an
affection of parts not vital.  The only differences between these is
in the time of the hectic's coming on", and its rapidity and violence
when it does come on.  In vital parts, hectic will be produced by
many complaints which will not produce it  in other parts, as
scirrhus of the stomach or mesenteric glands, also diseases of the
lungs or liver.  These also produce other symptoms, according to
the nature of the  part injured and of the injury;  as coughs, when
in the lungs; sickness and vomitings, when in the stomach; drop-
sies and jaundice, when in the liver.
  When the  hectic arises from disease in a  part not  vital, it is
generally in parts where such a quantity of mischief can take place
as to  make  the constitution sensible of it,  as the large joints.  In
small joints, although the same  local effect takes  place as in large
ones,  yet the constitution is not  made sensible of it, so that we find
scrofulous joints of the toes, &c, not affecting the constitution with
hectic, and the  ankle,  elbow,  and  shoulder are  much  longer in
affecting the constitution than the knee or hip.
  Although hectic  commonly  arises  from some incurable  local
disease of a vital part, or of a  common part  of  some magnitude,
yet it may be an original disease of the  constitution; the consti-
tution may fall into the same action without any local  disease
whatever.
  Hectic may be said to be a slow mode of dissolution; the general
symptoms are those of a low  or slow fever, attended  with weak-
ness ; but more the action of weakness than  real weakness, for on
the removal of the  part causing the hectic  there is immediately
the action  of strength produced.  The particular symptoms are:
debility; small, quick, sharp pulse; the blood forsakes the skin; there
is loss of appetite; often vomiting; wasting; tendency to  sweating,
especially when in bed; constitutional  purging;  urine clear at one
time, and  at  another depositing a  branny  brick-dust   sediment;
dissolution.   This disease has been supposed to arise from absorp-
tion of pus;  but I have  long   thought that the blame  has been
improperly laid to the absorption of pus, and the following facts
will make this evident.  First,  hectic takes place where there is
disease, and no suppuration in vital parts;  also in many inflamma-
tions before actual suppuration  has taken place, as in many of the
large joints, called white swellings, while the same kind and quantity
of inflammation and suppuration in any of the  fleshy parts,  and
especially such of them as are  near the  source of the circulation,
have in general no such effect.   Therefore  in  such cases it is only
an effect on the constitution, produced by a local complaint having
a particular property.
  I have said that with all diseases of vital parts the constitution 
OF SUPPURATIVE INFLAMMATION, ETC.        209
sympathizes more readily than with many other parts; and also
all diseases of vital parts are more difficult of cure than those not
vital; as also diseases of bones, ligaments, tendons, affect the con-
stitution  more readily  than  of muscles,  skin,  cellular  membrane,
&c.;  and we find these general principles hold good in universal
remote sympathy with  local disease of those parts and structures.
  When a disease is in  the vital parts, and is such as does not kill
from the first constitutional  effects, then  the constitution becomes
teazed with the complaint, which is destroying the necessary actions
of health which are  vital.  In diseased joints there is not a proper
power, or rather, perhaps, disposition to  produce salutary inflam-
mation and suppuration for their recovery; therefore the constitution
is irritated with an incurable disease.
  If absorption of pus  always produced  such  symptoms, I do not
see how any patient who has a large sore could escape this disease,
because we have as yet no reason to suppose that any one sore has
more power of absorption than another.   If in those cases where
there is hectic the absorption of pus is really greater than when the
habit  is  healthy, it  would  be difficult to determine whether the
increase of absorption is a cause or effect.  If it is a cause, it must
arise from a particular disposition of the sore to absorb more at one
time than at another, even while in a healthy state.  What reason
we have to suppose that a sore in a healthy constitution has power
to absorb more at one  time than at another, I  do not see.   If this
increase of absorption does not depend on the nature of the sore, it
must take its rise from the constitution; if so, there is a peculiarity
of the constitution ; therefore the whole of  the symptoms cannot arise
from the absorption of pus, and the cause must be a peculiar con-
stitution and absorption combined.
  If the absorption of matter produced such violent effects as are
ascribed, which are never of the inflammatory kind, but of the hectic,
why does not venereal matter produce the same effects ?  We often
know that absorption is going on  by buboes  taking place, yet  no
symptoms appear until the matter  appears to  produce  its  specific
effects, and these symptoms are not very similar to those called
hectic, though from reasoning we should expect that venereal matter
would act with more violence than common matter from a healthy
sore.
  Again, as matter is often formed on the inside of veins in inflam-
mation of those  cavities, and this  matter enters directly into the
circulation, why have we not the hectic symptoms in these cases
We have the inflammatory, and sometimes  death.  We also find
the  matter of large abscesses which have been produced  without
visible inflammation, such as many of the scrofulous kind, wholly
absorbed, and that  in  a very short time, yet no bad  symptoms

  From all these facts and reasonings we may conclude that the
absorption of pus from a sore cannot be the cause of so much mis-
chief as has been generally supposed.   If it was owing to matter in
                              18* 
210           HUNTER'S PRINCIPLES OF SURGERY.
the system, I do not see how the  symptoms  could ever stop until
suppuration ceased; yet we often do find that they get well before
suppuration ceases, even when no medicine was given;  and in the
case of inflammation of the  veins, there is reason to  believe that
after all the bad symptoms are gone suppuration is still going on, so
that though matter is still passing into the constitution from the vein,
hectic is not produced, which it must be if it was  caused by matter
getting into the circulation.
  But I much doubt the fact  of absorption going on more in one
sore than  another.  In large abscesses hectic seldom comes on till
they are opened, though they have been forming matter for months.
In such cases the disposition often comes on soon after opening the
abscess:  in others very late; but till the stimulus  for restoring the
parts is given no such effect can take place.   If the parts were dis-
posed to heal, no such hectic disposition would come  on. In diseased
joints also, if the parts  are capable of taking on salutary  inflam-
mation we shall have only the first sympathetic inflammatory fever;
but as they seldom do this, the constitution is teazed by the complaint
not taking on immediate and salutary steps towards a cure.   Hectic,
therefore, would appear in some measure to depend on the parts
being stimulated to produce an effect beyond their powers, and this
stimulus is sooner or later in taking place.
   Treatment of Hectic.—We have as yet, I am afraid, no cure for
this.  I believe the cure consists in the removal of the  cause, viz.:
the local disease.  Strengthened and antiseptics are recommended.
Strengtheners are proposed on account of the debility, which has
evidently taken  place;  and antiseptics, from the  idea of absorbed
pus giving the blood a tendency to putrefaction.  To prevent, both
these effects taking place the same medicines are recommended,
namely, bark and  wine.   Bark will in most cases  only assist in sup-
porting the constitution; I should  suppose it could  not cure the con-
stitution of the disease; however it may render it  less susceptible of
it.   When  hectic comes on from  some  specific disease, as from
venereal irritation, the bark will enable it to support it better than
it otherwise would have done.  Wine, I am afraid, rather does harm,
as it increases the action of the machine without giving strength, a
thing to be carefully avoided.  However, I have  not yet made up
my mind  about wine.
   When hectic arises from the disease  of such a part as the system
can bear the loss of, the  part should be  removed.  On  removing
the cause (as by amputation of an extremity,) the  pulse, from being
very quick, returns  to its usual state; I have likewise knowm the
patient sleep the first night without an opiate, after having had little
or  no  sleep for a week before, and  the sweats called  colliquative
have been stopped; and I have known purging immediately to stop.
Perhaps the pain and newly excited action of the constitution may
assist in the abatement of the symptoms.
   Of Dissolution.—To  the hectic I have joined another  disease, 
PRACTICAL ILLUSTRATIONS, ETC.
211
arising from suppuration, which I have called dissolution, because
few recover from it.
   It may arise  in long-continued suppurations, which may not be
incurable in themselves, and in this it differs from hectic.  Dissolu-
tion seems more the effect of the past than of the present, which is
the reverse of hectic.  We never find this take place in consequence
of small wounds, or such as  affect the constitution but little, but
rather after bad compound fractures, amputations, &c.  It appears
more in hospitals  than in private practice; more in large towns
than in the country.  In cases of compound fractures and amputa-
tions,  we  find the constitution often capable  of going through
the inflammatory  sympathetic  fever, producing suppuration and
granulation, and continuing this for some time,  yet  sinking under
them at last, and often without any apparent cause, the effect taking
place  more readily if the patient was in full  health  before the
operation, than if he had been for some time accustomed to hectic
symptoms.
  " The first symptoms are generally those of the stomach,  shiver-
ing ;  vomiting immediately follows, if it does not accompany  it;  a
small quick pulse; perhaps bleeding from  the whole surface of the
sore:  often mortification and  speedy dissolution.  Here is  a very
fatal disease taking place in  some almost immediately, and when
everything  appears to be within  the powers of  the animal.   It
therefore cannot immediately arise from the sore itself: yet the sore
 certainly assists, because we never see the disease take place where
 the sore is healed.
    The removal of the local disease will not prove effectual for the
 cure of this as it does  that of hectic, nor do I find anything that has
 any effect.
                        CHAPTER XV.

       practical illustrations  of the preceding subjects.

Union of a broken tendon ;—rupture of the tendo-Achillis ;—principles of treat
  ment;—impossibility of causing  voluntary contraction of the  rnuscle ;—
  management of the injury ;—pain and inflammation triflings-length of cure.
  —Empyema;—varieties of contained fluid ;—symptoms differing;—ultimate
  effects of contained fluid the same;—to be distinguished from disease of the
  heart.—Symptoms of the disease peculiar;—general;—sympathetic—Opera-
  tion— After-treatment.—Pericarditis.—Adhesion;—suppuration  fatal— Em-
  physema  from  fractured rib ;—operation  to  be avoided.—Peritonitis ;—
  symptoms;—rapid progress;—true and erysipelatous.—Puerperal, not  from
  inflammation of the uterus;—causes ;—arising after tapping.—Hernia.—bava-
  rian section.—Opening cavities of joints.—Ganglions.—Inflammations ot the
  eye—Phlebitis following venesection ;—causes ;—extension;—frequency in
  the horse.—Arteritis.

   Union of a broken Tendon.—The treatment  of a  broken tendon
is very similar to the treatment of a fractured patella, because 
212           HUNTER'S PRINCIPLES OF SURGERY.
 their  uses,  and in  some  degree  their situations,  namely,  the
 giving way of an intermediate substance between the  power (that
 is the muscles,) and  the resistance.  All come under  one general
 principle of  cure, though the mode of  treatment  is somewhat  dif-
 ferent.
   These intermediate parts are principally tendons, probably some
 ligaments, and bones.  The fracture of a tendon is probably always
 produced by the power being in action, and the resistance counter-
 acting at the same time and with great velocity.  We might sup-
 pose that every tendon in the body would be liable to such accident,
 but  I believe there is only one that stands any chance of such effect
 by the natural  exertions of the  body; this  is the tendo-Achillis.*
 There is also, probably, but one bone in the human body which can
 be broken in  the same way, that is the patella;  though there may
 be instances of processes of bone being turn off near their insertion,
 which would be somewhat similar.
   The tendo-Achillis seems liable to be broken by the natural actions
 of the body, from having at the same  time to sustain the action of
 the power and of the resistance also.  When it has only the action
 of the  muscles  to contend with, there  is no danger of its rupture,
 because the tendon is capable of supporting a much stronger power
 than that of the muscles.   Though the tendon is continually in this
 state, yet there is little danger, because when the action is voluntary
 all the actions tend to support one  another; but in a careless un-
 guarded action  the motion is more violent and quick, and the part
 less  prepared against it.  I believe fracture of this  tendon often hap-
 pens when a  person is fatigued and  off his guard, as after dancing,
 &c, and after  the  muscles have acted  spontaneously,  as in  the
 cramp;  at least it happened to me after dancing, and after a violent
 fit of the cramp.  The general principle of cure in parts displaced
 is the replacing them in their natural situations, which is the whole
 cure in some, as dislocations, and the first step to be taken in every
 case where the continuity of parts is broken.
  When the tendon is broken it is seldom attended with pain in the
parts.   It commonly gives a pain, which instantly seizes the calf of
the leg.  The noise or snap which it produces gives no idea of the
mischief done; but being at the same  time attended with  pain in
the calf of the leg, and the patient not being able to walk as usual,
he conceives that some one has struck him with a hard body on the
calf, and if he is so  situated as not to have been liable to a blow*, he
becomes puzzled to conceive what can  have happened.    We gen-
erally find that the muscle is thrown  into a state of cramp when the
tendon gives  way, losing the power of relaxation by the will, or of
itself.  As a surgeon is seldom present when such an accident hap-

  * [This is a mistake: the tendons of the patella, triceps  extensor  cubiti, and
quadriceps extensor cruris are sometimes ruptured from a sudden and abrupt
exertion of these muscles.  An example of  the  latter kind is at this moment in
one of the wards of St. George's Hospital.   I may also mention that fiactures of
the collar-bone, from muscular exertion, are not very uncommon.] 
PRACTICAL ILLUSTRATIONS, ETC.
213
pens, it is often allowed to remain some time in that state; but the
pain often leads to the right mode of cure, the patient squeezing the
muscle down with his hands, which a surgeon should do if at hand.
The broken ends will always at first  be some distance from each
other,  because they are pulled apart by opposite forces.
  The parts should be allowed to remain nearly in their natural posi-
tion; no inconvenience will attend a small separation of the broken
ends of the tendon, namely, half an inch or so; whereas considerable
disadvantage would arise if we were to  push the two broken ends
together by throwing  back the heel  (which has been the general
practice).   The only circumstance that would seem to forbid such
practice, namely,  letting the broken tendons remain without a ban-
dage,  is, that the  muscle will lose half an inch of its power of con-
traction, which the motion of the ankle may or  may not lose; but
though this may be  lost  at  first, we know muscles will acquire it
again  afterwards, and therefore no attention  need be  paid  to this
objection.   The advantage  of not throwing  the  heel  up, and  of
allowing the tendon to heal nearly in its natural position is, that the
patient may be enabled to walk from the very beginning of the cure,
a very desirable circumstance.
   However, it is not necessary to adhere rigidly to either of these
 modes of treatment, but to adopt a medium between the two, which
 will be best.  The heel may, therefore, be  a little raised during the
 time of walking only, by raising the heel of the shoe. A roller should
 be passed several times round the calf of the leg, and kept constantly
 applied, as we cannot guard against the involuntary actions of the
 muscles ;  and at night we may apply an apparatus consisting  of a
 leathern slipper or sock, with a strap from the heel to be fixed to a
 belt, in order to steady the muscles.                       .
    When the tendo-Achillis is broken, there is but very little  inflam-
 mation attendant;  but  some  general fulness  comes  on about the
 small of the leg and ankle,  the skin looks dark from the effusion ot
 blood, and the parts have a firm feel, from coagulable  lymph being
 thrown out.  This firmness of the cellular membrane increases near
 to the fracture laterally, and this assists in  keeping the tendon in its
 place.  The  inflammation hardly requires any particular treatment
 when the foot is in a proper position.
    As I would not restrain the patient from walking almost from tne
 very  beginning, (the inflammation may prevent it for the first day or
 two,) it is necessary to give him some directions how he is to manage
 the muscles under the cure, as walking  cannot be performed in the
  usual way.  I have recommended to  keep the  position ot the toot
  nearly at a right  angle with the leg, as in standing, but not quite so,
  the heel being a little raised, by some pieces of leather put into the
  shoe, which may be removed one by one.   When he walks  he must
  turn  his toes out, and carry the inside of his foot forwards  without
  attempting to bend the joint of the knee; indeed, the  latter  precau
  tion  is unnecessary, for this motion is only necessary when thehee
  can be raised from the  ground, which he cannot do.   1 his toot win 
214           HUNTER'S PRINCIPLES OF SURGERY.
be for some time the leading foot in  walking, for it will be an easy
motion to set it forwards  before the other, especially if  the heel is
not much raised; but it will be impossible to set the other foot for-
wards and leave this behind.  The patient will be hardly able to
mend his pace for two months, except it be by getting familiar with
his present mode of walking.  The ankle and foot will swell occa-
sionally, especially in the evening; and this may continue more or
less after the tendon is united, but is of no importance.   Three or
four weeks after the accident he may  remove  the  roller from the
calf of the  leg, and about the same time leave off the slipper at night.
We cannot say when he may use the muscle of this tendon:  that
will  depend on  the  fitness  of the  tendon to  be used, which can
only be known by the power the patient  has  of putting  it to use.
About two months after the accident we  find him gradually bring-
ing his  toes  more and more forwards, until he at  last walks  as
usual.*
  It is impossible for a patient with  a fracture of the tendo-Achillis
to act with the gastrocnemius and soleus  muscles, if he were to try
to do so.   When the Duke of Queensberry broke Tiis tendo-Achillis
he was immediately aware  of what had happened, and pointed out
to me the  broken ends.  He  readily submitted to  my reasoning:
walked about his room as well as he could, and found it impracti-
cable to contract the gastrocnemius muscle. Some surgeons thought
the tendon could not be broken, because he was walking about his
room; but in such a case the patient has no more power to contract his
gastrocnemius and soleus muscles than to jump over St. Paul's.
  Of simple Fractures.—A  fracture is the solution of continuity of
a bone, whereby  more  or  less of  a cavity or space  is allowed
between the broken parts.    It often, if not always, happens that
the surrounding soft parts are also torn by the broken ends of the
bone.  On the surface of this broken or  torn  part  are the mouths
of many ruptured vessels, which immediately fill the cavity writh
blood.  This is  the  first stage of the bond of union.  This  blood,
having the living  principle  in it, unites with the  torn surfaces, in
the  same manner as in ingrafting the living parts of animals.   An
inflammation generally comes on, similar to that which produces
adhesions where there is no ruptured vessel, which is of service in
this case for the better union of surrounding parts, where extrava-
sated blood  cannot  enter,  by which means the callus  becomes
larger than it would otherwise be.   Vessels are either continued
from the old parts into  this  extravasated  blood, or it forms  new
  *  [The period of perfect recovery is generally protracted several months before
the ultimate organization of the  uniting medium is effected, in consequence of
the low powers of vitality  which tendinous parts possess.  Simple  incised
wounds of tendons, as in amputation, are observed to heal without  difficulty;
but the union of ruptured tendons is a much slower process, depending upon the
slow reproductive powers of these parts.  At first the union is by cellular mem-
brane, which gradually  becomes  harder and tougher: very  often  it becomes
osseous, as in  Mr. Hunter's  own case; but very frequently it remains a fibro-
cartilaginous knot, which never assumes the tendinous character.] 
PRACTICAL ILLUSTRATIONS, ETC.
215
vessels in its own substance;  this substance then goes through the
regular stages of ossification, becoming first cartilaginous and then
bony.   Thus 'new parts are formed and old ones  united without
the occurrence of any considerable inflammation, and all owing to
this circumstance of the extravasated  blood being  preserved, and
allowed to retain its living powers.  All the surgeon has to do in
such cases is to put the parts as much into their natural situation
as possible, and to keep them there by art in the easiest way to the
patient that he can.  The same idea and the  same  practice is
extended to all unions by the first intention.
   The position of  the  patients  themselves, when  the fracture is in
the lower extremities, (abstracted from the nature of the fracture
itself,) has been of late a consideration.  It has been  a question
whether they should lie on their backs  or on their sides.  I am in-
clined to prefer the back; for, from the  experience of one patient,
who had the same thigh-bone broken twice, lying on the back was
the easiest, though it was the last, method of lying:  and I conceive
that it is a position that can be  borne longer than that on the side.
   The pain arising from fracture  is but little, only from the bones
either tearing or wounding the soft parts.   The inflammation is of
course but little, if the parts have not been violently torn.
   Of  Compound Fractures.—If the violence of the fracture has con-
tinued the laceration through the skin, so as to have  allowed part
of the blood to escape, and to have exposed the remainder sufficiently
long to allow  it to lose its  living principle, so  as to  become an
extraneous body, unfit for the purposes of union, then the suppura-
tive inflammation must take place, and granulations finish the  union
which the blood was incapable of doing.  In this case the granula-
 tions become the origin and seat of formation of the callus, and go
through the regular changes until they become ossified, as was the
 case with extravasated blood  in  simple fracture.  In  these  cases
 considerable fever  and  inflammation, proportioned  to the local
 injury, come on.
   There  are two cases which partake of the nature both of simple
 and  compound fracture.  The first is, where the injury was a
 simple fracture at first but afterwards  becomes a compound, which
 I shall call the simple  compound fracture;  the other is when the
 fracture  is a  compound one  at  first, but  the external wound so
 small, and the soft  parts having sustained  so  little injury, as to
 require very little different treatment from  what happens  in the
 simple fracture; and this kind I call a compound simple fracture.
    Of the Simple Compound Fracture.—This is owing, in some cases,
 to some part of the  extravasated blood losing its living principle,
 and then  acting as  an extraneous body ;  in others it is owing to
 the sharp end of the bone pressing against the inside of the skin and
 causing it to ulcerate.  In these  cases we see inflammation come
 on, at first, as in simple fracture, with  that mildness which generally
 attends such cases;  but some days after a stimulus is given  by the
 broken pieces of bone, or  by the blood  which has  lost its living 
216         HUNTER'S PRINCIPLES OF SURGERY.

principle, or from the parts being beyond the power of union by the
first intention, and the suppurative inflammation comes on.
   The cases which I have seen of this kind have been much less
dangerous than fractures that were compound from the first.  The
only reason I can assign for this is, that the whole of the blood pro-
duced from the lacerated parts does not lose the living principle, so
that a considerable portion becomes so much a part of the  living
solids during  the first  few days as to be able  to keep its ground,
only a portion of it acting to produce the suppurative  inflamma-
tion, which is therefore less.
   The treatment of the simple compound fracture is  very simple:
the limb  may be bound up in general  as in a simple fracture, with
splints and  a  roller, only  leaving a free space for  the  change of
dressing and to keep the parts clean.
   Of the Compound Simple Fracture.—The effect of this is similar
to the foregoing, though the cause is different.  There are cases of
compound fracture where the wound in the skin is but very little at
first.  If the broken ends of the bone have not done much mischief
to the soft parts, and only made  a small wound in the skin, they may
be treated  as  simple fractures, which gives us an opportunity of
retaining the uniting matter.  By immediately closing up the wound
with a bit of sticking-plaster, or a little lint soaked in the blood and
allowed to dry on it, the greater portion of the wounded parts and
broken ends  of the bone will unite by the first intention, and only
those parts of the  solids which  are  exposed will  suppurate.   This
small suppuration will oblige the surgeon to leave the  wound in the
skin free from bandage, in order to be enabled to look  at it occa-
sionally; though, from some accounts, it might seem that even this
was not  necessary.  This  mode of treating it as a simple fracture
obliges it to heal  as such.  This practice has  been followed even
when the laceration in the skin was considerable; but I have not
seen a sufficient  number  of cases to say  how far it may be
extended.
  Inflammation, Suppuration, and Ulceration of circumscribed Cavi-
ties.—All circumscribed  cavities, as the  pleura, peritoneum, &c,
admit of the three inflammations.   They may be  formed into true
and distinct abscesses by adhesions inclosing the matter, as in com-
mon abscess.   If the inflammation  does  not stop at the adhesive,
then suppuration follows,  and ulceration also becomes necessary for
the exit of the matter, which is an extraneous substance.  A material
circumstance happens  in  the inflammation of cavities containing
vital parts, which  is, that very little  sympathy exists between the
surrounding part and the parts contained, whence the inflammation
of the one is not always continued to the other ;  thus, inflammation
of the peritoneal coat of the abdomen and of the  intestine may exist
without inflammation of the inner coat of the intestine.   But this
does not hold good  universally, for inflammation  of the tunica vagi-
nalis spreads through the whole  body of the testis.
  Inflammation of the Pleura.—This membrane is more subject to 
PRACTICAL ILLUSTRATIONS, ETC.
217
inflammation than any other investing membrane.  Probably this
does not arise from any difference of structure, but from its situa
tion, by which it is  exposed to  the operation of cold air, and fron
its contact with the lungs.  Perhaps there is hardly one in fifty who
at the age of fifty, is without adhesion of the  lungs to the pleura
We often find the lungs adhering to the whole surface of the pleura
lining the thorax, and it does not seem necessary that inflammation
should take  place on both surfaces to produce adhesion.  Abscesses
may be formed here, either having the matter inclosed in a parti-
cular bag or diffused through the whole side,  forming one large
abscess; hence true and  false empyema.
   Empyema.—The  cavity of  the chest is subject  to  the two
diseases of  other circumscribed  cavities, dropsy, and inflammation
and suppuration, or empyema.  These two kinds  of disease will
have some  of their symptoms very different, though the symptoms
arising from  the  ultimate effect, namely, the collection of fluid in
the chest, will be nearly  the same in both.   But as this cavity has
connexions  with parts whose symptoms when diseased will be very
different from  those of  this  cavity simply, and as those  parts will
sympathize  with  the  diseases  of this cavity, we shall find that a
complication of symptoms will often take place which  may mislead
the judgment so much as to make us suspect that the  sympathizer
is the seat of the disease.
   This sympathizer is the heart; and as a  disease of this part has
produced symptoms which have been lately called angina pectoris,
we find that it requires particular  attention to be paid to the
specific symptoms of empyema, to separate them from those of the
heart.
   The general cavity of the chest is divided into two distinct cavi-
 ties : therefore whatever disease  affects one simply,  cannot affect
the other by its having affected this.
   Water may collect in the cavity of the chest almost at once,
without giving much previous notice.  It may be the consequence
 of various causes, as cold, fever, &c.  The symptoms arising from
 the presence of a fluid are either peculiar, common, or sympathetic,
 which last  may or may  not occur.
   The first true specific  or peculiar symptom arising from an extra-
 neous fluid, in some considerable quantity, in the cavity of the chest,
 is difficulty of breathing, which is always an attendant,  and is dis-
 tinguished  from difficulty of breathing  from other causes by this,
 that the patient is  always able to  breathe much better in certain
 positions.   This  position will vary according to circumstances: if
 water  is only on one side, the  person can  lie on that side, and  on
 that side only;  if on both sides, he can lie on his back, not hori-
 zontally, but with the chest raised as much as possible.  He feels
 the fluctuation of the fluid within the chest whenever  he  moves,
 especially when he raises himself up.  I have heard  patients often
 say that'they could hear the fluid move.  The fluid is felt pressing
 like a weight on the diaphragm.  An anasarcous habit often takes 
218
HUNTER'S PRINCIPLES OF SURGERY.
place,  and sometimes ascites.  These two last symptoms would
seem to arise from a universal irritable debility.
  The second, or common symptoms with other diseases, of those
parts are difficulty of breathing, and of expanding the chest; great
lowness and oppression ;  a feeling of suffocation or of dissolution.
  The third, or sympathetic, symptoms are often great irregularity
of the pulse, palpitations, flutterings.
  When the  symptoms are known to arise from the presence of a
fluid in the chest, it should in general be let  out  by an operation
called  paracentesis thoracis, which is only making an opening into
the  thorax and allowing the fluid  to flow out.  The wound should
be made to unite by  the first intention.  The fluid to  be evacuated
may be of various  kinds:  as blood  from a ruptured vessel,  or
wound made with a ball or cutting  instrument; or  extravasated
serum, as in hydrops pectoris; or pus, the consequence of inflam-
mation.
  Whatever  the fluid is which is to be discharged, I have always
found  suppuration, take place in all the operations I have seen per-
formed ;  for when the discharge  was nothing at  first  but serum,
(as  water in ascites), yet afterwards it gradually changed into pus.
This arose simply from keeping the external  wound  open.  I am
inclined to think that nothing could have  saved these patients but
resolution of the inflammation, and the parts falling back into their
natural disposition.  This, as I have mentioned, sometimes takes
place in common abscesses, especially those of a scrofulous kind,
and in the present cases it might the more readily take place,  as
there is here  no change  of  structure or granulation  of the whole
surface of the pleura or lungs.  However, wounds have been made
into the cavity of  the thorax, suppuration has taken place,  and yet
the  patient has  got  well;  but how this  has been brought about I
cannot tell.*   General Murray, to  whom I have often expressed a
wish to peep into his chest, has been  twice wounded in this way.
I tried the experiment by shooting a dog;  but  both Nature  and the
dog cheated me, for  I intended to keep open  the wound until the
whole  surface of the  pleura had taken on suppuration, when  I meant
to let Nature have her way and  cure the dog as she  pleased, and
then I  intended to kill the dog and  see what she had done.  But
the  dog would always lie on the wounded side; and when, after
death,  I examined  it, I found the  lungs had adhered to the wound
and prevented the  inflammation spreading  over the surface of the
lungs.  The  wound, after  the  evacuation,  therefore, should  be
united  as quickly as possible, to prevent the whole pleura from sup-

  *  [There cannot be any doubt that the cure is effected in these cases by the
obliteration  of the cavity of the  pleura, partly by coagulable lymph  which is
effused  at the same time with the serum or pus, and partly by granulation ; the
cavity of the pleura being precisely under the same  conditions  as a common
abscess, and healing by the same methods.  In these cases the  patient seldom
regains  the power of complete expansion of that side of the chest, which alway»
remains in a more or less contracted and  flattened state.] 
PRACTICAL ILLUSTRATIONS, ETC.
219
purating, which would destroy the patient  in nineteen cases out of
twenty.
  Inflammation of the Pericardium.—The cavity of the pericardium
is not so apt to produce universal adhesions as that of many other
cavities.*  When it goes no further than adhesion the patient lives,
although this produces many disagreeable symptoms, as palpitation
of the heart, irregularity of the pulse, great oppression and faintings,
which in general produce a bad state of health, a great debility, and
symptoms which have gone by the name of angina pectoris.   If the
inflammation approaches  to  suppuration, it will certainly kill.
  Emphysema.—It will not  be improper here to say something of
the  treatment of patients  affected with emphysema arising from a
wound in the lungs by a fractured rib, for if any surgical operation
is necessary, great caution is required not to make the wound com-
municate immediately with the cavity of the thorax, in order to
avoid the mischief above  described.
  If the lungs are wounded by a fractured rib, we know that the
pleura must  be  wounded, and that there must be a  communication
between the cells of the lungs and the cavity of the  thorax.  There
is also a communication between this cavity and the common cel-
lular membrane of the body by the wound  in the  pleura.  The air
escapes from the lungs into the cavity of the thorax, and in the act
of respiration is squeezed into the cellular membrane of the body.
The internal wound  does not inflame  so quickly as  the external,
because the internal depends on extravasated blood for the renewal
or adhesion of parts ; and the wound of the lungs, from its being
in contact  with  the air, may be considered as an external wound,
while that  of the pleura is an internal one ;  the former will therefore
probably heal sooner than the latter, whereby the air will be con-
fined in the cavity.
  The operation for the relief of this disease is making a perfora-
tion into the cavity for the  relief of this disease, which operation
should be religiously avoided, because it will produce the suppura-
tive inflammation all over the  internal cavities, and most probably
make the wound in the lungs  ulcerate.   If an external  opening is
necessary, it should be made at  some distance from the fractured
rib, and never on the rib itself.   If  this is not attended to, it will
make what was at first a simple a compound  fracture, which pro-
bably would produce  the same effect as an incision at once into
the cavity  of the thorax; or if it did not produce  this evil, would
produce adhesive inflammation quickly about the fractured rib,

  *  [This may be accounted for by the unintermitting action of the heart, which
must present the most unfavourable conditions imaginable for the organization
of the lymph.  The opposing  surfaces of the pleura or peritoneum may be pre-
served by the patient in the most perfect state of apposition during the progress
of inflammation, by breathing only by the chest or diaphragm, according as  the
case may be.  But the heart  has only one mode of action, which must con-
tinually tend to disturb the process of union, just in the same manner that  the
continually recurrent action of the sphincter ani prevents the cure of fistula; in
that situation.] 
220
HUNTER'S PRINCIPLES OF SURGERY.
which would  prevent any future escape of  air from  the  pleura,
which should  be allowed; and for the same reason  the  patient
should not have  a roller bandage put on, as this would  cause an
impediment to the respiration by the other lung, and, by preventing
the escape of the air, cause the whole contents of the thorax to be
pressed to the other side.
  Peritoneal Inflammation.—This  inflammation is  attended  with
great pain, not of the colicky kind, but a violent soreness or  tender-
ness on external pressure.  The fever or sympathy of the constitu-
tion, arises much higher than if it arose from the inflammation of
a common part, and runs through all its stages much sooner than
another part.  When the immediate cause of these constitutional
symptoms is  not known, and  the effects are violent, it  has  been
called a fever, and the chief attention has been directed to check-
ing this fever ; but  the  symptoms are  merely the consequence of
the inflammation in a  part by which  the constitution  is easily
affected ; so that if it wrere possible to restore the healing disposition
to the cavity of the abdomen, the  other  symptoms would vanish
and  health be  restored.   A diarrhoea sometimes comes on, but at
other times there is costiveness, both of which I am  inclined to
think may be considered as sympathetic affections.
  It is perhaps almost impossible at first to say what the inflamma-
tion is, whether the true inflammation or the erysipelatous, because
we are only  guided by the constitutional  symptoms,  not  by the
appearances.   A person in seemingly tolerable health  attacked at
once with so violent  a local disease will be at first roused, which
will  make  it  appear a  truly inflammatory complaint;  but  if it is
erysipelatous he soon sinks.  Still at first the apparent indication
would be bleeding, and that largely; but if it is of the erysipelatous
kind we may be led by those  symptoms  beyond  the  quantity
suitable to the constitution.  Yet I  do  not know wdiat we  can do
better;  I  should be  inclined to reduce the patient to  the  lowest
pitch rather than allow suppuration to  take place, for  that would
certainly kill.  In whatever  light we consider an inflammation of
the peritoneum that is capable  of producing suppuration, it is one
of the most dangerous  diseases we can meet with.  How far in
such cases it might  appear desirable to  make an  opening into the
abdomen,  and  throw in warm water repeatedly to wash away the
matter, I will not undertake at present to determine.
  Peritoneal  Inflammation  after  lying-in.—Inflammation often
attacks some part or the whole  of the peritoneum in women some
days after childbirth, and hence has been called  puerperal fever,
from supposing it to  be a fever peculiar to that state, and the
inflammation of the peritoneum a consequence of this fever, whereas
the fever is only a sympathetic  symptom of the inflammation; but
as this inflammation is connected with vital parts, the sympathetic
fever is so much the more violent and dangerous.  I believe I am
the first who formed this idea of this disease.
  Why such a disease should occur after so natural an operation 
PRACTICAL ILLUSTRATIONS, ETC.
221
is not easily explained.   It does not arise from an inflammation of
the substance of the uterus first taking place, as we might at  first
naturally expect;  for if the uterus  did inflame in consequence of
delivery, there would be no more necessity for the peritoneum of
that viscus to inflame than  for the peritoneum of an intestine to
inflame when the intestine is itself inflamed, which it seldom does;
and if the  peritoneum  of  the  uterus  inflamed in consequence of
inflammation of the uterus, that is  not a necessary cause why the
whole peritoneum should inflame, excepting the inflammation was
carried so far as to produce suppuration on that part of the perito-
neum.  But the substance of the uterus generally appears as sound
as  in  those who  have no  such disease; however, although  the
uterus is to  appearance sound, yet it may be in such a state as
to give the  same  stimulus  of  imperfection  as if it were  entirely
removed or not existing.   To  illustrate this we may bring forward
the circumstance of two cocks' combs that were frozen and thrown
off as dead sloughs, for I suppose from analogy that  the frozen
parts were still alive, and if  so we may see that a living part  may
be  so circumstanced as to  give the stimulus of death  to the  parts
with which it is connected.  That the inflammation of the perito-
neum arises from the stimulus of imperfection is also evident, because
if a man is  wounded  in  trie  belly with a sword which has also
wounded one  of the  intestines, if the wound in the  abdomen is
closed, and unites by the first  intention, the wound in the intestine
will unite with some part with which it comes in contact, either
by extravasated blood or the adhesive inflammation, and no further
trouble wall  ensue, because  the stimulus  of imperfection has not
been given.  But if a man is wounded in the belly, and there is no
wound of the viscera, yet if the wound  is kept from healing by the
first intention, the whole peritoneum becomes inflamed immediately,
not from the spreading of inflammation by the continuity of surface,
but the consciousness  of imperfection in the  membrane itself, by
which the whole  is brought into the same action. It  is probable
that the  uterus  suddenly  contracting, the neighbouring  parts,
becoming sensible, as it were, of the  loss of  a part they have been
accustomed to, inflame.  Sometimes  adhesion will lake place, and
a circumscribed abscess will  be formed in the lateral and  lower
part of the  belly,  and probably the inflammation was chiefly in the
round or broad ligament;  first there is hardness and  pain, then
prominence and fluctuation, when it may be  safely opened.*

   * [Mr. Hunter has fallen into two errors  on  this subject: first, in ascribing
 puerperal peritonitis to an ideal cause ; and secondly, in supposing that the con-
 stitutional fever invariably  arises from inflammation of the peritoneum,   ihere
 cannot, I should think, be the least hesitation in ascribing the inflammation  ot
 the peritoneum which ensues on child-birth to the irritation which the uterus has
 suffered during that process, for the inflammation is not only sometimes confined
 to that part of the membrane which covers the uterus, and always is most violent
 there, but it invariably commences from  that point.  The fact, however,  ot the
 same cause giving  rise to inflammation of  the adjacent organs  is completely
 subversive of the  imaginary  cause assigned  by Mr. Hunter, arising from tlie
                                19* 
222
HUNTER'S PRINCIPLES OF SURGERY.
  Inflammation of Peritoneum after  tapping.—A man whom  I
tapped at the hospital died the third day.  I said he died of the puer-
peral fever.   This was smiled at in the  hospital, and some were
pleasant in remarking  on the curiosity of a man  being  delivered;
but a few months afterwards another  having the same fate, I  con-
vinced them, by dissection, that he had  died of suppuration of the
peritoneum, which we must admit to happen in puerperal fever.
Frequently the inflammation does not go  so far as to produce sup-
puration, and then the patient commonly recovers ; but it often runs
the whole course and produces  death.  It seldom  attacks those
parts of the peritoneum that are pretty sound, or where  the disease
is not of long standing; but where the disease has arisen  from a
bad constitution  or  diseased viscera, it seldom fails  of attacking
them, especially in the second or third tapping.
   Hernia.—The consideration of inflammation of internal cavities
leads me to make a few remarks  on  hernia.  We might suspect
that the operation for  hernia would often be the cause of  universal
inflammation  of the peritoneum, but I believe in bubonocele and
femoral hernia it is generally prevented by the sides of the skin  of
the abdomen being pressed together  after  the  operation.  This
inflammation  is met with after the operation  for umbilical hernia,
because the edges of  the wound cannot be  brought together.
   In this case we should contrive  that a portion of the epiploon
 shall remain at the bottom of the wound, and if it is not protruded 1
 think it would be the  best way to find it if possible: in this  way,
 by  adhesion taking place  round the  opening, the general cavity
 would be excluded.
   Caesarian   Operation.—In this  operation,  and in every  other
 instance where the lips of  the wound  do  not come well together,
 assistance should be had from art to unite them as closely as  possi-
 ble.   If it should be found necessary to use sutures, care  should be
 taken that they do not pass  through into the cavity of the  abdomen,
 as by this they would produce effects exactly contrary to what was

 " consciousness of imperfection." No such imperfection can be supposed to be
 felt by the veins, the absorbents,  or the ovaries, and yet these parts are frequently
 inflamed, independently of the peritoneum.  Of forty-five fatal cases of puerperal
 fever which were examined by Dr. Lee at the British Lying-in  Hospital, (in all
 of which was found some morbid change, the effect of inflammation,) the perito-
 neum and uterine appendages were found inflamed in thirty-two;  in  twenty-four
 there was uterine phlebitis; in ten there was  inflammation and softening of the
  muscular tissue of the uterus ; and in four the absorbents  were filled with pus.
  In short, the irritation of parturition may extend to any or all the circumjacent
  parts within the sphere of ils influence, and give rise to puerperal fever by exciting
  local inflammation.  Local inflammation probably always exists, but the perito-
  neum is not always that part which the inflammation attacks.
    The morbid  appearances presented on dissection are extremely various,  and
  closely resemble those which arise from inflammation of the peritoneum following
  the great operations of surgery, as lithotomy, hernia, &c, viz., large effusions of
  lymph, turbid  serum,  or pus separately or blended  together in different  pro-
  portions.  Pus is not an invariable product of this inflammation, as might be
  inferred from the text.] 
PRACTICAL ILLUSTRATIONS, ETC.            223
wished —that of rendering the cavity perfect; for as these continue,
suppuration of the wounds made by them will come on, they acting
as a seton,  by which the exposure  of the cavity will be greater,
though perhaps, from the irritation they would  occasion, adhesions
would be formed at the bottom of the wound before they suppurated,
which might prevent the admission of air.
   In a woman in whom I performed this operation, and who died,
I found, thirty-six hours  after death, that the intestines had adhered
 o  the inner edge of the wound of the belly for  the breadth of an
 nch: the uterus  was entirely within the pelvis; but the edges of
 he wound  in the uterus had not closed at all, and a good deal of
 coagulated blood was found  in it   I should therefore in  future watt
 until the bleeding  had  nearly  stopped  from  the uterus before I
 closed the external  wound.                                 ,,„m
    Bladder.-lt may be said that the bladder  be.ng  so  seldom
 inflamed after the operation for stone, is an objection <o my suppo-
 sition that  an opening into  any circumscribed cavity, by the expo-
     e and consciousnlss of  imperfection induced in that cavity is
 almost  necessarily  productive of inflammation of that  cavity, but
 here it must be  observed that the internal surface of  the bladder
 nartake more of the nature of an outlet than  of a circumscnbed
 ^.taCtting therefore iess ^J^-^

 l^lrrtteTwS mu°t  rtde'r H ^susceplibie of inflam-

  mct"iwS.-It is from the disposition that the cavities of
  ioints have to fa Unto the suppurative inflammation when anopemng
  is made nto them that  unionby the first  intention does not take place.
  ThTareatest care should be taken to put this in their power if pos-
  ^5"  sVey do not readily run through the regular ^ofi^







   mGo*   r    ,  .;    There are  other cavities, besides those  of the

   joi^"^^
   SS5E MS  Th^esugect



     * [The lighter  and cooler the dressing, in *»-5»J^^^S^ fJS JiJjSd
    Perfect repose  of the organ, an easy P"*?* «** u?a alio th Simplest mod?e of
    in blood over the wound, is probably the best, ^'V'u^dbe combated at once
    treatment.  If symptoms of infl*™«™*™\£U^^tj, until the
    by a copious venesection, which should be repeateo,
    inflammation is subdued.] 
224
HUNTER'S PRINCIPLES OF SURGERY.
with suppurative inflammation ;  nor does the absorption of the fluid
which they contain readily take place.  Ganglions have been some-
times dispersed by soap p'lasters, and sometimes, although  rarely,
by electricity.   A gentleman was cured of a ganglion on the wrist,
which had returned after being dispersed by a blow, by the Balsa-
mum Canadense, applied  thick  and bound on tightly.  I   would
advise a blow  to rupture the sac; but the fluid is soon reaccumu-
lated. For a radical cure, an opening should be made, and this pre-
vented from healing by the first intention, that it may suppurate and
heal by granulations.   As these are  connected with joints, weak-
ness and stiffness may be produced for a time; but this is overcome
by motion.
  Inflammation of the Eye.—I shall consider the eye now as a cavity.
Inflammation of the eye often takes  place  after extraction  of the
crystalline lens.  The lips of the cornea not adhering by the first
intention,  suppuration ensues, which is followed by  a  shrinking of
the globe.  The same effects are sometimes produced  when an
opening is made to discharge the accumulated aqueous humour, as
also when the globe has been suffered to burst spontaneously.  This
has sometimes happened from accident, the opening into the anterior
chamber not closing; but probably  these effects only take place
where either the crystalline lens or the vitreous humour have been
disturbed  or lost in  part, but  more  particularly the latter,  as the
adherence of the crystalline to the processus ciliares would prevent
the inflammation extending; but when separated, the posterior part
of the eye becomes conscious of this, and suppuration follows. The
pus may be seen through the cornea, but no fluctuation can be felt.
It is necessary  to distinguish between simple opacity of the  cornea
and the accumulation of pus in the anterior  chamber; they may ap-
pear similar, and both may be present at one time ; the first  maybe
of long standing, the last must be recent: an inflammation must have
very recently preceded the accumulation of pus.  If the progress of
the opacity  can be observed,—but it cannot always, especially in
children,—we  may distinguish  them:  if in  the cornea, a dimness
may be seen to begin over the  whole, and get white  by degrees, or
it may remain  in a point, and remain  there only; if pus, it will be-
gin at the bottom of the cornea, and its shape will be semilunar, the
straight line being uppermost,  and as it advances the line will rise
till it comes to the top, and if first seen in this state it is with difficulty
distinguished.
  If the disease is an opacity of the cornea, reabsorption is the only
cure, and  no operation is to be  performed; in the other case, the
removal of the pus  is the cure.  There appear to be two natural
modes of cure  ; one the absorption  of the pus into the constitution,
which I have often seen take place;  the other is ulceration of the
cornea, as in other abscesses, and discharge of the pus.  The latter
is the worst mode of cure, for the pus, by its pressure on the crystal-
line lens, may  disease it,  and an irritation  will be  kept up by the 
PRACTICAL ILLUSTRATIONS, ETC.
225
distention, which should be avoided, as the consequence will be the
obliteration of the cavity of the eye, as in any other abscess.
   This, then, leads to an artificial cure,  which is by removing the
pus at an early period, when we  see it will not be absorbed, by an
incision like  that  for  removing the lens, by which we  avoid the
second or natural cure; but it is  not  always perfect, as we cannot
heal the wound by the first intention.*
   Of the  Brain.—I have not seen a  sufficient number of cases to
determine how far inflammation  attacks the pia mater when it is
exposed in trepanning, but from the protrusion of brain in such cases
inflammation may be inferred, as  I have mentioned already.  I never
saw a case  recover where the dura  mater had  been punctured,f
which I attribute  to inflammation of the pia mater extending to the
brain below.
   Inflammation of  Veins.—The  cavities of veins  are subject to
inflammation, either in consequence of inflammation of surrounding
parts, or from  themselves taking on the inflammatory disposition and
involving the surrounding parts.
   This inflammation of veins happens sometimes after bleeding, and
has  been attributed  to a pricked tendon or nerve by some,  and by
others to a bad constitution; but if we  consider this consequence
arising from bleeding more accurately we shall find that it happens
after bleeding in  veins where  no  tendon could be wounded, and
when no nerve is in  the  way, as often as in  the  others, and fre-
quently in constitutions where there is no apparent want of health,
and also  where the wound, on bleeding from another part in  the
same person, probably with a view to cure the  former, has healed
readily.
   The manner in which these  inflammations come on  shows very
plainly that they arise from the wound made by the lancet not healing
by the first intention,  and in different arms we have also the different
degrees  of extension of the inflammation.  In some, suppuration has
only spread superficially, the veins and parts below having united,
and the  inflammation only seated between  the vein and the skin,
and then it is of little consequence ;  in  other  cases the  skin sha
appear united, but not close to the vein, so that a small abscess shall

   *  THvpopium, or the accumulation of pus in the anterior chamber of the  eye,
is very often the result of inflammation of the whole internal part of the globe,
which rarely admits of a  cure.  When  it proceeds from an ulcer situated on the
internal part of  the cornea, a cure may be  expected, particularly if mercury is
employed, which causes  the effused pus to be absorbed.  Neither of these cir-
cumstances, however,  can  justify the surgeon in_ making an opening into the
cornea, unless there is at the same time an  excessive accumulation of purulent
fluid, giving rise to great pain and tension of the g obe.  In which cases relief
may bi afforded by letting out the pus, although little hope of saving the sight
can be entertained from the operation.]                          ultimate
   +  [Wounds of the dura mater undoubtedly very much  aggravate *he ultimate
danger arising from other accidents, but are not in themselves universa"y :&*!.
On The contrary, numerous cases are recorded of extensive  penetratmg wounds
of the brain which have recovered without a single untoward symptom.j 
226
HUNTER'S PRINCIPLES OF SURGERY.
form between the skin and the vein.  But when this imperfect union
of wounded parts is carried on to the cavity of the vein, then more
mischief ensues; the external wound in most cases festers  or
inflames, then suppurates and ulcerates ; then the vein inflames from
being an imperfect cavity, the inflammation extending both towards
the heart and from  it;  and  also, for  a considerable way,  the
surrounding parts join in the inflammation.  We find in these cases
all the different degrees of inflammation in different cases; some-
times it goes no further than the adhesive inflammation, and suppu-
ration is prevented by adhesion being allowed to take place in this
part.   The veins in such cases are ever after obliterated, and may
be felt, after the  surrounding inflammation has subsided, like hard
cords.   But these slighter effects are not always all, and suppuration
will unfortunately too often take place.
  The suppuration has all the degrees of violence and extension.   It
is often so confined as only to form a small abscess near the orifice;
this arises  from  adhesions having taken place  in the vein a little
above and below the orifice.  In many cases the inflammation and
suppuration extend further, adhesions not having taken place; some-
times a very long abscess is formed, and  often there is a series of
abscesses, following one another in the direction of the vein,  between
the orifice and the heart; but not always in this course, for we find
them sometimes  between the  wound and the extreme parts.   I have
seen from a wound in the foot the saphena inflame all up the  leg
and thigh,  nearly to the  groin, and have been obliged to open a
string of abscesses almost through the whole course.
  I have almost  always found that inflammation has taken place in
the larger veins which pass through a part that has been violently
inflamed.   This  disease often happens in horses after bleeding, for
the operators do not take proper care to close the orifice  in these
animals.  This has sometimes proved fatal; but whether from  the
inflammation extending  to the heart, or from the matter that is
secreted in the veins passing  in considerable quantity into  the cir-
culation, I cannot say.
  The method of preventing these ill effects is to bring the edges of
the wound  carefully together, when the bleeding is finished, that
they may unite by the first intention.   I would recommend a com-
press  of linen in preference to plaster; for I imagine that the blood
itself  being applied over the orifice is a kind of bond of union which
is more natural than any  other application.  I have seen more sore
arms after bleeding where a plaster has been applied  than in any
other cases.   I  have also seen it several times where the orifice
has opened a second time and bled again, and has not been properly
closed.
  Treatment.—If inflammation  has just come on  and not arrived
to suppuration, a compress should be applied to produce adhesion
of the sides of the vein, whereby the inflammation may be prevented
from reaching the suppurative stage.   If the suppuration  is come 
OF HYDROCELE.
227
on, let pressure be applied immediately above, to prevent the matter
from passing to the heart, by producing adhesion there.
   Inflammation of Arteries.—Arteries unite by adhesion when their
sides are compressed.   This we find after the division of the larger
arteries after amputation.  I never have seen arteries suppurate, and
do not  know whether they ever do suppurate, nor what would be
the consequence.   Perhaps it would produce mortification; but  I
am about to determine this by experiment.
                        CHAPTER XVI.

                           OF HYDROCELE.

Theory of the cure simple, but in practice the operation often fails.—Description
  of the disease;—distinguished  from others.—Encysted  hydrocele;—its
  nature;—common to all ages and constitutions ;—disappears spontaneously in
  children;—rarely in adults;—symptoms;—state  of the testicle to be ascer-
  tained ;—hydatid ;—scirrhus ;—false membrane covering testes ;—adhesion of
  testis to cicatrix after puncture ;—former cicatrix to be avoided.—Palliative
  treatment;—heematocele ; diffusion of blood into  the cellular tissue;—suppu-
  ration following simple puncture.—Radical cure;—various  methods recom-
  mended;—object  of  all;—adhesive  inflammation  occasionally  occurs;—
  obstacles  to  its taking place.—Erroneous  notions  of the mode  of cure.—
  Injection ;—tent;—seton ;—caustic ;—laying open sac ;—violence of the latter
  method;—all severe.—Practice of  removing  testicle  when  enlarged;—
  doubtful if always  required.—Causes of failure of all the above operations,—
  of each in particular.—Mode of operating recommended;—after-treatment, and
  consequent symptoms.—On the actions of medicines.—On  diseased  disposi-
  tions and actions.—Of the difference of different parts to heal—Of one disease
  curing another.

The disease called hydrocele is a very common one ; it consists of
an  undue secretion of the fluid which moistens the tunica vaginalis
testis,  and admits of a cure according to the laws of inflammation,
suppuration, and granulation, which is the  process of a  common
abscess.  Although the theory of the cure  of a  hydrocele is  very
simple, yet no disease affecting the human  body, and  requiring  an
operation for its  cure, has  called forth the opinions  and pens of
surgeons so much as this disease.*  The reason  of this is easily
accounted  for ; for they  have gone so far as to find that every mode

  * [This was no doubt  the reason which led  Mr.  Hunter to enter so fully into
the consideration of the  subject.  " At the  time,"  Sir Astley Cooper remarks,
" I was attending Mr. Hunter's lectures, the town  was divided in opinion as to
the best mode of performing  the operation for hydrocele;  and so great was the
difference of opinion among the students of the different, hospitals, that it was
quite ridiculous to observe their warmth on this subject. The operation, by injec-
tion, as recommended by Sir James Earle, was not  introduced until a few years
afterwards, but has  since been universally  acquiesced in as  one of the most
simple as well as most effectual remedies of  surgery.] 
228           HUNTER'S PRINCIPLES OF SURGERY.

of operating but their own has failed, but have not noticed the cause
of failure.   It was enough for them that  they could condemn.
They rested contented with  having recommended a method which
was to them infallible;  nor did the condemnation of this favourite
method of theirs  by others rouse them into an inquiry as to the
cause of its failure.
   The scrotum in man has two circumscribed serous cavities in
it, which may become  the reservoirs of any part of the blood that
may be extravasated, but which are  generally in these cases dis-
tended with water, forming an aqueous cyst.   Besides this, there
are other extravasations of water into the scrotum, but  they are
common to every part of the  body as well as it.
   Each of these cavities is called tunica vaginalis testis, and when
either of them is  filled with fluid it is called a hydrocele.
   There are other cavities formed in these  parts from disease, like
those formed from similar diseases  in other parts, and which may
be called hydatids.  I believe  they are more common in these parts
and  in  the ovaria in women  than in  most other parts, probably
from  their being glands of a peculiar kind.
   But every  distention of the scrotum with  water is  called  a
hydrocele: even water collected in the cellular  membrane of the
scrotum in anasarcous habits, where it has  only soaked through
from the parts above, or arises from irritation: this kind might be
called diffused hydrocele.  This collection in the cellular membrane
is often so great as to be diffused into the cellular membrane of the
penis, which  always produces phymosis, with twisting of the skin
of the body of the penis, from the frenum not being so  extensible
as the  common  skin.   This often proves  very troublesome,  by
confining the urine.  The  radical cure  of this kind of hydrocele
will be the cure of the disposition, which is commonly more consti-
tutional than local.  But this  cannot  always be done;  and we may
then  give  a temporary relief to the  parts where the scrotum  is
become considerably  enlarged,  with  much phymosis.   It  then
becomes necessary to  procure an evacuation of the water, which
can easily be done  by making small punctures with a lancet or
needle  in the  most depending  part  of the scrotum,  and also,  if
necessary, at the end  of the  prepuce.  However, some  attention
must be paid to  the state  of the patient; for, if very weak  and
debilitated, mortification may take place at these orifices;  there-
fore the smaller and fewer the punctures the better.
   Another  watery swelling,  similar to the  above, is described,
namely, an anasarcous state of the  spermatic cord.   This disease
I never saw.*

   * [Pott and Scarpa have both described this disease, which they represent as
consisting of an enlargement of the  cells of the spermatic cord, which in process
of time, particularly towards the bottom of the tumour, merge in one general
cavity, divided by a number of septa  more or less perfect.  Essentially, there-
fore, it does not differ from  encysted hydrocele of the cord, except in the mode
of its commencement.] 
OF HYDROCELE.
229
  The  encysted hydrocele  is  a collection of water in some cyst
situated in these parts.  This species of hydrocele has been divided
into three kinds, according to the situation of the water: first,
when it takes place in the tunica vaginalis testis; secondly, when
it occurs in the  body of the  testicle: thirdly, when in the spermatic
cord;  and, indeed, by the same  mode of multiplying species, I
could from my own knowledge, make a fourth  and  fifth, namely,
hydatids at the back of the testicle, where the vessels enter, and
hydatids on the body of the  testicle,* within the tunica vaginalis
testis;  which last may be complicated with hydrocele of the tunica
vaginalis, as I have  seen.   These two last, as  also  hydrocele  of
the  cord, are only hydatids in those parts.   The hydrocele in the
body of the testis must also be classed with hydatids: but this I
have never seen.   Of those on the outside of the testis I have seen
several cases.   All  these  tumours, however,  are  properly only
divisible into two kinds; hydrocele of the  tunica  vaginalis,  and
hydatids;  for it does not alter the disease whether the hydatids be
in the spermatic cord, cellular  membrane, scrotum, or body of the
penis;  it is still hydatid, wherever placed.
  As the  symptoms  arising from the  testicle being in a state  of
irritation are different from  those of irritation in other parts, so we
shall find  that  the symptoms  arising from, and the cure of, these
encysted  hydroceles will be  different from those  arising  from
hydatids in the  body of the testicle ; whereas these will be similar
to those of the  tunica vaginalis testis because  in both they have
connexion with the testicle.  But the  symptoms arising from the
cure of hydatids  not connected with the  body  of the  testicle will
be  similar to common inflammation in all cases of the disease.
   The  cause of the anasarcous hydrocele is very evident: it arises
from a universal  disposition to throw  out serum: and, from the
situation of the part, it becomes a universal  detainer of the water
as  it is descending from the upper parts.
   In the encysted hydrocele  the cause is generally  not known,
especially of the hydatid kind.  However,  the hydrocele of the
tunica vaginalis often arises from a disease of the testicle; for I have
observed that many who are operated on for  the radical cure show

  * [According to Sir Benjamin  Brodie, these swellings commence between the
tunica vaginalis and tunica albuginea of the testicle, and  not in the proper struc-
ture of the testicle as has generally been supposed ; they do not therefore essen-
tially differ from encysted  hydrocele of the epididymis, except in being  more.
strictly bound down by the tunica vaginalis which will necessarily tend to limit
their growth, and  on this account to  obviate the necessity of surgical interference.
  Simple hydatiform cysts in the  body of the testicle are referred  to by Dr.
Hodgkin.  See Med.-Chir. Trans., vol. xv. p. 289.
  It will scarcely be necessary to remind the reader that the term hydatid 19
employed by Mr. Hunter in the  old  acceptation.  The true hydatid has no con-
nexion  with the  surrounding textures, and is probably a  parasitical animal,
endowed with independent vitality and a peculiar mode of propagation,  these
do sometimes occur in the gland of the testicle in association with malignant
disease; but never, I believe, as an  original and independent affection.]
                                20 
230
HUNTER'S PRINCIPLES OF SURGERY.
a disease in the testicle ;  also I have seen several hydroceles that at
first were hardly anything but true  hydrocele, the testicle hardly
appearing diseased, yet in time (viz.,  a year or two) the testicle has
increased gradually, and the water has been diminished so much,
that hardly anything was left- but  a  large diseased testicle, and all
this time giving little or no pain.
  Hydrocele of the tunica vaginalis is  common to  all ages;  it is
met with in children, in middle-aged and old  men.  In children
they arise sometimes before  communication between  the  tunica
vaginalis and abdomen is completely cut off, so that any fluid from
the abdomen can pass down  and  distend the bag.  In  appearance
this somewhat  resembles a rupture ;  for when the water is pressed
upwards, it makes a swelling close up to the ring, but by squeezing,
it can be made to pass  up into the  belly.   In these cases a slight
bandage or truss should  be worn for some years.
   Hydroceles are common to every  kind of constitution; not more
common to the dropsical and  anasarcous person than to the healthy,
which is not the  case with ascites or hydrops pectoris; therefore
it is probable they arise from a  disease in the part, or are what
my be called truly local.  They are common in all  countries; but
they would appear to be most common in warm climates.
   In general we  find them go away of themselves ; in young lads,
therefore, in such cases, I never recommend any mode of treatment.
In grown  people they seldom or never go away ;*  I have known
only two or three cases in which  they have disappeared without
the obliteration  of the  sac.  I have tried several  stimulants,  as
mercurials diluted, turpentine, &c, by way of application, but they
had not the desired effect.  However, I  once thought the latter,
 namely, turpentine, checked  the  progress of a  hydrocele.  Even
 letting out the  water  simply does  not prevent the accumulation
again taking place, whence the term palliative cure.
   Diagnosis.—The encysted  hydrocele consists of a  bag filled with
water placed in the scrotum, sometimes a little higher on the sper-
 matic cord.   The principal points to be known or discovered are,
whether, when  a tumour appears in this part, it contains  water;
 and, if possible,  the  true  situation of that water as respects the
 testicle:  for there  is another disease that will imitate this so as to
 be with great difficulty distinguished from it, which is a diseased
 testicle simply.
   Some ruptures put on an appearance somewhat similar to hydro-
 cele, and when the gut contains  a fluid, it  often gives an obscure

   * [Many examples  are on record in which old hydroceles have disappeared
 spontaneously ; an event which is most likely to happen, according to Sir Astley
 Cooper, when the  disease has originated in inflammation; or, according to Sir
 Benjamin Brodie, about once in twenty  cases.  However, there is no rule on this
 subject.  As ruptures of the tunica vaginalis from external injury are not followed
 by a permanent cure, we  have no  right  to suppose that slighter degrees of
 external violence will have this effect; although something of this  kind  has
 frequently been supposed, when spontaneous cures have taken place.] 
OF  HYDROCELE.
231
fluctuation;  so that hydrocele  is  but too often confounded with
rupture.
  Fluids contained in a  circumscribed  bag are commonly easily
made to pass from one side of  the bag to another, unless  the bag
is extremely full and thick in its coats, and then there will be only
a gentle receding of the  fluid  from  the  side pressed on.  This is
made plain to the  senses  by applying  our hands or fingers to two
different parts of the bag, and pressing those two parts alternately;
this is called fluctuation.   But solid bodies also, of a loose texture,
inclosed in a  bag,  can be  made  to recede from pressure, and give
nearly, if  not wholly in many  cases, the sensation of a complete
undulation; a feeling which the testicle sometimes takes on in one
of  its diseases.   Therefore, as  this  body sometimes conveys the
feeling of fluctuation of a  hydrocele,  and as the latter often acquires
a hardness like that of  the testicle, the difference we might expect
to find between the feel of water and of the testicle is in some cases
wholly lost.
   I think that in general  a distinction is  to be made in the shape ;
for I observe that  in general when the testicle  swells, it flattens on
each side, having an edge forwards and backwards, and is not,  like
hydrocele, of a pyramidal figure, with the apex upwards, passing
into the cord towards the ring of the abdominal muscles, and even
in  some cases passing a little  way into the  ring, with (in  many
cases) a slight contraction at the part where  it  does pass  into.the
cord.   But this cannot be  set  down as an invariable rule, for the
testicle will vary in shape according to the disease and other cir-
cumstances ; and hydrocele will  also vary in  shape according to
circumstances, and if it  be an hydatid, and  not within the tunica
vaginalis, it will have less of the pyramidal form, though even then
it often retains or acquires that shape; but if flat, it may be suspected
to  be the  testicle.   It  has been  recommended that we should put
a light on the opposite  side, and see if the tumour has  a degree of
transparency; but this can only take place where it must be evident
from other symptoms, where,  namely, the skin is not thickened,
and the fluctuation is therefore  perfect.*
  * [There is only one disease of these parts which there  is much  danger of
being mistaken for hydrocele, and that is the medullary disease of the testicle,
which it is often very difficult to distinguish from hydrocele.  Besides the points
of difference which have been noticed  in the  text, I may  observe that the oval
shape of the testicle in fungus  haematodes is generally marked with some degree
of bulging, which destroys the perfect ovality of the swelling; that the cord may
be  felt perfectly distinct for a greater  extent of its course than in hydroceles of
equal size ; that the/ee/, although generally pulpy and  elastic, is  not uniformly
so, but softer in some parts than it is in others;  that the weight of the tumour is
greater than that of hydrocele, and the superficial veins more swollen ; and, finally,
that the swelling commences uniformly in every part, unlike that  of hydrocele,
which begins at the lower part of .the scrotum and gradually ascends. The test
by the lighted  candle ought not to be despised, especially as it conveys useful
information as to the real situation of the testis, and very often gives immediate
knowledge of the disease, when, from the tension of the swelling, it is scarcely 
232
HUNTER'S PRINCIPLES OF SURGERY.
   But supposing the disease to be well ascertained to be water, we
 are not in all cases properly prepared  for  an operation until  its
 situation with respect to the testicle is exactly ascertained, for the
 situation of the testicle with respect to the general tumour will vary
 according as the water is situated.   When the water is in the tunica
 vaginalis, as is  most common, or in an hydatid in that bag, the
 testicle will mostly, if not always be placed at  the posterior part of
 the  tumour, and there is consequently but little danger of  doing
 mischief to the testicle by any of the operations, unless adhesions
 between the  tunica vaginalis  and  testicle have previously  taken
 place, and then the testicle will be  confined  to the  side on which
 the  adhesions are, as well as  to  the posterior  part.   If water is
 contained in an exterior hydatid, then it is not at all certain in what
 part of the general tumour the testicle may be.   Perhaps it is often
 not possible in such cases to distinguish  the  situation even by the
 sensations of the patient, and therefore we must always be on our
 guard when the situation is not ascertained.  If the testicle is  found
 on any side of the scrotum except  the  posterior, it  is  more than
 probable that the water is not  within the tunica vaginalis, but  in
 some cyst or hydatid placed contiguous  to the  testicle, or that some
 adhesions have taken place between the tunica vaginalis and testicle,
 cases of which I have seen.  If an hydatid is within the  tunica vagi-
 nalis, and fills up the whole tunic, it will in general be similar to the case
 of water within the bag itself;  but it admits of a variety of compli-
 cations, which may lead the surgeon into error even in the time of
 the operation, a case of which I think I have seen.  The complication
 appeared to be the following:  water both in the hydatid and tunica
 vaginalis, which led the  surgeon to remove  the whole  as a  scir-
 rhous testicle ; for on opening the tumour and letting out the water,
 he found another tumour within this, which he  naturally took  to be
 the testicle itself, and which of course led to the extirpation  of it.
 On examining the parts after removal, it was found to  be  simply
 another cyst of water, with the testicle sound within it, or rather
 behind it.*
   There is another mode of complication which  the above case gave
 me an idea of, and  which I do conceive I once met with in a patient
 of my own, namely, that inflammation had taken place over the
 whole sac, so as for the  sac to have  become lined with  coagulable
 lymph, similar to what I have seen in other cavities; that this lining
 at last became part of the sac; but that a part of this  lining had
 separated from it, and the space between the two had become  filled
 with water, as also the general cavity, so that  they formed a sort

possible to discern fluctuation.  In doubtful cases, it is always expedient to insert
a lancet or explorative needle into the tumour previously to the operation of cas-
tration.]
  * [There is reason to believe that this mistake has frequently  occurred.   The
 danger, however, of confounding haematocele with disease of the testicle is still
greater, although the history of the case, and the suddenness with which haema-
tocele commences, will never fail to point  out the difference to the intelligent
surgeon.] 
OF HYDROCELE.
233
of double hydrocele.   This case and the anterior  hydatid would, I
presume, assume the same appearance.
   We should naturally suppose, when the  situation of the  testicle
is not immediately known, and where the temporary cure has been
performed with success, that there could be but little doubt  of the
testicle being at some other  part of the tumour than the part where
the wound was first made;  but this is not  always to be trusted to,
for the operation  of  the temporary cure often becomes  the cause
of adhesions of this part of the sac to the body of the testicle.  This
very case occurred to me when about to perform  the radical cure,
for after having made the first incision on  the cicatrix, and cutting
through the tunica vaginalis as I thought, I was cutting on the body
of the testicle.  In performing this part of  the operation I suspected
all was not right, but did not in the least expect to find the testicle,
and therefore cut carefully on till I came  to the tubular  substance
of the testicle.  I of course desisted, and performed the  operation
in another part, at no great distance from the first, as the testicle is
not a large body, and I did not require to make a second incision in
the skin.   There did not appear to be any additional  symptoms in
this case, in consequence of the wound in the testicle, which seemed
to.heal  as  readily as a wound elsewhere would  do.  When  the
testicle is in the fore part of the tumour, either from the water  not
being in the tunica vaginalis, or from previous adhesions there, and
its situation is not known or attended to, and  the  operator  makes
an incision on the fore part  where the  testicle  is,  like that  in  the
above-mentioned case, and he finds he is cutting on the testicle, and
determines to shift his ground, I would advise him either to go lower,
or to ward one side with his future incision; but at all events  not
to go above the testicle, to get into the sac, for there he will most
probably find the spermatic  cord passing along the fore part; and
by cutting through it he may cut the spermatic artery and castrate
the patient, or cut the vas  deferens,  which will in all probability
render  the sore fistulous.  A case of this kind I once saw, where
the spermatic artery being cut, the blood escaped into the cellular
membrane  of the scrotum.  This circumstance   of  the  cellular
membrane of the  scrotum being sometimes filled with blood  in con-
sequence of an operation, may at first mislead the  surgeon  to  sup-
pose it  is mortification, if he is not acquainted with the cause.*

  * [Every species of hydrocele, as Mr. Hunter has remarked, is  reducible to
two forms, that of hydrocele of the tunica vaginalis, and encysted hydrocele of
the cord.  The first, or common form of hydrocele, is a true  dropsy of the tunica
vaginalis, and arises from the same causes which produce dropsies in other
situations.  The encysted hydrocele of the cord  is an adventitious production,
which has no existence in the primary structure of the parts, and ought to be
classed with serous cysts occurring in other parts of the body.
  The varieties of common hydrocele depend on the form or structure of the sac,
or the nature of its contents.  The ordinary situation  of the testicle in hydrocele
is two-thirds  of the way down  the  tumour at the posterior part;  but, as Mr.
Hunter  has remarked, the tunica vaginalis is liable to every possible  form of
adhesion, which will necessarily occasion great differences in the position of the
                               20* 
234
HUNTER'S PRINCIPLES OF SURGERY.
   Of the temporary Cure.—I  shall not say much with  regard  to
the palliative or rather temporary cure of  hydrocele, as it consists
only of the evacuation of the water in the easiest and shortest way,
without doing anything to prevent a recurrence of the disease, and
is hardly so  nice an operation as  bleeding.   The  same  care is


testicle and its vessels, as well as of the external configuration  of the hydrocele.
When  the testicle has united to the anterior  part of the tunica vaginalis, at the
lower part, the vessels  of the cord are generally  spread out over the anterior
surface of the tumour, and become liable to be injured by the trocar.  Sometimes
the tunica vaginalis presents a honeycombed appearance on its internal surface ;
occasionally it is much thickened, especially in those who have  resided in hot
climates; or converted into  cartilage, in which more or less extensive deposi-
tions of bone have taken place; at other times it is presented under  the form of
an hour-glass contraction, which may be either partial or complete, or may, after
being partial at first, become complete afterwards.  When there are no adhesions,
and no thickening of the sac, the hydrocele may attain a very considerable mag-
nitude.   I have known several cases in which the apex  of the  tumour has
advanced considerably beyond the external abdominal ring, so that no part of the
spermatic cord could be distinctly identified, and the quantity  of fluid exceeded
from three to four pints; but a case is mentioned by Sir Benjamin Brodie which
increased till  it hung down to the patient's  knees. The fluid of this form of
hydrocele resembles that of ascites, that is, it is of a deep yellow colour, and is
readily coagulated by heat.   It loses its transparency, however, and becomes
whitish when  inflammation  has  been present, or becomes of a chocolate hue of
various shades when from any cause the smaller vessels  of the  sac have  been
ruptured, so as to cause an effusion of blood into the cavity of the  cyst: some-
times  it  contains a  number of micaceous particles, consisting of adipocire ; at
other times a number of small bodies, looking like melon-seeds ; and occasion-
ally one  or more loose cartilages, which exactly resemble those which are  con-
tained in the joints.
   The serous cysts  which are developed in the spermatic cord and  epididymis,
or between the membranes of the testicle, are wholly different from the common
hydrocele of the tunica vaginalis, and resemble those which are not unfrequently
met with beneath the common integuments of the body, on the surface of the liver
and kidneys, in the breast, the ovary, and in other  situations.  It is possible that
they may be produced by the distention of one or more of the cells of the cellular
membrane, which a partial inflammation or some other cause may have shut off
from their communication with the adjoining cells; but this  has  not been ascer-
tained.   The secreting cyst is extremely thin and loosely attached ; and the
fluid,  instead of being like that of hydrocele of the tunica vaginalis, is remarkably
transparent and watery, and does not  coagulate  by heat.   The occurrence of
these cysts on the  body of  the testicle, or epididymis, will necessarily give a
lobulated and  very irregular appearance to this organ,  and  expose it to be mis-
taken  for malignant disease, although this  mistake may easily be avoided in
general,  by a careful examination of the part with the fingers,  or by a lighted
candle.  When they occur high up, they are liable to be confounded with hernia,
especially as from their loose connexion with the neighbouring parts, and conse-
quent great mobility, they may easily be pushed up towards the abdominal rin<r,
or even through it,  and in that case be  protruded  again whenever the  patient
coughs.  In such cases, however, there is always a visible bulgino- above the
situation of the ring, which cannot be entirely dispersed ; besides, hydrocele in
this  situation  may  always be distinguished by pushing the tumour downwards,
and then feeling for the spermatic cord above the  tumour;  under such circum-
stances,  no impulse will be communicated to the finger when the patient couohs.
   Hydrocele of the tunica vaginalis may coexist with encysted hydrocele of the
spermatic  cord, hernia, varicocele, diseases  of the  testicle,  and  hematocele.
These complications may generally be distinguished without much difficulty,
provided all the circumstances of the ca6e are duly considered.] 
OF HYDROCELE.
235
necessary  as  above  described  to  ascertain  the  situation of the
testicle,  lest  the  operator should  puncture  the  body  of the
testicle, and wounding it, will certainly fail in his intentions with
regard  to  the evacuation of the water, and may be  led by his
failure to mistake the disease, and suppose it of more consequence
than it really is ; not to mention the injury which might be supposed
to arise from  injuring so sensible a part, though I believe this last
circumstance is not of so much consequence as might be imagined,
for I know a case where the water was placed in a distinct bag
on the posterior part of the testicle, so that this body could not be
distinguished from the general  tumour by the surgeon,  who there-
fore supposed  it to be a  hydrocele of the tunica vaginalis, with the
testicle in its proper place ; and that he might avoid wounding the
testicle, he pushed  his lancet  into the fore and lower part, but no
water came.   This he repeated four  times, nearly in the  same
place, with the same effect; and on a further knowledge of the
disease it was found that all those four wounds were in the testicle ;
yet no bad consequence followed, nor did the patient suffer more
pain than afterwards, when the lancet went  into the cavity of the
bag where there was only water.
   In such cases the best guides are the feelings of the patient, and
not that of the surgeon,—a circumstance to which too  little atten-
tion has been  paid,  for a great many diseases  may be distinguished
by the sensation of the  part when  in pain.   It is  well known that
the pain felt on squeezing the testicle  is very different from that
arising from other parts; therefore if it is this organ that is swelled,
the sensation  arising  from squeezing the tumour  will be the same
in every part, and  will  be that sensation which is peculiar to the
testis ; but if  it is  a  hydrocele, or any adventitious swelling, the
sensation will be different in different places, that is, when the part
pressed  is the testicle,  the pain will  be such as is  usually felt on
squeezing the  testicle ; and when the watery part of the tumour is
pressed, the sensation of common  pain only  will be felt.  From
attending to this circumstance only, I have been able to distinguish
a hydrocele from a pulpy testicle, when the disease was supposed
by other surgeons  to be the latter.  However, there are cases in
which I have still had  my doubts  about the situation, from the
impossibility of pressing on it with sufficient  firmness  to give the
true sensation when the coats are much thickened.
   The  operation for the temporary cure requires an  incision not
bigger than that made in bleeding ; or it may be done with a small
trocar.  When the water is let out in this way, it sometimes hap-
pens that a vessel is wounded either in the skin, cellular membrane,
or sac, which bleeds pretty considerably, and the blood is  either
diffused into  the cellular  membrane  of the  scrotum, giving the
appearance of mortification, or extravasated  into  the sac, and fills
it up  probably as large as ever.   Both these  effects from tapping I
have seen, but never  saw any bad consequences  arise  from  them,
the blood being always absorbed.  I could even  conceive a good
consequence  to arise from the last, as it might be the means of 
236
HUNTER'S PRINCIPLES OF SURGERY.
forming a bond of union between the sac and  the  testicle by the
first intention, which I have seen take place partially.  This is one
of the diseases called haematocele, described by authors; they have
also described others of a different kind, but taking  place from the
same accident;  and also some cases of haematocele of the spermatic
cord, which I have not seen.
  A blow has been known sometimes to  burst the bag, by which
means the water has been  diffused into the cellular membrane  of
the scrotum, and a temporary  cure has been produced in this way.
The patient, and  also the  surgeon, have been alarmed sometimes
with this  case; for  blood  has been diffused with  water into the
cellular  membrane,  which has given  the idea  of  mortification
having taken place.
  I would  advise  that the operation for the palliative cure should
not be performed but at a time when  the patient  can lie by, as
inflammation may come on and produce the radical cure where
only the temporary was intended.   A gentleman  who was usually
tapped every six  months  begged I would do  it for him before he
went  to  Paris.   I objected,  telling him my  reasons.   He  was
pleased with them, and postponed the operation until his return,
and fortunately for himself, for it actually happened that inflamma-
tion succeeded  the tapping, which proved the radical cure.
  In cases where  such an occurrence takes place, the wound made
by the lancet or trocar has generally healed up in some measure;
but inflammation has taken place in the whole  sac, and suppuration
has come on, and  ulceration has led  the matter to and through the
skin.  As the orifice has in many cases healed up, the cause of this
inflammation is not so evident as  it would be had the sac remained
exposed, and the inflammation is therefore not so quick in its ter-
mination, and in many cases seems to be stationary,  as if suspended
between  resolution and suppuration.   In other cases resolution will
take place when the inflammation has been very violent, and when
we have been  every day in expectation that suppuration  would
ensue.   In this  case I would advise  you to open the sac, and com-
plete the operation by suppuration.*
  Of  the radical  Cure.—As various methods have  been practised
and recommended to effect a radical cure, it naturally leads me  to
make some observations on those methods, for they cannot be all
equally  proper  in  all cases; however, I mean not to be very par-
ticular in my criticisms on those different  methods  that have been
proposed, only so far as to  point out different cases where they may
be attended with  inconvenience,  arising from  particular  circum-
stances in them; nor shall I mention these different methods further

  * [Besides the  suppuration of the sac which occasionally follows the pallia-
tive operation, particularly in West Indian patients, the sac sometimes mortifies
in old people.  Sir Astley Cooper has mentioned two cases of this kind, which
were followed by death, from which he has judiciously enforced the propriety of
keeping old persons to their beds whenever this apparently simple operation is
performed.] 
OF HYDROCELE.
237
than will illustrate my own opinion.  I do not even mean at present
to recommend  one method in preference to another, but only to
show the advantages that each  has, although they all proceed on
the same principle, leaving to the surgeon, and in  some  measure
to the patient, to choose for himself after he has thoroughly con-
sidered all the different circumstances  of the  case ;  while  at the
same time I mean to show that more depends on the mode of treat-
ment after the operation has been performed than  on the mode of
operating.                                             .
   The radical cure depends on the obliteration  of the  cavity which
contains the water.  There are  but two natural methods in which
obliteration of the sac  can probably take place,  namely, by our two
inflammations, adhesive  and suppurative ;  for union by the  first
intention can hardly take place, though I can  conceive it possible
in some cases where the operation for the temporary cure has been
performed.
   I have observed that this is a disease which never arises from
the constitution,  and  seldom or never affects it;  nor  are the parts
themselves much affected by the consequence of the disease, namely,
the accumulation of water, especially if it is occasionally let  out.
It is  necessary, therefore, that we should be very particular in our
method of cure, for whatever danger arises rests  in the mode of
cure alone.  We should always make a material distinction between
an operation which is to cure a  person of a  disease  which will pro-
bably kill of itself without an operation, and an operation which is
performed to cure an inconvenience only, and where the danger is
not in the disease but in the method of cure.*
   The method of cure by adhesive inflammation is union of every
 part of the cavity with itself; and as the testicle makes part of the
 cavity, the tunica vaginalis must also unite  with it.   However, this
 method is one which I need hardly take notice of, as it is one which
 very rarely  occurs in these cases, and  as yet  we  have no  certain
 method of procuring it without  running a  risk of the suppurative
 following it.   It is much to be wished  that such a  method ot  cure
 could be put in practice with certainty and success.   That it is pos-
 sible for such  a method to take  place I know from experience, and
 also from the dissection of dead bodies, for we very often find the
 cavity of the tunica vaginalis entirely obliterated,  and fixed to the
 tunica albuginea; but it is  more than  probable that in such  cases
 there never had been water in  the cavity, and therefore adhesions
 the more readily took place, these adhesions being  a very common


   * [M. Dupuytren, in his Lecon Orales, used to remark that <operations> of con-
  venience much more frequently prove fatal than  others such for  "J*™*"
  Imputation of the thigh for old anchylosis of the knee,  the removal or^d .charge
  ofTrge bursae, &c; So much so that he was accustomed to decline  operating in
  subcases.  Surgeons occasionally  allow themselves to be-persuaded, bythe
  fmportunif.es of a patient, to undertake operations against ^Jh™°™jXng
  ments loudly declare : surely such conduct ought  o be  reprobated, as proceeding
  rimer from culpable weakness or some motive still  more reprehensible.] 
238          HUNTER'S PRINCIPLES OF SURGERY.

consequence of swelled testicle from gonorrhoea.  Perhaps letting
out the water,  and only keeping the wound open a short time,
might just procure the adhesive state, and by allowing it to heal up
before the  suppurative took place the latter might be prevented;
however, I believe the knowledge of this critical time, if there be
such, is beyond the power of human sagacity; therefore I believe it
would not  answer in most  cases.  Indeed I have seen suppuration
follow simple tapping; and admitting we were masters of the degree
of inflammation, yet many arguments might be brought against the
probability of its success, for we might  suppose  it not possible for
the adhesive to produce its effects universally:  first, because it  is
next to an impossibility to evacuate  the whole  of the water, and
that remaining would be sure to keep some parts separate; secondly,
as the tunica vaginalis is much enlarged in such cases, the collap-
sing of the skin might prevent adhesion taking  place at all; thirdly,
the contact could not be so uniform as to bring all parts into appo-
sition.  I  know but of two cases where this method occurred suc-
cessfully.
   Observations on the  different methods of radical cure.—I believe
I am-the first who have taught that the radical  cure is performed
by inflammation, suppuration, and granulation;  it was the general
opinion, and  I was always taught, that  it was by adhesion; but if
union took place by  adhesion, without granulation, then we should
not have had suppuration.
   The most  simple mode recommended for obliterating this cavity
consists of making a small  opening into  the sac, and introducing an
extraneous body to prevent union by the first intention in the wound,
by which means universal inflammation should take place over the
whole surface of the sac.  This probably was not thought sufficient
to raise an inflammation, therefore it was recommended to throw
into the cavity by this orifice stimulating liquors, so as to increase
the inflammation; they had not an idea  of an imperfect cavity pro-
ducing inflammation of itself.  In very old cases, where suppura-
ation is but slow in its progress, this mode  may be of considerable
service.
   Another method was by seton, which was no more than a double
tent, or two wounds instead of one.
   The  ideas annexed  to these modes of practice were, that  they
produced adhesions of the sides of the sac  to each other, and also
to the testicle, by the first method of union.   Great pains have been
taken in a  treatise published by Mr. Douglas  to  show the impossi-
bility of the sac collapsing so  readily as to unite in every part of its
extent.  But this is neither  the effect one might naturally expect  to
ensue from the  methods put in practice, nor what really takes place
in the very cases where they were tried, as is easily  known from
the symptoms described by the operators themselves, which were
plainly those of the suppurative inflammation, though they did not
see it in that light.
   So far was this disease treated to procure adhesions of the tunica 
OF HYDROCELE.
239
vaginalis  to  obliterate the  sac, and perhaps it was on the same
principle that a small caustic was at first applied, and which has
been  used with success; but in a  late publication (Else's) it is
recommended on principles very different from the foregoing, for it
is there supposed that the whole tunica vaginalis sloughs off and
passes out through the opening.  But that the whole tunica vaginalis
should slough away by this treatment more than when the whole
cavity is laid open, is not to be conceived.   It is, however, a well-
known fact that the tunica vaginalis often throws off partial sloughs,
and in some very old cases may slough wholly away; but it is
not to be  expected as a general effect.  When it does slough, this
is owing  entirely to  the  diseased state in which the sac is  at the
time, and not to any particular virtue in the method of cure.   I sus-
pect that after caustic, more than after other methods of cure, there is
an appearance very much like sloughing, so much so as very readily to
deceive;  this appearance is the coagulable lymph thrown into the
cavity among the water from the internal surface of the sac in the
time  of the adhesive inflammation.
   From the  ignorance of the true principles of cure, and the uncer-
tainty of success from the  former methods, practitioners were led
 naturally into the method of opening the whole sac or bag; but most
probably they were led  to  this practice by imitating what may be
 called the natural cure, in cases where the sac had burst, and a
 radical cure ensued.  It is most likely that the bursting of the sac never
 happened from mere distention, but from preceding inflammation
And suppuration, which  might arise from the distention, and in that
 light is  only to be considered as an abscess.   And here it will be
 proper for me to observe, that such a case might lead a surgeon to
 form an  erroneous idea  of it; for if he had not been consulted from
 the beginning of the disease, namely, when in the state of hydrocele,
 and  also had not made himself master of what the disease  now is,
 he might readily suspect it to be a diseased testicle,  and might be
 confirmed in the opinion by the inflammation and suppuration, unless
 the  appearance of  these should cause him  to suspect it not to be
 cancerous;  but if it does  not, he will  be most likely  led to the
 extirpation of the whole mass, unless by first laying open the abscess
  freely he should gain a knowledge of what the disease is.  Even
  then, however, he"might continue to be deceived, for the inflamma-
  tion having attacked the body of  the testicle, he will find it very
  much swelled, and to appearance diseased, especially if the abscess
  should  not  have been  thoroughly  opened.  A case  of this kind I
  once saw, and also the  mistake above-mentioned:  the abscess was
  opened,  and the testis  exposed and condemned; when I saw the
  abscess  and the testicle at the bottom, I suspected  what the case
  was; the testicle was not  removed, and the patient got rid of his
  hydrocele.
    It is possible that a  case of this  kind  might happen where the
  disease  would not  show itself so manifestly;  for if  the water had
  been contained in a hydatid, the testicle would not be exposed bv 
240          HUNTER'S PRINCIPLES OF SURGERY.
 opening the abscess, and the whole tumour might appear to be the
 body of the testicle.   In a case of this kind the sick heavy pain and
 the pain of the back which attend diseased testicle would not  be
 present,  nor the pain in the small of the back ; so that if these
 symptoms were attended to, there might still be a means of saving
 the testicle.
   Although this natural cure might have shown the possibility of a
 cure being effected by inflammation and suppuration over the whole
 sac, and that very probably no more was necessary to produce it
 than  making an opening  into the sac, and not allowing  it to heal
 by the first intention, yet it was certainly not understood, for it was
 thought  necessary by some to open the whole sac, and indeed  to
 make it still more secure by cutting off a part of the sac, or even
 the whole, which indeed was all that they could, unless they had
 dissected off the tunica albuginea from the testicle.  As this method
 of operating is much more  violent  than the others, of course its con-
 sequences are more  violent; it is,  therefore, evidently not  to be put
 in practice to its full extent, if a less violent and  as sure a one can
 be devised.   However, do not suppose that I  mean to  prefer a
 patient's ease during an operation  to his cure.
   In every one of the operations for the radical cure of hydrocele,
 the suppurative inflammation  is an effect which is pretty violent,
 and therefore in many cases of thickened sac it produces an inflam-
 mation which is absolutely sufficient to kill some parts which are
 not able to  support the actions of life, and which  are thrown off in
 the form of sloughs.
   Incision, it has been said, is to be preferred, because it  gives the
 operator an opportunity of seeing the state of the  testicle, which has
 been found very much diseased in such  cases, so that the operator
 has thought  himself obliged to have recourse to extirpation of it.
 This is a case which sometimes happens ; but I suspect that, if the
 symptoms  were particularly attended to, we might inform ourselves
 exactly of it before  the operation  was performed.
   Perhaps in most cases it would be right to perform the temporary
 cure first, which  would  show  the state of the testicle at the time ;
 and  as the sac generally fills  again pretty fast, there could be  no
 danger of the testicle becoming diseased during the time of refilling:
 for in most cases where the testicle is diseased there is an obscurity
 in the feel;  it will give the feel of water in some  positions, and  in
 others of more of a solid substance.  However, in any of the opera-
tions, excepting that by caustic,  we might judge, I think, of the
 state of  the testicle  as soon  as the water was  wholly or in part
evacuated ; and if the testicle is found of its natural size, there will
be no reason for apprehension about it; and if very much thickened,
then the surgeon  is to act accordingly.  But I  am inclined  to
believe that such diseases of the testicle as are generally attendant
 on dropsy  of its coats, and are perhaps the causes of that dropsy,
 seldom do much mischief.
  I cannot say I ever saw  a cancerous testicle that began by pro- 
OF HYDROCELE.
241
ducing a common hydrocele, nor can I call to mind any case of
common hydrocele, where the radical cure has been attempted, in
which the testicle ever became cancerous afterwards.  Yet I have
known cases where it appeared a true hydrocele at first, and the
testicle afterwards enlarged, and by  degrees the water diminished,
till at last the whole has been an enlarged testicle, and  has  been
obliged to be extirpated.   I have often seen the testicle diseased on
opening the sac, and it has been generally thought proper in such
cases to remove the whole ; yet I imagine it is  seldomer necessary
than is thought.  This disease would appear to be not sufficiently
distinguished from cancer, to which I believe  it has no real affinity;
however, it is possible that cancer of the testicle may be attended
with hydrocele.  Perhaps this disease may have some  connexion
with scrofula,  for I have seen scrofulous testicles, and have even
extirpated them as cancerous.  In some cases this practice is right,
 and it was so in those in which I did it, but it was not intentionally
 right; for although not cancerous, yet they often become so much
 diseased  and so large that  it is  absolutely necessary to extirpate
 them.  But still such have an advantage over cancers, as we may be
 pretty certain  of the cure from the operation, which is not always
 the case where there is a cancerous disposition. If the case appear
 very dubious, I should recommend an incision, that the state of the
 testicle may be better understood, and the patient will be equally
 sure of a cure.                                             ,  ,
    I shall now mention the causes of failure common to every method
 of cure, and then the causes of failure peculiar to each.
    The sac containing the water being membranous, it only can be
 distended by the water  which it contains, and readily collapses and
 throws itself into folds whenever this distention is taken off; and, as
 every method of cure requires the evacuation of the water, the mem-
 brane will collapse, if not prevented; and this collapsing I find to be
 the common cause of failure in them all.
    It is a principle in the animal economy, when any natural internal
 cavity  is exposed, that if any two  parts of  the cavity are brought
 together they will unite, but only at the  edge  next  to the exposed
  surface ;  beyond this, if any two parts  of the surface are in contact,
  they will not unite, being excluded  from the necessity of union by
  the union of the edges which  are  nearest to the exposure,   lms
  part that does not unite then is formed into a cavity capable ot con-
  taining a fluid, and of being hereafter filled in that  way  ; where the
  sac has been large and  not thickened, several such cavities may  be
  formed, each capable of carrying on the disease.  Until I understood
  the above facts, I could not understand why we have recurrence of
  this disease in the same tunica vaginalis.  The first time I saw that
  a recurrence could take place was  in a patient of my own, who died
  of small-pox  whilst under the radical  cure of the hydrocele   Ihe
  recurrence of the disease will follow every method which does not
  prevent the two  sides of the sac coming into  contact with one
  another in the time of  inflammation.
                                21 
242          HUNTER'S PRINCIPLES OF SURGERY.
  Of the causes of failure common to theSeton, Tent, and Caustic.—
In either of these three methods of treatment, if the water is eva-
cuated immediately,or is evacuated soon after the operation, at least
before suppuration has come on, it often  happens that the surface
of the sac  surrounding the orifices  shall come in contact with  the
body of the testicle and adhere, which will immediately exclude all
the other parts of the cavity from the necessity of inflaming, suppu-
rating, &c, so that no union of the sac is produced but at the part.
I have known a seton inclosed in this way along its whole course,
and lying  in a canal formed  for it, instead of being  loose  in the
general cavity.
  I have known the same thing happen to the parts when the caustic
has been applied:  the edges of the sac all round  have adhered to
the testicle, so that when the slough has come away this has formed
the bottom of the wound, which granulated ; the  wound filled  up,
the disease recurred, and required a second operation.   I have also
found sometimes, where the caustic has been used, that Nature  has
covered the inner surface of the eschar with new  living matter, by
which the inner cavity has been made perfect.  A patient of mine
had a hydrocele in each tunica vaginalis.  I applied the caustic to
each; when the sloughs came out, I observed at the bottom of each
a bluish white  surface, while the  edges  all round  were red and
granulating.  This surface I suspected was the tunica vaginalis not
affected by the caustic.   I endeavoured to  complete what the caustic
had failed in; but  was surprised to find that I was obliged to push
my lancet in half an inch before the water  came; when I intro-
 duced a tent to prevent its being wholly evacuated. I made a similar
attempt on the other side;  I introduced my lancet half an inch,
and no water  came, and I then  made  a puncture  through  the
sound skin, and had not to go so deep as when the eschar had fallen
out.
   I suppose that when a breach or waste or loss of  substance is
produced  in the outside of any cavity  (and probably in every other
part) there immediately takes place an  irritation suitable  to  this
cause, and this  irritation produces an extravasation of coagulable
lymph on  the inside,  to preserve the cavity or part as entire as pos-
sible, which it had certainly effected in this case.  Probably  this is
the common cause  of failure in the immediate effect of caustic, which
was not before understood.
  We see the same thing take place in-joints ;  where that part of
the bone which makes part  of the joint  becomes dead, we  find a
layer of coagulable  lymph  laid over the dead part or end of the
cartilage,  which preserves  the joint perfect;  otherwise  the  whole
cavity must suppurate.  In these cases of joints,  as well as in the
above,  it  has puzzled  me  to know how the layer of coagulable
lymph was formed.  If in either case death in the part did not go
quite to the cavity,  but leave a living surface, (no matter how thin, so
as it is sufficient to produce a surface by extravasation,)  we may then
conceive how new matter may be laid on this surface  and increase 
OF HYDROCELE.
243
to any thickness.   If we can  provide  one layer, we  can easily
make it increase.  It is a curious fact, and deserves attention.   It
is as if Nature was making the same opposition as we should do if
a neighbour was endeavouring to niake a way through the wall of
our house, and, as we could not prevent his endeavours on that side,
we should barricade further on this side, by raising up another wall.
  To avoid these failures, I have practised and recommended that
the tent or seton should be as large  as  the opening made for the
introduction of it, so as to fill up the whole wound, and to allow
but little or no water to escape, until  inflammation and suppuration
have come on; and in  cases where the caustic has been applied I
have not cut through  the eschar, but allowed it to slough off, by
which  time the necessary inflammation has come on.   This mode
would  seem to give the preference  to  the caustic; but we  find
Nature taking all the  steps  she can to frustrate our operations
whenever they are violent upon her, as described above.
  In some of the cases where the sac has collapsed and united as
above  described, leaving a cavity beyond it loose, it has happened
that the preceding inflammation has gone too far for those cavities
to remain in a quiet state, and suppuration has taken place  in them
while  under  cure, forming there an  abscess which either breaks
through the adhesions and opens into  the first sore, or makes a new
passage through the scrotum, like any other abscess,  and  a com-
plete cure has been effected.
  I have reason to  believe that from the small opening made by
these three modes, old hydroceles are sometimes deprived of the
full effect of exposure; and  that, though  the  parts inflame  and
suppurate, yet when the orifice has become small and taken on the
closing process, the sac loses the suppurative disposition, (like  the
pleura  when suppuration takes  place,)  the surface never having
granulated, but simply secreted  matter  like the inside  of a duct;
and when the exposure ceases, falls back into the natural state, and
the accumulation of water recurs.
  When the radical cure is to be performed, either by tent, seton,
or caustic, it is more proper to do it in one part of the tumour than
another.   One might at first suppose  that the most depending part
of the  tumour would be the best, as in an abscess; but in fact it is
the very worst,  because here the inflammation  is to follow  the
operation, whereas in an abscess the opening  follows the inflam-
mation.  Why this should be  a reason for performing it in a differ-
ent part may not  at  first sight appear: but it is to be considered
that the  tumefaction attendant on the inflammation which  is to
succeed, will not be so great in the  part where  the operation is
performed, if the extravasated juices, which are the chief cause of
the swelling, can be allowed to depend;  hence the opening will be
less liable to close up  when  made  at the  upper  part  of the  bag
than at the lower, where it would be in the centre of the tume-
faction, and would not allow a free discharge of matter, as  we
really  see  to  be  the  case  on  many occasions.  To avoid this 
244
HUNTER'S PRINCIPLES OF SURGERY.
 inconvenience, the opening should not be made at the lower part of
 the tumour;  nor at the  upper, for  the following reason, viz., the
 water as it increases commonly pushes up the  sac into the  sper-
 matic cord;  therefore the situation of the upper part  of the sac
 is changed immediately on  the  evacuation of the water; and the
 sac collapsing and contracting in proportion to the evacuation, its
 upper part moves  downwards,  which of course  must  alter the
 relative situation of the opening in the sac and  in the skin.  The
 opening should therefore be made in the middle of the tumour.
   Of the Mode of performing the Operation with the  Tent.—When
 the bag is pretty full of water,  examine the bag carefully for the
 testicle.  The situation of this being ascertained, grasp the bag in
 the hand, and squeeze the vyater  towards that side where the  testi-
 cle is not.  Push the lancet in until the water comes out by the side
 of it, and then carry it forward, and  enlarge the wound to about
 double the  breadth  of the lancet.  Withdraw the lancet, but keep
 the tumour in the same situation, that the orifices in the skin and
 sac may continue opposite each  other, or  it will  be almost impos-
 sible to introduce the tent; but do not press the  sac quite so hard,
 or all the water will come out before the tent is introduced.  Intro-
 duce  the tent with  the right hand, and hold it till it swells, when
 there  will  be  less danger  of its  falling out.  Then put on a piece
 of sticking-plaster, to secure the  whole.
   The tent  may be kept in till the edges of the  wound swell,
 which will be in  a few days, and then the tent becomes loose, after
 which there will  be no danger of the wounds closing up, for by this
 time the alarm will be given to the whole cavity, and the irritation
 of an imperfect part will be sufficient to prevent the wound healing.
 I recommend a sponge tent, as it swells and keeps the orifice perfectly
 open, and as this swelling  is greater at the two ends than between
 the  lips  of the wound, by which two disagreeable accidents are
 prevented:  the one, the escape of the tent into  the cavity of the
 tunica vaginalis;  the other, the escape of the tent altogether from
 the wound.
   Of the Seton.—This is to be preferred to  the tent, as being more
 easy to  perform.  The most easy  method is with the  common
 seton  needle:  holding the  scrotum as above, introduce the needle
 perpendicularly where we know the water is ; lower the end and
 raise the point, and bring it through the skin about half an inch or
 more above the other incision.   Take off the needle, and apply a
 piece of sticking-plaster over  the wound.
   A lancet  and eyed probe, carrying a skein of silk, is sometimes
 used, but it does not  answer so well.
   When suppuration is established, the seton may be either left in
 or removed, according to circumstances.
   Of the Caustic.—A small caustic applied to the tumour is com-
 monly sufficient to produce the effect, if it acts quite through the
 sac.   In applying it, we should attend to the feelings of the patient,
to  judge  when the sac is deadened by the  action of  the  caustic. 
OF HYDROCELE.
245
  The uncertainty of its acting through all the coverings of the sac
  has been an objection to this practice by many; and when it does
  fail in  this way, the finishing what the caustic has  not  effected
  reduces the operation to the case of a  simple puncture.  I have
  before shown  another objection also.
    If the chance of the caustic not penetrating was the only objec-
  tion, I should  prefer the caustic to all other methods of cure for the
  following reasons:  because it removes a small part, which gives a
  freer  passage  to the  water than a  simple wound; and we may
  produce the adhesive inflammation  in the  inner edge  surrounding
  the slough before the water is evacuated, which in some degree
  determines the thickness of that part before the general tumefaction
  comes on.   This gives it a considerable  advantage over the punc-
  ture or seton, for they produce the general  inflammation nearly as
  early as the local one, which proves inconvenient  in  many cases
  by thickening the scrotum at the orifice, which lengthens the pas-
  sage and almost shuts it up.  Besides, if  the effects of caustic are
  produced quite through into the cavity, they excite the  suppurative
  inflammation over the whole cavity before the water is evacuated,
  the presence of which more readily allows it to become universal.
  However, the  caustic is  not always a certain cure, even when its
  immediate  effects are completely gone  through, for I  once saw a
 case where the seton had been used first, and on the recurrence of
 the disease the caustic was employed, yet after this there remained
 a small sac which required a third operation.  The cause of failure
 in both the first was, I believe, that which I have before noticed of
 the edges of the opening collapsing and becoming united to the
 body of the testicle.
   From  what  has been  said it must appear that the great art in
 this operation  is the prevention of the possibility of a relapse ;  to
 prevent which  it is requisite that every part of the  sac should be
 obliterated, for  which purpose it is  necessary that every part  should
 be subject to suppuration.
   I  have now  considered this disease, the precautions necessary
 before the operation, and  the different methods of operating, with
 their advantages and disadvantages.  I have endeavoured to show
 that every method hitherto recommended has in many instances
 failed,  and I  have also endeavoured  to show the causes  of their
 failure.  It is proper now to consider of some  method  which shall
 not be subject to the above mentioned inconveniences.
   I have of late used the following method of cure, with a view to
 producing universal inflammation and suppuration of the sac.
   Make an incision into  the sac about three inches  in  length,  and
 let the  whole of the water escape  ; then fill it as full  as  possible
with pretty stiff poultice,  occasionally introducing your finger to
direct  the poultice  into every corner of the bag; and, lastly, put
some lint into the wound to keep the poultice in.   The poultice
should  be be made of linseed meal, and pretty  stiff;  if it is  made
into  little balls  it will be still more convenient.  The advantages
                             21* 
246
HUNTER'S PRINCIPLES OF SURGERY.
that this method has over the others are, first, that it is simpler than
exposing the whole;  secondly,  the  parts are kept universally dis-
tended by an extraneous body,  so  that the inflammation becomes
universal;  thirdly, the poultice does not become  entangled  in the
granulations as dry lint does ; fourthly,  as the parts granulate and
contract, the poultice is gradually squeezed out, and only requires
superficial dressing during the whole time.  With the same intention
I have sometimes used lint dipped  in oil or lard, which prevents its
becoming entangled in the granulations, which without this precau-
tion it is liable to do ; so that I have known it retained in the sore
for six weeks, when it was obliged to be removed  to allow the sore
to heal over.*
   To prevent inflammation coming on too quickly and  causing
unnecessary pain, I believe it is right to apply a piece of linen  cloth,
folded ten  or twelve  times, and of sufficient breadth to cover the
scrotum, first dipping it in brandy and squeezing it dry.  Over this
apply a suspensory bandage, which should be wetted as it becomes
dry.
   The symptoms  following the operation are those common to all
wounds, but as there is also a part in some cases concerned in this
operation which has  symptoms peculiar to itself, it becomes neces-
sary to describe these; this part is the testicle.  The testicle is only
concerned when the collection of water is  in the tunica vaginalis.
The symptoms  peculiar to it are in some measure those of a vital
part;  a dull  heavy pain is felt, the stomach is sooner affected, and
lassitude  sooner produced, than  in affections of common  parts.
Besides these, there is one peculiar symptom, that is, the pain in the
back attending inflammation of the testicle.   This is generally sup-
posed to arise from the nerves of the testicle arising from the nerves
of the loins.  If this  is the true  solution of the case, we can only
say this is peculiar to this part; therefore out of the common way
of symptoms.   In less than twenty-four hours the symptoms  of the
operation will begin: for, although the patient should have no pain,
he will soon feel a lassitude, small short rigors attended with rest-
lessness, which  show that where this operation of inflammation is
going on in the part, though it may not affect the senses, it is yet capa-
ble of producing considerable effects on the animal economy, so as
very much to effect the vital principle.  These symptoms increasing,
the scrotum  becomes sore to the  touch, a greater  degree of heat
than  common arises in the skin, the patient complains of thirst, and
at last the diseased part becomes painful, swells, and throbs.  The
swelling is often very considerable; and, from  the pain, this might
be supposed  to arise from the testicle, but it consists principally of
the cells of  the scrotum, which being composed only of cellular
membrane, and that  very ductile,  gives way to the extravasated
 fluid, viz.,  coagulable  lymph  and  serum.   However, the testicle

   * [Mr. Hunter afterwards substituted  the use of flour, which he dusted over
 the exposed surfaces] 
OF HYDROCELE.
247
itself swells and inflames in hydrocele of the tunica vaginalis, espe-
cially when that body is  laid  bare, as might be expected, as  that
part, or rather its coats, inflame and suppurate.   Besides, we have
the symptoms which denote affection of the testicle.
   The future treatment is like that of common wounds, only a  sus-
pensory is required, as it relieves the pain in the  back.
   After the parts are healed, the  testicle, for a  considerable time
appears hard and large, and the  skin of  the scrotum adheres to it.
This  gradually subsides  by the  contraction of the granulations,
which are the chief cause of it, and by the absorption of the adven-
titious substance  deposited  by the  inflammation.   This natural
process may be much  accelerated  by  the use of the  mercurial
ointment, rubbed on the scrotum, for a month or six weeks.*


                    On the Action of Medicines.

   Before I proceed to make any further  observations on  particular
 diseases and injuries, I shall say  a  few  words on medicines,  or
 rather of their action on the human body.

   * [There is one capital objection to all the operations above mentioned, which
is their severity and danger.  Many cases of death occurred, and many more of
high  constitutional irritation which placed the patients' lives in imminent peril.
The operation which is now almost universally resorted  to, and which is only
cursorily alluded to by Mr. Hunter (p. 238), is free from these inconveniences, at
 the same tune that it very rarely indeed fails of curing the disease.   It was intro-
 duced by Sir James Earle, and consists in injecting the evacuated sac  with
 any mild  stimulating liquid,  such  as a solution of zinc,  or equal  parts of port
 wine  and  water,  which are allowed to remain in from  five to  ten minutes,
 according to the feelings of the patient.   A moderate inflammation generally fol-
 lows this  operation, and in a few days the fluid re-collects : after a short  time,
 however, the inflammation subsides,  and the  fluid is  absorbed.  The  time
 required for the  absorption  of the fluid varies from one to six months.  Occa-
 sionally, but very rarely indeed, the disease returns.
   It was imagined that this operation effected the cure by causing an adhesion
 between the opposite sides of the sac.  An effect which is doubtless sometimes
 produced, and probably in all cases to a certain extent, although later observa-
 tions have proved that universal adhesion of the  sac is by no means a general
 consequence of the operation, which cures by destroying the morbid action of the
 secreting vessels in some manner which has not been explained.  The  success
 of this operation is not by any means in proportion to the quantity  of inflamma-
 tion produced, although a certain quantity seems necessary for the  effect.  The
 inflammation arising from injection rarely exceeds the adhesive stage; although
 this does sometimes occur.   Only three cases of this kind are mentioned by Sir
 Benjamin  Brodie  as  having occurred  in his experience, and these three  were
 West Indians, in  whom suppuration took place.  Occasionally  the scrotum
 sloughs.  (See note, p. 236.)
   Where the operation by injection has failed, the operation by incision may be
 had  recourse to.  In  children it is generally advisable to have recourse to the
 seton, using a few threads of silk only, passed by a common curved needle.  In
 encysted hydrocele of the cord the  same means may be adopted ; or, what is still
 better, the sac may be laid open, and the fore part of it cut  away.  If it be situated
 on the testicle or epididymis, and of small  size, it had better not  be  meddled
 with, or it may be simply evacuated, provided it is inconvenient to the patient
 from its magnitude.  The operation by injection does not succeed in encysted as
 in common  hydrocele.] 
248
HUNTER'S PRINCIPLES OF SURGERY.
   The living principle, I before observed, is susceptible of impres-
 sions which may be productive of action, either diseased or healthy,
 *'. e., productive of restoration; each of these may be brought on by
 medicine. Whatever affects the animal body otherwise than mechan-
 ically  must be in a state of solution.  From our juices being chiefly
 watery, the solution of many substances can easily be conceived;
 but they  are likewise  capable  of dissolving earths, metals,  &c.;
 nay, there is, I believe, hardly any substance which is not capable
 of being  dissolved in the  human body.   Earth, and even  iron, is
 found  in  animal substances  on analysis, which must have  been
 dissolved in  the fluids, as  well as essential  oils,  which  may be
 detected passing off by our excretions.   Taste is one proof of the
 power of our fluids to  dissolve, for there is hardly any substance
 capable of stimulating but what will give a taste if applied to the
 tongue:  thus, almost all metals held  in  the mouth for a little time
 will give  a taste : the same thing  most probably takes place  with
 substances applied to  the  organ  of smell.  The  blood, from  its
 being  so  heterogeneous a  fluid, may have  its  powers of solution
 inferred;  and as  I suppose a  necessity of solution of these sub-
 stances to affect the  organs of smell and taste, so in like manner
 I suppose the necessity of solution, not only  for its introduction,
 but for it to affect the system.  Simple water possesses  much less
 power of solution than when combined with some other substances ;
 thus,  by the  addition of fixed  air it becomes  capable of holding
 earth  in  solution.  From  some similar  combination perhaps the
 blood  and other animal fluids derive their extraordinary powers of
 solution.
   Medicines affect the living principle by their stimulant or sedative
 qualities only, unless  they act chemically, as caustics; they have
 the effect of irritating or quieting, and these two contrary effects
 are generally to  be  found in the same substance, the difference
 resulting  from the difference of quantity; thus, a small quantity of
 heat relaxes and softens, but a larger quantity will stimulate.  A
 stimulus is what  either causes a natural action, or increases one
 which has already taken place, or excites an action contrary to one
 present, as by giving an opiate when a  patient cannot sleep, &c.
 Medicines may either stimulate or irritate; such as increase the
 natural power  of acting are stimulants: such as excite new and
unnatural actions are  irritants.  The powers of both will be accord-
 ing to the medicine  and the parts combined,  for  fixed  air in the
 stomach  increases its  action;  in the  lungs it destroys  action.*
 The effects of medicine will be different  according to the mode of
 action the parts are  in at  the time, that is, diseased, natural, or
 restorative.  This is well illustrated by many diseases of the consti-

  * [Sir Humphry Davy found that when he attempted to breathe pure carbonic
 acid the glottis spasmodically closed, from the stimulant action of this gas, so as
 to render further inspiration impossible; on the other hand, Fodere" has remarked
 that a too free use of aerated waters will sometimes produce precisely the same
effects as the inhalation  of the  dilute acid by the lungs, viz., giddiness and
 intoxication.] 
OF HYDROCELE.
249
tution, as fever, &c, curing diseases in parts which had before been
incurable;  if the part had  not  been diseased the effect would not
have taken place, for fever deranges a healthy sore.
  Actions may be, first, of healthy parts ;  secondly, action produced
by stimuli or irritants on healthy parts; thirdly, action of diseased
parts: fourthly,  action of stimuli  and irritants on a diseased part.
Irritants may produce very different effects on a healthy part, or
whilst disease already exists ;  thus, mercury,  by its irritation, will
produce diseased action in a healthy part; the venereal poison, by
its irritation, will  also produce diseased action in a healthy part;
but from the application  of mercury to a part  already affected with
diseased action from venereal irritation,  an action results different
from that which would be produced by the application of it to a healthy
part; for from the conjoined action of the two, results the action of
health ; but  if carried beyond  that it may do harm, producing its
own specific action.   Besides this, it is to be observed that the vene-
real action, or in fact any other morbid action, may produce a dis-
position for other increased actions, which may require only the
absence of  the former  disease to  allow  it to  come into  action.
These consequences are therefore to be distinguished from the ori-
ginal disease, otherwise the mode of cure maybe continued too long,
and that which might be curative of the first  disease may increase
the consequent one.
   In a former part of the course I mentioned  susceptibility, disposi-
tion,  and action.  Can the same medicine have an influence on  all
these? Will mercury, for instance, destroy the  susceptibility and
the disposition for the venereal disease, when formed, as well as the
action?  It will certainly  destroy the  latter, and  we have cases
which would make us think it will lessen the susceptibility also; but
as to its having any effect in lessening the disposition I should very
much doubt; but it may perhaps  retard  it.
   A  gentleman had a  chancre, for the  cure of which he used a
large  quantity of mercury, both  by friction and internally, which
produced very little soreness of his mouth.  The  sore at last healed,
and from  the  quantity  of  mercury which had been useditwas
thought that the constitution was preserved; but in  a  little time
discdorations of  the skin appeared; for these he drank a quart of
s^rsaparilla  daily, without their  removal; on the  contrary fresh
ones appeared.   I gave two grains of  calomel  twice a day, and
he wafcured.  No^ 1  supposl that a disposition for  this diseased
action might have existed before the mercury was first used, which
deposition was by this not lessened, but only retarded, and thecure
d dPnot take place until  the venereal action took place, which was
?hen cured by the action of mercury the first mercury not prevent,
  ng the disposition from  forming;  and it  thus appears that what wiU
cure  the  action will not cure the  disposition,  hence lues often
requires repeated  courses  of  mercury.  The  ultimate effect of
[mpTessions, I have already shown, are  actions; and I also  showed
  hTd seased actions were thus produced; and here is the place to 
250           HUNTER'S PRINCIPLES OF SURGERY.
observe, that in the same manner actions may be  produced which
are destructive of that which is diseased.   But disease is not always
the consequence  of impression,  but  sometimes of imperfection of
parts; thus, there may  be a wasting of the body from a want of
absorption of chyle from the intestines, or mesenteric obstructions.
There is no impression without a counter-impression ; as if one has
a pain in the knee from a disease in the hip or loins ; here it would
be ridiculous to  apply  a remedy to the knee, as that is only the
effect; yet this is often done.*
  Medicines have visible and invisible effects.  The visible may be
divided into two, the constitutional and the local, the former pro-
ducing the latter.   The  local are vomiting,  purging, &c.;  as  an
instance of the constitutional, the effects of mercury may be men-
tioned. Their invisible effects  are commonly the specific effects,
for we find that their curative do not always depend on their visi-
ble effects; and indeed their specific effects are often greater when
they have no visible effect, as mercury producing  salivation  in the
attempt to cure  the venereal disease, bark in intermittents: but
others cure by their visible effects.
   Of Stimulants, Irritants, and Sedatives.—The two former are most
commonly used by surgeons, because a want of disposition for res-
toration is more common  than excessive wrong  action; and  a
backwardness to heal is more apt  to excite the idea of sluggishness
than of excessive or wrong action, though perhaps even the latter
may be the case.   Medicines given slowly and continued  long will
produce effects  very different to those  produced  on their sudden
application, and  thus  it is that even  stimulants and irritants may
produce weakness.
   On restoration of Action.—In the  restoration of action of the whole
body,  or  of diseased parts, attention should be paid to the strength
of the parts, or of  the whole system, for  there  may be too  much
action and too little strength, or too  much strength  and  too little
action.  Strength and action should  be well proportioned to pro-
duce good effects.   When parts have  lost their  action for some
time, they become  weak,  as we  see in  people  recovering after
drowning.  If we do not attend  to the degree of strength, we shall
often produce irritability by hurrying on action too soon in weak
parts.   If a  man  is weak from  loss  of blood or from famine, his
strength should  not be tried  by too much food, stimulation, &c.
When strength exceeds action, then  there  is  room for the use of

  * [However unscientific this practice may appear,  yet it is often found  to
relieve the pain, probably upon the simple principle of counter-irritation.  If (it
is argued) the knee sympathizes with the hip, why may not the hip sympathize
with  the knee] The principle is not very different upon which leeches are
applied to the anus, and sinapisms to the  feet, in affections of the head ; that is,
certain  parts of the  body sympathize  with  each  other more readily than with
other parts, and on this account are thought to afford the most favourable situa-
tions for counter-irritation ; hence blisters to the  knee relieve this part  by first
relieving the hip.  The precise meaning of the term " counter-impression" in
this connexion is not very apparent.] 
OF HYDROCELE.
251
stimulants.  If the effects of medicines did not extend beyond  the
point  of contact, their effects would be  very trifling indeed;  but
their effects are extended much further by sympathy.  This sym-
pathy  may be either contiguous, continuous,  or  remote.  Such
sympathies as are continuous and similar lose their power by  dis-
tance only, and medicines acting thus maybe termed local.  But it
is to be remembered that the remote sympathetic effect of medicines
is not always the same as their effect on  the part to which they
were first applied.  If the  continuous sympathy was not similar,
and if the effect of any medicine on any part thus affected was not
continued by that same similar continuous sympathy through  that
part, how trifling would be the effect of such applications; and how
could  any application to the surface affect an inflammation which
extends to a great  depth  but  by the same  sympathy?   It is by
sympathy  that ether, applied to the forehead, relieves headache;
applications to the skin of the abdomen, its contents, &c.; in short,
if this were not the case no medicine could cure without coming in
contact with every part  of the diseased organ.
   On ihe effects of external applications.—The  commonly-received
opinion respecting external applications is that  they enter into the
pores of the skin, and so reach the part; and on this idea practice
 was built.  Parts were supposed to be relaxed and  moistened by
Jie joint effects of warmth  and moisture, and  on  this idea warm
Vjaths were used to ruptures and dislocations.   In many cases, indeed,
 very salutary effects were derived  from their use;  but this cannot
 be from the cause assigned, for the warmth  of a living part is not
 thus increased ;  and a living part may be immersed for ever in warm
 water without becoming  moister, except where  the  water  is in
 contact.   The  good  effects are produced  by the  external  parts
 being  soothed,  and  by sympathy the  parts  beneath  lose  their
 irritability, and the natural actions return.  In  suppression of urine
 the warm bath is often effectual; not surely because it penetrates
 from without, but because relaxation is brought on  by sympathy.
  Volatile spirits and vapours have been used with the same idea, but
 it is well  known that water will  often penetrate where these will
  not.  Oils are  often  used for the  purpose  of  restoring stiff joints,
 perhaps from seeing their salutary effects on rusty hinges; but rusty
  hinges have greatly the advantage of the animal body, as  oil will
  penetrate into every part of them and wash off the rust, whereas in
  a stiff joint not  a particle of the  oil will penetrate.  The idea of
  their penetration has been carried so far as to lead some to prefer
  animal to vegetable oil,  on the supposition that as  it had  come
  from an animal it would  more  easily enter an animal.  Essential
  oils  are used as stimulants in rheumatism, &c, but I suppose their
  effects are only produced by sympathy.
    Although I do not admit of this mechanical penetration of sub-
  stances, I have no doubt of their absorption  by the  action of the
  proper absorbing vessels: thus, mercury  applied  to the thigh is 
252
HUNTER'S PRINCIPLES OF SURGERY.
absorbed and carried through it; but if rubbed on the bubo this
can only be affected by sympathy with the skin.*
   Pressure and Friction.—The ultimate  effect of these seems to be
similar, namely, stimulating, but from different causes.   If pressure
is used as a stimulant, it must be gentle: if violent, it will irritate,
and produce vesication, as we see in bedridden  people.   Pressure
produces increase of action, by first impeding action, the impedi-
ment acting  as a stimulus on the part.   Friction is more powerful,
more active  and immediate than pressure, and may be applied to
larger surfaces; it does not impede action as pressure does at first,
but rouses the parts into  action, and excites a warmth in them.
Stimulating or irritating medicines render friction  more powerful
in torpid parts.  Fibres, by frequent rubbing, are stretched, and
lengthen.
   Heat,  cold, and electricity produce effects not only at the part to
which they are  applied, but much deeper also.  Water as it con-
ducts quicker, is a better  vehicle for the application of heat than
air.   Cold, when  applied  to  the  skin,  has  great  and  immediate
effects.   We have two opposite effects from cold-bathing, according
to the mode  of application  and the state of the constitution at the
time.  By its quick  and sudden  application  the power which the
body possesses  of forming heat  is  called up and  exerted, and a
glow of  heat is soon felt on the surface; this is what takes place
in a strong constitution ; but if it is too  often repeated in the same
day,  or  the  constitution is weak, instead of being  refreshed, the
person is more languid, is chilly through the whole day, the con-
stitution  not  having  sufficient power to restore the heat so suddenly
abstracted.
   Heat would seem to be  produced in the vital parts;  and it is to
be observed  that both birds and beasts have warmer clothing over
their  vital organs than their extremities, which abound  more with
oil, even in the bones.   Action from  the application of cold may
be diseased, being sometimes the action  of weakness; it may also
act by sympathy, as  cold  applied to the  back will stop  a  bleeding
from  the nose.  Applied to the  skin it  will  produce pain in the
intestines, and a relaxation of the bladder.  In  a sprain it is com-
mon to pump cold water on the part, as it is supposed to produce
action in old sprains.   I believe it is not so plainly indicated, except
where the constitution is sluggish.
   Heat pervades all matter: the quality made evident to our senses
is here meant; for the matter of heat is  to be found  more in some
bodies than in others, though their sensible heat may be the same.
Heat may be native or foreign: the latter I mean to consider here.
Heat may be either  stimulant,  irritative, or sedative.  It tends
directly to increase  action ,» cold, to lessen it.  A  case  explaining

  * (Later observations have shown that many of the phenomena of absorption
are referrible to imbibition.] 
OF HYDROCELE.
253
my idea of the necessity of adapting action to the strength may be
introduced here.
  A child, with fever of the putrid kind and sloughs in her throat
was very low and weak;  she  had  taken bark, and had  been
blistered.  I was  called on  account of a large slough appearing
on  the  blister, to which I  applied poultices, with opium.  It was
proposed to  apply stimulating applications, which I objected to,
on the idea that action had been already beyond the  proportion
which it ought to keep with the powers of the patient.   The warm
bath was likewise proposed, and on the same ground objected to ;
but it was tried, and my opinion  confirmed, by the ill effects  it
produced.  In fact, in such a case as this  I should  be careful of
not increasing action too  far;  for as it is spared, so must the
powers and the strength he preserved.
  Heat is either applied in a dry or moist state; the first can only
convey absolute heat to the part: water  or bran in a bladder are
the best dry applications.  Electricity is  the  only  application,
perhaps, which can be said to penetrate,  and its influence is  very
extensive.
  On Diseased Dispositions and Actions.—I have formerly compared
the dispositions of the body with the dispositions of the mind, and
observed that dispositions were cured by  actions taking place.
  In  some  cases  the action entirely destroys the disposition;  in
others it destroys  it only for a time, but the disposition is renewed;
in others the whole  action never destroys the disposition, or if  it
does, the action goes on without the disposition, as if  from habit,
till stopped by some unnatural power, as  medicine.
  In the  first case, where the  action destroys the disposition, it is
the action of restoration, as  suppuration  after inflammation.  In
the second case the disposition is destroyed for a time, or its power
of continuing the action is destroyed for  a time, but recurs again
because the original cause, whatever  it is, continues to exist, and
is capable of renewing the disposition again, which again renews
the diseased action.  This is the case with all  periodical diseases
as agues, &c, and  even  some natural  actions, as the  menses.
But whenever the constitution or part is capable of forming the
full action of the disease, then that  constitution or part is perfectly
master of the disease, and it will seldom if ever prove  dangerous,
excepting it should produce some local effects in a vital part, as
sometimes is the case of the gout.   Let us take an ague as an
example: it consists of three actions, which complete  the whole,
namely, the cold fit, hot fit,  and  sweat.  If it stops in the cold fit,
debility  is either the cause, or it takes place; if it stops at the hot
fit, strong action takes place which will probably prove a continued
fever; if it goes through the third, then it is completed.   It often
happens that  it is not able to form the  hot fit, and,  as it were,
passes over it with sweat, which  is cold and clammy, as if the dis-
charge  were not common  sweat.   But such cases  approach to
dissolution, for the sweat appears not to be the termination of dis-
                              22 
254
HUNTER'S PRINCIPLES OF SURGERY.
eased action, but the termination  of all action.  Fits of all kinds,
as epilepsies, are the same ; they are a full action of the disposition ;
for such people shall be ill for days  before the fit comes on, and
after the fit they shall  recover perfectly, only feeling a little weak
from the exertion.
   Of the third we have  an instance in the lues  venerea; for it
appears, from experience, that it goes on increasing, till it is either
cured  or  destroys the patient.  (See note, p. 90.)  Cancer the
same, and probably many other diseases.
   Of the first class there are many more diseases  than we might
at first imagine.  Vomiting would  appear to produce the cure of
sickness; for  sickness is  the  disposition;  and  the  action,  which
we must suppose  to  be  the ultimate effect, destroys the disease.
Causes may produce  a disposition, and that may bring on  action
at some distance of time, although  health may intervene.
   A young  man applied  a strong  solution of corrosive sublimate
for the cure of an  itching of the pubis; by this application a violent
inflammation was  produced.  I ordered a  wash of lime-water, to
decompose  any part of the sublimate still adhering, and a poultice
of oatmeal   and  lime-water  to  cover  the parts, with tinctura
thebaica sprinkled over it, wdiich gave him  much relief.   This was
continued two days,  when I ordered him  the bark, to diminish
irritability;  but the apothecary chose to  give  him  an emetic first,
which brought up a  great deal  of blood  from the stomach, for
which Dr. Heberden, who was called in, ordered tincture of roses;
but  this proved ineffectual.  Seeing the patient dying, and  well
knowing the good effects of turpentine in stopping bleeding exter-
nally, I gave him  two spoonfuls  every two hours  of an emulsion
made wTith  Chio turpentine; cold water clysters being also used.
He continued for some time very low, and had scarcely any pulse,
having lost so much blood; but he recovered, and got strong and
fat.  He now became dropsical, but recovered from this  by the
use, first of emetics, and then of  squills and turpentine.  Here the
loss of blood produced not only debility but a disposition to dropsy,
which disposition  was not at first brought into  action, and  the
patient got fat and well; but the disposition being at length brought
into action he became dropsical.
   It is on the same principle that many acute diseases cure chronic,
the disposition being removed by a full action taking place.  Should
we  not therefore  attempt to induce this action for a  permanent
cure?
   This practice  is attempted in  some obstructions to the  full
actions of natural operations, as in the menses: the period of attempt
being  wrhen  the  natural effort is  made, which is judicious.  In
 intermittents, when there is not full action, perhaps giving a glass
 of brandy in the hot fit, and sudorifics to complete the termination,
 might be proper.   At present this  is only conjecture; but it  shall
 be tried.
   On  the greater  or  less Disposition of different Parts to  Heal.__
 Some parts of the body have a stronger disposition to heal in con- 
OF HYDROCELE.
255
sequence  of common inflammation  than others.   Those  parts
which have the greatest powers sympathize most and inflame most,
as the muscles, skin, and cellular  membrane; but we  must also
observe that these parts have different powers in different parts of
the body.  Other  parts have  but  little powers of healing, which
may be owing to  their natural want of powers as  tendons, liga-
ments, bones, &c.  These parts often lose their living principle, and
be  sloughed off, which is often salutary.   The cellular membrane is
common to different parts, and partakes of  the  power of such
parts; thus, that connecting tendon to tendon has much less power
than that  of muscle.  The sensation of those parts  which are
backward to heal is very different  from that  of the muscles and
skin, as we should find on pricking them.
   There is a difference in the power of healing, according to the age.
—The diseases peculiar to different ages we  have observed, some
of which  are specific.  Those diseases which are  common to all
are less difficult to  heal in  youth than in old age.  In  youth the
healing powers "are much stronger than when that period  is passed:
and this is still more the case with regard to the powers of  resto-
ration than in the cure of diseases.  Ages I  divide into growth,
rest, and decline.  The powers of restoration may be  ranged in
the same order, and may be  snpposfid greater in a r.hild of two
years old than in one which is younger, because it now has strength
adding to its powers of growth, the increase  of strength being in
 proportion to its growth up to a certain period.
   One Disease often cures another.—We have observed  that there
 may  be universal  sympathy with local affection; now this principle
 is  capable of being  reversed.  One local  disease often   cures
 another, as hernia humoralis a gonorrhoea: and we have a local
 complaint curing  a  constitutional, but this local complaint  is pro-
 bably caused by the constitutional, the whole disease centering in
 one part, as gout, which I have called an act of the constitution.
 It is on this principle that blisters, setons, and issues are ordered ;
 the former are useful, but from the latter two  I have seen but little
 advantage.   Constitutional  diseases  may  cure local  ones;  the
 reason is, no part escapes the constitutional disease.  I  have seen
 fevers  cure  old ulcers, noli  me tangere, &c.; which is done by
 destroying morbid action in the part; the local diseased  action  and
 the constitutional  producing the third act, or health.  Constitutional
 diseases sometimes  cure themselves without taking on the complete
 action  or crisis.  When a  local disease  cures another  (which is
 often the case) it must be by contiguous or  remote sympathy, as
 headache by blistering the  arm, gonorrhoea  by  swelled testicle,
 &c.; but I have seldom seen the second  affection cured by bring-
 ing back the former.  Local may be cured by constitutional, but
 may have reflected back on it the same disposition as that from
 which the constitutional action proceeds.
    Of ihe Mode of Recovery.—As there is no disease but what has a
 peculiar mode of  cure of its own, and every particular part a par- 
256           HUNTER'S PRINCIPLES OF SURGERY.

ticular mode of curing its own diseases, it is  necessary to see how
far in this case Nature imitates natural principles.   We shall  first
give the original or natural ones, and then show that Nature is always
uniform in her operations, and when she deviates is still regular in
her deviations.  We may observe that a disposition is given at first to
particular parts, and that that disposition continues in restoring their
own properties, as cartilage grows cartilage, bone bone, &c.; but
sometimes she changes the disposition, as the parts become adapted
for different purposes, as  where  a joint  is created at the end  of
an unreduced dislocation.  Nature's adherence to her original prin-
ciple may be exemplified by observing  that in the regeneration of
bone which was originally cartilage, as the long bones, there when
a fracture takes place she begins  by forming cartilage, but in the
head, where the bone  was at first membrane, there membrane  is
formed.
                       CHAPTER XVII.

                     tlVrilRIES OT THE  HEAD.*

Injuries of the head ;—of four kinds ;—concussion;—compression ;—wounds;—
  want of due support.—Three first to be treated of;—symptoms attending all
  three.—Concussion.—Compression,  from  internal  or  external  causes.—
  Wounds, and loss of substance.—Want of compression from loss of blood.—
  General remarks on fractures of the skull;—mode of examining them ;—com-
  plications ;—treatment.

Injuries of the brain may be said  to be of two kinds; one where
the imagination is  diseased, as madness, which probably arises from
many different causes, which we have nothing to do with at present;
the other, where it has suffered from some external or internal injury,
which is mechanical.   This mode of injury may  be  of four kinds :
first, concussion;  secondly, compression;  thirdly, wounds, and loss
of substance;  fourthly, want  of  due compression, which  last does
not come within  our present subject.   To these may be  added a
consequent,  namely, inflammation ; but as  this may arise from other
causes,  and  is not always  the consequence, it only requires to be
mentioned.  The first may be simple, that is, existing alone,  or it
may be complicated with one of the others.   The  first three kinds
of injury will produce symptoms  similar to each other, but very dif-
ferent from the fourth, as also from what may be called the fifth, or
inflammation.

  *  [It may be observed that the lectures on gun-shot wounds have been omitted,
in consequence of their great similarity, both in substance and arrangement, to
Mr.  Hunters's  published  opinions on the same  subject.   It was considered
useless to repeat them under these circumstances, especially as they are less
perfect in several particulars.] 
INJURIES OF THE HEAD.
257
  The symptoms of an injury done to the brain can, I think, be but
two, viz., an increase of imagination, or a diminution.   The first is
least frequent, and I should suspect arises from a slight cause rather
than from a violent one, namely, such derangement as takes place
in common madness, fevers, inflammations of the brain, &c, and
which may arise from very slight compression.
  The three first injuries will generally give the appearance of too
much repletion.  The muscles about the mouth and throat become
flaccid, hence laborious respiration; and as respiration must  go on,
a kind of rattling in  the throat is produced, which often works  up
the saliva into a  froth.   But all these symptoms will be in proportion
to the  injury done, and perhaps  many  other  circumstances.  The
fourth  will produce an insensibility, attended with restlessness similar
to convulsions or fainting; and I suspect that  the fifth  produces a
delirium, if but in  a slight degree.   In all cases of affection of the
brain,  sympathy takes place in the stomach, which produces vomit-
ing ;  but I believe that in order  that this  symptom should take
place it is necessary that the senses  be not entirely gone, for those
who are struck perfectly insensible, I believe, do not begin to vomit
till  they begin to recover in some degree their senses.
  Sometimes erysipelatous  inflammation of the head  arises, and
then the patient often feels violent headaches, sometimes approaching
to delirium, rigors, &c.   In these  I suspect  that the brain is in
some  degree  affected with the  same  inflammation, therefore the
symptoms are not to  be attributed  to the immediate effect  of the
blow.
  Concussion is  always from some considerable violence.   It may
arise from  some  degree of displacement or alteration of the texture
of some part of the brain, so as to destroy the arrangement on which
health, sensation, &c, depend.
  Compression may arise from accident, or  from many other dis-
eases.  Those arising from accident may  be either  immediate or
secondary.  Immediate, as when  a piece of the skull is beaten in
upon the brain,  or a  blood-vessel  ruptured,  producing apoplexy.
The secondary is from slow extravasation, as from inflammation, or
the formation of pus.   Compressions arising from  disease will
always be the immediate effect of that disease.  They may be said
to arise from eight causes; two of  which may be called external,
the other six internal.  The two  externals are, when the  brain  is
compressed either by the skull being beaten in, or from the thickening
of the bone by disease.   The six internal causes are : first, distention
of the ventricles  by water; secondly, distention of the blood-vessels
of  the brain;  thirdly, inflammation; fourthly, formation of pus;
fifthly, extravasated blood, as in  apoplexy;  sixthly, tumours in the
substance of or on  the brain.
  Wounds or loss of substance are somewhat similar.  When the
substance of the brain  is broken in upon, loss of substance may  or
may not be the immediate effect of the violence.  It is the  imme-
diate effect, when part of the substance is carried offby the violence;
                             22* 
258
HUNTER'S PRINCIPLES OF SURGERY.
but the consequence, when a part is lost in consequence of an open-
ing being made to take off any fluid that is pressing.
  The fourth species, where there is want of due  compression,
arises from large bleeding, or where the water is let out which the
brain has been accustomed to  bear, as  in hydrocephalus or spina
bifida, which are rare, and which are  out of the power of surgery.*
  Whichever of the three first  species of injury takes  place, the
effects  are  nearly the same,  if the  degrees are  the same; and
whatever are the causes  of compression, the symptoms are the
same.
  If we only know that symptoms have arisen in consequence of
violence, then it is necessary to know  the date of the  violence, that
we may know whether the symptoms are  the immediate or the
secondary effects, or both; for  they are often attendants on one
another.
  The symptoms of concussion, if slight, are  always the immediate
effect,  that is a more or less immediate loss of sense,  &c, which is
proportioned to the violence done.   Under certain circumstances,
the effects of concussion will be  more violent than what belongs to
the injury itself;  for  a man who»is drunk may get a blow on the
head which, joined with the effects of the liquor, will produce violent
symptoms, and may lead the surgeon  to do more than is necessary.
Therefore it is better to wait until the drunken state is gone off, and
the effects of concussion left pure.
  When there is depression of bone or extravasation,  the symptoms
of concussion are lost, though  it may be  at  the bottom of all.  If
the symptoms  of concussion have kept up eight  or  ten  days, we
may expect extravasation has taken place; if three or four weeks,
suppuration.   We may know whether the symptoms are caused by
blood or pus, by  their going off entirely and then re-appearing.  If
they come on soon after, it is blood;  if not for a week or so, it is
probably pus.
  A gentleman for two years  after receiving a blow on the skull
was delirious.  I felt a little depression, and applied the trepan, and
took out a piece of bone which had been depressed  all  this time,
part of the internal table of which was absorbed, and pus was lying
on the dura mater.t

  * [Modern experience has shown that both these diseases are  capable of relief
from surgery.   The  operation of drawing off the water, when performed  under
favourable circumstances and with  proper precautions, holds out a reasonable
hope of success, and has effected a cure in several cases.]
  f [The great importance of injuries of the brain may justify a few observations
in this place, for the purpose more especially  of pointing out the distinction  be-
tween the symptoms of concussion, compression, and lacerations of the brain,
which is a part of the subject which has been only slightly adverted to in the
text. Indeed, Mr. Hunter has said that these u three kinds of  injury will pro-
duce symptoms similar to each other."
  1. Concussion—When a severe injury  is inflicted on the head, the patient is
instantaneously deprived of volition and the power of voluntary motion;  the
pulse becomes feeble and intermittent, and  the whole system labours under a
remarkable depression, approaching to a state of syncope.  After a few minutes, 
INJURIES OF THE HEAD.
259
   General Observations on Fractures of the Skull.—Fractures of the
skull may be divided  into three kinds, and these  are  sometimes


or perhaps several hours, the patient recovers his consciousness;  the action of
the heart is re-established ; the  sickness, with which he was at first affected,
passes off, and nothing remains but a severe headache, which may last for several
days as a solitary symptom, or else  recur at different intervals, upon any occa-
sional excitement.
  These effects  of concussion may of course  be variously  complicated with
wounds of the scalp and brain, compression of  the brain, and  fractures  of the
cranium;  but very  often these complications do not exist; and yet after  death
no perceptible lesion of the affected organ can be detected, except perhaps a sepa-
ration of the dura mater  from the internal table of the skull, or the extravasation
of blood in minute specks  in the substance of the brain.   In the severer forms of
concussion, indeed, the  brain is generally lacerated in  one or more parts, from
whence it is reasonable to suppose that disorganization  of a less  palpable and
extensive kind is also produced in the slighter forms, although it is not capable
of being detected by the eye.
  Now it is observable, that although one of the first effects of severe concussion
is complete insensibility, yet this state is soon followed by one in which the
sensibility is only impaired, so that it is not  difficult to rouse  the patient by any
sudden  and strong impression.   Upon being roused, his manner is generally
peevish, obtuse,  and incoherent, and he instantly relapses into his former state
of tranquil lethargy, as soon as he  is left undisturbed.  There are no indications
of paralysis : the pupils contract on exposure to light; the pulse, which  at first
was exceedingly feeble, now rallies and rises  above the natural standard ; the
circulation is easily accelerated upon the slightest exertion, and there is very
generally an intense headache, which becomes proportionably more severe as the
reaction of the circulation  takes place and the sensibility returns.
  The dangers attending  this species of injury are twofold.  The first  arises
from the state of collapse immediately following the injury, which may be so
considerable that the constitution is not able to make any effectual effort to rally
from it.   The second arises from the inflammation which may afterwards ensue.
Cases of  the first  description are of rare occurrence and only require that the
surgeon should bear in mind the  possibility of such an event, in order to guard
against it by the administration of cordials whenever the necessities of the case
seem to demand these  aids  to reaction.  The  danger of inflammation is much
more formidable, and will be in general in proportion to  the severity of the first
symptoms and the rapidity and violence of the reaction.  Other circumstances,
however,  will exercise an  important influence on this event, as, for example, the
separation of the dura mater from the cranium ; the existence of disorganization
or rupture of the minute structure of the brain ; the denudation of the pericranium
from the bone; or the patient's being in a state of intoxication at the time of the
accident.   These circumstances will greatly increase the dangers of  his  situa-
tion, and require a more vigorous adoption of such measures as  are calculated to
avert inflammation.  At first, when the reaction of the heart has taken place, the
patient should lose  a considerable quantity of blood, so as completely to subdue
the force of the circulation; afterwards, for  the  most part, it  is  only an occa-
sional  bloodletting which is required, and  that to a moderate extent.   These
measures should be assisted by perfect repose of body and mind ;  depleting and
cooling medicines; cold  applications to the head ; a spare  diet, and a raised
position of the head and shoulders, which should be persisted in more or less for
several  weeks, even although all apparent effects of the injury have disappeared.
It is unnecessary to observe, that the  old practice of applying the trephine in
such cases is in the highest degree pernicious, and cannot possibly answer any
good  object.
  The occurrence of secondary inflammation, at the end of four or five days to as
many weeks, should  be jealously watched  for, and instantly combated  by the
most vigorous depletion.   Such cases generally  terminate  unfavourably; but 
260
HUNTER'S PRINCIPLES OF SURGERY.
complicated  with  one  another:  first,  when the  external  table  is
beaten in;  secondly, fissures ;  thirdly,  when the bone is  broken off'


happily they are of less frequent  occurrence than they were formerly, in conse-
quence, it may be presumed, of the steady antiphlogistic  measures which are
now almost universally resorted to in the first  instance.   When, however, these
symptoms  arise, followed by rigors and the evidences of compression, attended
at the same time with a puffiness in some point of the scalp, or a glassy unhealthy
state of the  wound, if there happens to  be  one,  then the application of the
trephine, to let out the matter which is collected between the dura mater and the
skull, is justifiable, and ought not to be delayed.   Still it must be  evident that
this operation will  be unavailing when the  matter is effused on the interior of the
dura mater, which  very frequently happens in such  cases.
   2. Compression.—The  enumeration of  the causes of compression  by  Mr.
Hunter will probably  be found to include every possible variety; yet it is to be
observed that compression  produces  different effects, according as  it is gradual
or sudden  ; in the substance or on the exterior of the brain ; in one spot or dif-
fused over  a large  surface ; or as it is situated at the inferior or superior part of
this  organ.  The slow encroachment of a tumour on the brain does not so  sud-
denly rob the patient of his faculties, as a  portion of the cranium suddenly
depressed by accidental violence; neither is it of common occurrence  for  san-
guineous effusions  on the  surface of the brain to produce hemiplegia, although
this is one  of the most frequent symptoms  of apoplexy arising from  spontaneous
effusions into the  substance of this organ.  "There is reason," Sir Benjamin
Brodie observes, " to believe that pressure is on the whole more dangerous when
it affects the  lower part of the brain than when it affects the upper part; and it
has appeared to me that more urgent symptoms are  produced by a given quantity
of blood when it is effused  into the cells between the tunica arachnoides and pia
mater  than when  it is  collected  in one  mass  so  as to produce a  less  general
pressure."   In speaking, therefore, of the  effects of compression, I would wish
to be understood as confining myself to that form of the  affection which arises
from accidental violence.
   It should  never be forgotten that  the  blow which  occasions a  fracture and
depression  of the cranium or an extravasation of blood is  likely to produce  con-
cussion also, although, as Mr. Hunter has remarked, the symptoms of concussion
in such cases will be proportionally less severe, as the cranium has yielded more
readily to the cause of fracture.
   The leading symptom of compression of the brain is insensibility, which  is
generally much more complete than that which arises, from concussion, and more
nearly allied to that of apoplexy, with which in other respects the symptoms of
this accident closely correspond.  The pulse is oppressed  and slow ; the pupils
are dilated and immoveable;  the respiration is slow and stertorous; and the
voluntary muscles are paralysed.  Sickness and vomiting do not usually occur,
at least in  the worst cases, until the cerebral  symptoms have undergone some
mitigation, and it is observable that the symptoms all disappear the  moment the
compressing cause is removed, which explains why a copious venesection shall
frequently produce a temporary but fallacious amendment.  When these symp-
toms arise from depression of bone, they show themselves immediately after the
infliction of  the injury; but when they depend on  an extravasation of blood, a
longer or shorter interval elapses before they come on, depending on the  rapidity
of the effusion, which will in general be greater in proportion to the  celerity and
violence of the reaction from the  first impression of the accident.  Not unfre-
quently, therefore, the first insensibility is produced by concussion, then the
patient  recovers, and  then  relapses  again  upon the effusion taking place.  In
other cases,  the insensibility, which was only  partial at first, gradually termi-
nates in complete stupor, corresponding to the  gradual manner of the effusion ;
in other cases, again, the  patient does not recover  from his insensibility until
inflammation has set in, and then the two sets  of symptoms are  confounded
together.  In short, the symptoms of compression not only vary in degree, but as 
INJURIES OF THE  HEAD.
261
into a loose  piece.   I  have  also been  told of  a case where the
symptoms of an injured  brain arose, but the skull showed no frac-


they happen to be complicated with those of other injuries of the brain ; and it is
worthy of remark that the same amount of compression gives rise to symptoms
of very different degrees of severity in different cases ;  while of two individuals
in whom the early symptoms appear to be equally urgent, one may  die in  the
course of three or four hours, and the other may survive for several days; in one
the symptoms  may wholly subside in the course  of a day or two,  and in  the
other continue, at least some remains of them, for several  months or even years.
Sir Astley Cooper,  for example, has related  an extraordinary case, in which a
total loss of volition  and voluntary motion continued for upwards of thirteen
months, on which  Mr. Cline  afterwards  operated  successfully by removing a
depressed portion of bone, which restored the young man to the perfect posses-
sion of his intellect in the course of four days.
  But  compression may give rise to other symptoms besides those which have
been mentioned, as, for example, pain in the head, general convulsions, furious
delirium, partial paralysis of particular muscles  or  sets of muscles, and various
states of the pupil.  The pupils, as I have already mentioned, generally remain
permanently dilated ;  sometimes, however, they remain permanently  contracted,
or contract and dilate as usual, although in other respects the patient may be in
a complete state of insensibility.   Dr. Hennen has related a case  in which  the
admission and withdrawal of  light operated differently to what it usually does ;
and Sir Benjamin Brodie has referred to cases in which the two pupils were in
opposite states, or in which they dilated and contracted independently of light
>nH darkness.  The loss of one entire class of sensations, as  of speech, smell,
taste  hearing', or sigui, 10 nut voij unvuiiimun, vn iue  arrtecuon may Be even still
more partial, as, for example, a ptosis of one eye, a paralysis of one  arm or  one
side of the face, the destruction of the  sexual powers, or  the loss of memory,
which may be either of recent or of remote events.  In some of these cases dis-
section has disclosed some local cause of pressure,  while in others the removal
of a depressed portion of bone has immediately removed the symptom, so as to
leave no doubt on the mind as to the real cause which produced it.  In many in-
stances, however, it is only possible to offer a conjecture, derived from general
analogy and the particular circumstances of the case, guided by the knowledge
which we possess of the functions of the different parts  of the brain, from all
which it would appear probable that these partial lesions  are  sometimes due to
disorganization of, or pressure on, certain districts of the cerebrum, from whence
the nerves to the paralysed parts  are specially derived.   However, as Sir Ben-
jamin Brodie has remarked, " it is difficult to conceive that pressure on the brain
should exist in so great a degree  as completely to destroy a  complete class of
sensations, and at the same time be so  partial as not to affect any other function
of the nervous system.   On the other hand, it is also difficult to regard these as
the effects of concussion of the brain, since it is one of the characteristics of con-
cussion to produce no more than a diminution of sensibility, and that diminution,
instead of continuing for months or years, is completely relieved in the course of
a few days, and probably in a much shorter space of time."
  The most common situation in which blood is effused in accidents  of the head
is between the dura mater and tunica arachnoides, especially towards the base of
the brain.  It may occur, however, between this last-mentioned membrane  and
the pia mater, or between the pia mater and the brain,  or in the substance of the
brain itself.  It may also occur between the dura mater and the cranium, when-
ever the connexion  between these parts has  been destroyed  by the  violence of
the injury.  It is, however, to be  observed  that  considerable  effusions of blood
rarely  occur in this  last situation, except when the cranium has been fractured in
the direction of the middle meningeal artery, and the artery has been ruptured in
consequence.                                                           ,
  The treatment of compression arising from  depression of bone will be spoKen
of in a future note ; but where compression arises from extravasation ot blood, 
262
HUNTER'S PRINCIPLES OF SURGERY.
ture or fissure;  and on removing a portion with the trephine, the
inner  table was found beaten in, the external table  being perfectly


the same general principles must be followed as in cases of concussion, both to
prevent any further effusion and  to obviate the danger of inflammation.  The
question however arises, whether any operation can be beneficial for the purpose
of giving an exit to the effused blood ?  In answer to which it may be replied,
that as a general rule no operation can be beneficial in  these cases, both on ac-
count of the difficulty of ascertaining the precise seat of the effusion, and the im-
possibility in the great majority of cases of reaching it when it is discovered,
When, however, a blow has been  inflicted  over the meningeal artery, and the
symptoms of compression are not only not relieved by venesection, but gradually
become more urgent, it will be extremely proper to give the  patient the chance
of the operation, which will also be proper in other cases where the seat of the
injury  is well marked  and the stupor  is hourly becoming more alarming.   Un-
questionably it would be unwise and unwarrantable to resort to an operation too
hastily, but under the circumstances which  are  supposed  an  operation will
scarcely  be  supposed to add much  to the danger of the case,  at least the opera-
tion of dividing the scalp in order  to ascertain whether the bone bleeds freely,
or whether there be any  fracture.  If the  bone does not  bleed  so freely  as it
ought, or if there be a  fracture, these are justifiable grounds  for perforating the
cranium; and the surgeon will be further justified in puncturing the dura mater
if he finds  an accumulation of blood  beneath  that  membrane pressing on the
brain.   It ought, however, to be remarked, that it will always be  expedient to
remove the cranium extensively whenever the trephine  is resorted to for this
  urpose, or  for affording: an escape to pus, as  without this, is done only half the
  enefits of the operation will  be obtained.
   3. Wounds of the Brain and Membranes.—The peculiar danger of wounds of
the brain and its membranes  arises, in the  great majority of instances, not so
much from the immediate effects of the injury as from the extensive and intract-
able inflammation  which afterwards follows, giving rise to effusions of pus, dis-
organization of the substance of the brain, and hernia cerebri.  When the head
receives  a severe concussion, the brain is liable to be lacerated,  particularly to-
wards the base, in consequence of the inequalities of the cranium at that  part;
and the symptoms in such cases will  necessarily be complicated with those of
concussion as well as  with those of compression :  but when  the  brain has been
simply incised or punctured,  very  often no symptoms whatever arise to indicate
that the bodily or mental functions are in the least degree impaired ; indeed this
absence of symptoms is  sometimes very remarkable, and extends to cases in
which considerable portions of the brain have been lost, or foreign  bodies  been
lodged in it.  Wounds of the brain, however, are always dangerous, and it is
not to  be supposed that there can be an extensive destruction  of a part so import-
ant as  the brain without immediate death, or death  in the  course of a very few
hours.  A confusion of intellect beyond that which  simple concussion usually
produces, and twitches of the muscles  of the extremities, are diagnostic marks
by which (as Sir  Benjamin Brodie has observed) these cases may sometimes
be distinguished.  The same author also  observes :  " I have not  been able to
discover, among all the works which 1  have consulted, a  single instance  of re-
covery from a wound of the posterior lobes of the cerebrum,  of the cerebellum,
or medulla oblongata;  and in the  great majority  of  cases in which a cure has
taken place, the injury has been  confined to the frontal hone, and  that part of the
brnin which is  covered and defended by it."
   It is unnecessary to  observe that the general principles of treatment which
have been already pointed out are equally applicable to wounds of the  brain,
and must be persevered in with the most watchful assiduity.  The local  treatment
resolves itself into the management of fracture, which  will be considered in an
ensuing note.   I shall  only, therefore, further  observe, that  the most  judicious
surgeons of  the present day unitedly concur in  the wisdom of forbearance, and
in not attempting to extract foreign bodies, unless this can be done with the most
perfect facility.]
I 
INJURIES OF THE HEAD.
263
sound.  I have seen several instances where the external table was
beaten in, and the inner table not hurt.*  Depression of the external
table may be complicated  with extravasation or concussion, and
may become the cause of extravasation or of the formation of pus.
Fracture may be complicated with fissure, that is, fissures often run
from the fracture a very considerable way along the skull.  Where
the external table only is beaten in, it is owing to the meditullium
being  thick and spongy, and  allowing the external plate to sink
into it.   This is generally done by a small instrument with a good
deal of velocity, as the edge  of  a  horse's  shoe.  Every violence
that can  produce complete fracture must  cause  more  or less
depression, though it may  not be very visible; and sometimes, if
the force has not been very great, the piece may be  returned again
into its position immediately.   Besides, the inner piece  is always
broader than the point where the  violence has  been applied on tire
external.   All fractures of the  skull may  be called compound ; for
if not so naturally, they are made so by the removal of the scalp.
They  differ widely from  fractures  in general in other parts, as
healing the parts is only necessary in fractures of other bones, but
here we have to prevent the mischief arising from the broken bone
to parts essential to life.
   Fractures of  the  skull of  themselves produce   no  symptoms
respecting the brain, only those of  a broken bone ;  but when they
are  complicated with other effects, then symptoms arise accord-
ingly,  more or less according as the fracture is greater or less.
There may be bleeding at the nose  and ears when the fractures
must be running over  these parts, but they  may occur without a
fracture of these parts, and there  are symptoms  of other injury
besides fracture.   When  complicated with concussion, the symp-
toms of this will be less according as  the fracture is greater, for it
is from the bones not giving way easily that the head is violently
and quickly moved so as to produce concussion.  These effects will
be according to the weight and velocity.   When the weight is great
and the velocity small, we shall have more concussion than with a
small weight and great velocity : hence from gun-shot wounds we
seldom have any concussion.
   In cases of fissure only it  may admit of a dispute whether we
are always to trepan.   If there is no symptom of an injured brain,

  * [Dr. Hennen has  given an  account of a  case in which the internal table of
the. skull was splintered, and at one part driven more than half an inch into the
membranes of the brain, although there was not even a fissure of the external
table.  Cases of a similar kind are preserved in almost every museum, and are
easily accounted for by the  greater brittleness of the  internal table. Of course
the same cause will produce similar effects  in ordinary cases, so as to render it
impossible to ascertain the actual amount of pressure which exists in any given
case from mere inspection of the external fracture.  In children the bones generally
are more tenacious than in adults, in consequence of containing less earthy matter.
Hence the cranium may be depressed or indented in them without being fractured,
just as a tough  or green bough will yield to a  force  in a very different manner
 from a dry stick.] 
 264          HUNTER'S PRINCIPLES OF SURGERY.

 certainly it will not be  necessary.   It may not be necessary even
 when attended  with symptoms of an injured  brain, for the injury
 may only be from the concussion, and we never trepan in a con-
 cussion.  However, as we cannot tell  for certain at the time whether
 the symptoms arise from concussion, compression, or from extra-
 vasation of blood, it may be more advisable to trepan, as the ope-
 ration can do no harm.   In cases of  depression of the outer table
 it would also be unnecessary to trepan ; but it will be impossible to
 say that it is certainly a case of this  kind:  for, though there may
 be no symptoms of an injured brain, there may be depression of the
 inner table, which may do mischief afterwards.   In  young people
 there may be fracture with depression which may  cause  no  bad
 symptom at  the time, but as the patient grows up bad symptoms
 may arise, probably from this cause, that  there is  not  sufficient
 room for the natural growth of the brain.
   In all cases of violence attended with compression, either from
 fracture or not, the trepan is absolutely necessary ;  but we cannot
 always promise relief from the operation, nor can we always apply
 it where  it is necessary.  When compression is by bone, and its
 situation  known, and the situation is a  proper one for trepanning,
 there is no difficulty; but when the compression is by blood or pus,
 and there are no external marks of violence, then it is more puzzling.
 However, rather than let the person die, one would  trepan  some-
 where or other; and if this did not answer, one would not stop
 here: for I have seen a  collection of  matter on the opposite side to
 that on which the blow was inflicted ; yet this is a case where one
 would promise but little encouragement, there being but little chance
 of success.
   Even when we have external marks of violence to  guide us, and
 do trepan, yet this is often not sufficient to free the patient from the
 compression, for these fluids are often formed between the dura
 mater and the brain when none is found between the skull and dura
 mater.  The dura mater must not, however, be perforated without
 good grounds; we should be as certain that there is fluid contained
 under the dura mater as  we were certain of the necessity of apply-
 ing the trepan in the first instance.  In all cases where I have seen
 the dura  mater  wounded, it was by  a  crucial incision,  and the
 patients have all died.   When  it is  necessary to open the dura
 mater, I would recommend making  a simple incision, for this would
 be more likely to heal by the  first intention, and we  could then
move the edges to one side, and see if there were any injury below.
Whenever I have seen the dura mater opened, the brain has worked
through the opening, and the patients have died.*   This was the

  * [As hernia cerebri may occur simply from the support of the cranium being
removed, it will a fortiori be more likely to occur when the dura mater is removpd
also.  I should remark, hor,ever, that hernia cerebri does net necessarily ensue
under these circumstances.
  It may be proper to observe, that the treatment of this disease consists in the 
INJURIES OF  THE HEAD.
265
case with a Mr. Cooper, whose dura mater I opened with a crucial
incision on account of the state of parts beneath:  he died,  and
I think  it is probable I killed  him, by  opening  the dura mater.
Patients, under these circumstances,  might  probably have died
independently of the  opening, but this I think would  certainly kill
them.
  Fractures  very rarely run through the base of the skull where
operations cannot be performed ;  but if the bones of the base of the
skull are only fissured, it will be of sufficient  service  to trepan on
the fissure  as low as we can follow it.  I have  trepanned once
below the insertion of the muscles of the neck, and with success.
  Trepanning on sinuses has  been condemned, but  it can do neither
harm  nor  good if the blood  is between  the  dura mater  and pia
mater; if  there is  only  a depression on them it can  only obstruct
the sinuses, and not affect the brain.
  An  incision is sufficient to  examine for a fracture if made suffi-
ciently long; and if  a fracture is found, it is to be followed to its
full extent: but where it is found  necessary to trepan, it will be
proper to  remove  the scalp, and  do it  freely, for  an operation
should have  no incumbrance  which we can prevent.  We should
scalp  carefully, lest  there  should  be  some  loose  pieces  of bone
underneath which  we cannot see,  by which  otherwise  we might
plunge into the  brain; and yet I own I cannot always call to mind
this caution at all times when operating.*
  It has been  recommended lately, after trepanning, to put the
scalp  down  again, and  unite it by  the first intention; but I doubt
whether we should be able to bring  the angles perfectly together;
and if not, part of the dura mater must be exposed, and  must sup-
purate.
  A fungus is very apt to arise from the  dura mater.  Why this
should be more than from any other part I cannot  say.
  A poultice is the best  application after either scalping or trepan-

judicious application of pressure until the fungus is repressed below the level of
the dura mater, which then heals over it and prevents its reproduction.  This
plan generally succeeds, although the old method, consisting in  the removal of
the surrounding bone, or of the fungus itself, almost invariably failed.
  The danger of hernia cerebri being formed when the cranium is removed may
justly be urged as an argument for not  having recourse  to the  operation of
trephine without the most satisfactory reasons, to which may be added, the still
more alarming risk of inflammation and sloughing of  the dura mater from acci-
dental violence inflicted by the  trephine, or from the mere effects of simple
exposure. The fact also of a portion of the cranium being left undefended after
the recovery of the patient, should not be neglected in  estimating the dangers of
this operation, which unquestionably are very considerable.]
  * [It  is impossible to help being struck with this confession, so characteristic
of the love of truth and candour which Hunter possessed.   Indeed, the  same
remark appears to me to  apply to all the preceding observations, in which may
be traced a hesitation and forbearance of judgment uncommon to the author, as
if he had not fully approved of the existing rules of treatment, although he had
not yet  gone to the extent of substituting others in their stead.]
                                23 
266
HUNTER'S PRINCIPLES OF SURGERY.
ning, because  it always admits of immediate removal, and keeps
parts in an easy agreeable state.*

  * [No part of surgical treatment (with the exception perhaps of aneurism,) has
undergone such  important amelioration as that which relates to injuries of the
head.  Whoever will look into the writings of  the period when  these lectures
were delivered will be astonished at the officiousness of surgeons in counteracting
the restorative efforts of Nature by their rude interference, and converting into
complicated  wounds what were simple  in their  origin.   Hunter was unques-
tionably less infected with this evil than most of his contemporaries, but still
we cannot but observe the influence of this spirit in the directions which he has
laid down for the treatment of fractures of the cranium, for which reason it will
be necessary to guard the reader  against drawing false conclusions on this im-
portant subject.
  The propriety of these observations  will be  apparent from considering the
cases in which Hunter  thought the application of the trephine was justifiable,
viz. 1, in young  children  in whom  there was depression without symptoms;
2, in cases of depression of the outer table only;  3, "in cases of  fissure only it
may be more advisable to trepan, as the operation can do no harm,-"  4, "in all
cases of violence attended with  compression, either from  fracture or not, the
trepan is absolutely necessary," and if blood is not found on  one  side, to trepan
on the other; and lastly, in fractures of the base  of the cranium.
  Now it is  to be observed that there is as much, if not a much greater, difference
between  simple  and compound fractures of the  cranium as there is between
simple and compound fractures of the thigh ; consequently, nothing can be more
unadvisable  and rash than to convert a simple  fracture  into a compound  one,
unless the urgency of  the symptoms  is  such  as imperatively to demand  inter-
ference.
  In regard, therefore,  to simple fractures of the cranium, it may be laid down as
the general rule of practice never to interfere without the strongest reasons for so
doing, nor even then until a reasonable time has been allowed for the symptoms
(which  may depend  on concussion,) to subside, and depleting measures  been
freely employed.  Under such treatment the symptoms will often  disappear after
a short time, and the dangers of subsequent inflammation be  infinitely  lessened.
Nothing surely  can be worse than  the attempt to anticipate the symptoms of
compression by resorting to the trephine.
  And in regard to compound fractures of the cranium the same rule is  to be
observed. If there are no symptoms, the surgeon should desist from any  inter-
ference, and  endeavour, to the utmost of his power, to procure union by the first
intention. If, indeed, the  depression is very considerable, it may be advisable
to elevate it, although  there are no symptoms  at the time; but  if there are
symptoms, it will be right and proper to do so in all cases.  The same  principle
should guide the surgeon in the extraction of splinters of bone and foreign bodies,
and restrain  him  from making the  attempt unless his object can be accomplished
without adding to the irritation of the injury.  It is scarcely possible to imagine
a case in which an operation so near the basis of the  cranium as  the author has
described can answer any useful  object.] 
OF  THE DISEASES OF  BONES AND JOINTS, ETC.     267
                       CHAPTER XVIII.

OF  THE  DISEASES OF  BONES  AND  JOINTS J  OF FRACTURES,  DISLOCA-
                            TIONS,  ETC.

Bones liable to all the diseases of soft parts.—Death of bone.—Caries.—Dis-
  eased  actions; — ulceration; — induration. — General treatment of diseased
  bones.—Accidents to bones;  simple  fracture;—principles of treatment;—
  period and mode of union;—false joints.—Inflammation of bones;—treat-
  ment.—Suppuration of bones.—Compound fractures ;—treatment;—communi-
  cating with  joints.—Question of amputation.—Fracture of patella, olecra-
  non, and outer ankle.—Suppuration in bones;—spina ventosa;—necrosis;—
  treatment.—Of the contraction of diseased joints___Sprains ;—treatment.—Dis-
  locations ;—observations on their reduction.—Formation of new joints.—Acci-
  dents andinflammation of joints.—Loose cartilages.—Anchylosis.—Diseasestof
  joints.—Wasting of muscles.—Exfoliations and necrosis;—treatment, by actual
  cautery.—Extraction of  sequestra.—Rickets.—Mollities ossium ;—treatment.
  —Exostosis;—treatment.—Exfoliations of cartilage.

Bones have  been very much considered separately from other parts
in their growth, structure, and diseases.  Bones  being less subject
to  changes  after  death than the  soft  parts,  are therefore  more
favourable for the explanation of their diseases after death, such as
ulceration, tumours, &c.; and diseased bones of all kinds may be
picked  up in church-yards.
   The  bones, in their  causes of disease, in many of their diseases,
in the terminations of these, and in their restoration, are similar to
the soft parts.  They are susceptible of the different inflammations
and their consequences, but they are more backward to heal, form-
ing fistulas; in their  specific  diseases  also they resemble the soft
parts.  But, unluckily for bones, they  can hardly swell; nor  can
their coverings swell  without its  being immediately suspected as
venereal,  so that  mercury is often  given  to the detriment of the
patient.  Nor can they require a different treatment,  as regards
their vital  power,  from  the soft  parts, though they may in the
mechanical  part; but it  will be found that they require a different
mechanical  treatment only in consequence of their solidity.  The
hardest bones  are most liable to venereal  affections; the softer to
scrofula ;  but  the  surrounding parts very often partake of  their
diseases for very wise purposes.   Their diseases do not so readily
recover as those of soft parts, as  the restoring  powers  are  much
more weak  and tedious in their operations.  This slowness is pro-
bably owing to an indolent  disposition and weak  powers.   This
may, in some  measure, arise from the  earth in  them being a part
not possessed  of the living principle; yet we find that the hardest
bones are cured the soonest; but this  is when there is exfoliation,
which  shows they are  more ready  to die,  and, consequently, to
exfoliate. 
268
HUNTERS PRINCIPLES OF SURGERY.
  Their  diseases are often very  serious,  in  consequence  of our
ignorance of the  extent of disease, as well as of its  nature; for
though, from an increase of size  or  a fistulous opening, we may
know the bone to be diseased, still we obtain very little information
as to its nature.
  Death  of Bone.—Bones  often lose their  life from  becoming de-
tached, and their surface being either exposed  to  the  air, or to
matter surrounding it.   The reason of  this is, that  bones receive
most of their nourishment from the surrounding parts, as from the
periosteum; therefore it is natural to  suppose that the surface at
least will become dead when this  part is removed.  This may be
observed on the projecting end of a stump.  The harder  the bone,
the more ready it is to lose its vital principle by exposure.   Some-
times the external surface dies easier on being laid  bare than the
internal: this is  the case in the  skull; the external will often ex-
foliate without the internal.*
  Caries.—Death of the exposed surface makes  a material  differ-
ence in the appearance of ulcers of the  bone, and they have been
classed accordingly.  In  one case surgeons found the surface of
the bone dry; in others moist, and covered with matter; hence the
distinction of dry and moist caries ; but this arose from  ignorance
of the  disease.   When the bone is entirely dead, then there  is dry
caries; but in the moist the  bone is inflamed and  ulcerated, and
furnishes a discharge, not being dead.   When it wras perceived that
the dry caries only exfoliated, the actual cautery used to be applied
on the idea of drying the  moist caries ; but this was done without
knowing the principle on which it was done, viz. that of entirely
destroying the life of the bone.  By caries I  should  understand a
rotten bone, and by a rotten  bone a dead bone.   But the distinction
between  a diseased bone and  a dead bone  has not been sufficiently
attended to, for the term  caries has been  commonly applied  to a
bone in the state of an ulcer, and also to a  dead  bone.   Now a
disease must always be in a  living part, whether soft or hard; but
the same term applied to  the two  different states of bones can  give
no just ideas of  the  disease which it is intended to designate, for
that which is commonly called caries is, strictly speaking, an ulcer
in the  bones ; but ulcers of the bones  are as different from the death
of these parts as ulcers in soft parts are different from common
mortification.
  Diseased Actions of Bone.—Bones are very susceptible of diseased
actions and dispositions, and sometimes a very slight accident will
convert a disposition into an action, as  in  scrofula; and  this  may
again  be increased by the part of the bone which is injured ; thus,
in the  case just related the effect is most considerable when it hap-
pens at the end of a bone forming part of  a joint.   The  situation,
with respect to the body,  is also a cause of retardation in healing,
as it is in the soft parts.
  *  [The  reason of this is that these two layers are nourished by two different
sets of vessels.] 
OF THE DISEASES OF BONES AND JOINTS, ETC.
   Ulceration.—Ulcers of a bone are exactly the same  in  their im-
mediate causes as those of a soft part, and in some of  their effects
also, the difference not being that of the disease but of the structure.
Bones admit of every mode of absorption  that the soft parts do.
The most common cause  of absorption in them is pressure ; what-
ever makes an unnatural pressure gives a stimulus for  the removal
of the bone.  Bones admit of being absorbed from debility, or want
of power to support themselves;  but this I believe only takes place
in newly-formed bones.
  Induration.—It does not appear that ossific  inflammation takes
place in the parts pressed, so as to make them firmer  and harder,
as in the soft parts.   If bones were rendered  harder  they would
have  less power,  and therefore would be more liable to death.
However, there is often a thickening or running up of the bone all
round, as in old dislocations, so  that a  new joint will  be formed.
Diseased bones communicate  their disease  to contiguous parts;
most commonly to the nearest, as the  periosteum ; when near to
the joints, to the ligaments or cartilages.
   General treatment of diseased Bones.—This I shall refer, as much
as possible, to the treatment required  in soft parts, which is  very
similar, though the slow action in bones renders it more  tedious,
and requires a somewhat different method of cure.
  If an abscess is  seated in the soft parts,  and also in  the bones,
that in soft  parts will readily be  recognised, from the difference in
its appearance and feel from any of the surrounding parts; and it
will in general approach the skin very soon, which, however, will
depend very much on the  nature of the disease and of the soft parts.
The abscess in the  soft parts will generally make a  passage for
itself, without  the necessity of an artificial opening.  But this is not
so in bone ; if a spontaneous opening takes place, it is not sufficient
for a cure ; therefore the trephine is often necessary;  or it maybe
necessary to destroy the living principle in the bone, and  then the
actual cautery will be necessary.  To kill  the soft parts the caustic
is sufficient; but the actual cautery is required for bones.
  Of accidents to Bones.—The effects of  accidents which hurt a
sound bone are never to be reckoned as disease while it retains the
actions of restoration natural to the animal body.
  Injuries done to bones are of two kinds: one, simple injury without
exposure; the other, injury with exposure.   One simple injury is a
bruise; another simple injury is a loss of continuity, as in a simple
fracture.  The union of the bone in simple fracture is exactly similar
to the  healing of a wound in the soft parts by the first intention;
but here adhesive inflammation is unnecessary, though it generally
happens from the irritation, and  then adhesive inflammation is sub-
stituted for union by the first intention.
  Simple fractures'.—A simple  fracture is a solution of continuity,
generally with laceration of the surrounding parts, attended often
with splinters  of bone attached  to  the  soft parts, or loose.   The
space between the broken surfaces of the bone and other parts are
                              23* 
270
HUNTERS PRINCIPLES OF SURGERY.
first filled with extravasated blood from the ruptured vessels.   This
blood  coagulates, and in time becomes  vascular, as  in  the same
mode  of union in soft parts, forming  a callus.*   Then  the arteries
and absorbents, by  their action, model the part, and form it into a
cellular substanee, in which the arteries  deposit calcareous  earth.
It is first formed into cartilage, and then into bone.   Adhesion of the
detached splinters also takes place, interstitial  absorption making
them softer, and less pointed; and this takes place not only in those
which are attached  to the soft parts, but even in such as are entirely
loose.   (This was shown in a thigh-bone, in which one of the splin-
ters had been tnrned quite round on its axis, and adhered by its outer
surface to the bone.)   Therefore these pieces must retain the living
principle, and probably only this, while those that remain attached
have more.   I never examined a compound fracture without finding
some  of these loose pieces, which shows  they  must  be common.
Their union  must be similar to that in the transplanting of  teeth.
   Callus.—The  modelling  of  the  callus to the  parts in the neigh-
bourhood is very evident in ribs  that have been fractured, for on
that  side next the lungs  the inequality  is very  inconsiderable.
Whether the modelling in these cases is purely from the mechanical
pressure of the lungs,  or whether  it is from absorption in conse-
quence  of that pressure, I cannot pretend  to say: probably both

  *  [I have already observed, when speaking of the mode of union by adhesion
in soft parts, that this is  always accomplished by the  effusion of coagulable
lymph, which  afterwards  becomes vascular, and not by  the  organization of
coagulated blood.  The only difference in  regard to bone  consists in the time
required for the ultimate organization  of the new-formed structure.  It is pro-
bable that there is no difference  in the quality of the lymph (as it is first poured
out,) from any of the structures of the living animal body, because the organic
elements which enter into the composition of these structures  are essentially
the same, whether  of bone or any other  parts, viz. cellular membrane, nerves,
blood-vessels, and absorbents.   W'hen a bone is fractured, the periosteum and
surrounding cellular membrane concur with the broken surfaces and lining
membrane of the bone to pour out a mass of lymph  {callus),  which gradually
undergoes successive transformations of structure,  until  the  new-formed part
closely assimilates in all respects to the  old structure.  For the  first week or
ten days it is observed  to consist of a soft vascular granular-looking mass, which
gradually assumes, toward the twentieth day, a white and cartilaginous aspect,
and at  the same time diminishes in bulk : from  this period  to  the fortieth or
fiftieth  day the diminution of the callus still  proceeds, and the process of ossi-
fication is now observed to have  converted the greater part of it into true bone,
although towards the centre of the mass a  portion may still  remain, which is
not fully converted into bone before the expiration of the fourth or sixth month.
If at the end of this period the  bone be  examined, it will be  found to be thick
and irregular at the point of fracture ; the medullary cavity will  be found to be
obliterated, and the new bone to possess the hardness of ivory.   Ulterior changes,
therefore, still go on for two or three years, which at  last end  in  the complete
restoration of the external form of the bone, as well as of the internal medullary
cavity  and reticulated  structure. Dupuytren has called  the external callus,
which embraces the broken extremities of the bone like a bulky ferrule until the
union is consolidated, the cal provisionel.   There is not, however, as it appears
to me, anything peculiar in this process to require the application of a new name,
for the  surrounding induration which  attends the union of soft parts is precisely
a similar phenomenon.] 
OF THE DISEASES OF BONES AND JOINTS, ETC.
may act.   The increased solidity of the  new  substance is either
from the  deposit of new matter, mixed  with the first, or  from
absorption of the first, and deposit of new matter  instead.  I think
the last the most likely.
   Ossification of the Callus.—The ossific substance is first deposited
at the extremity of the bones themselves,  and then  extends to the
callus;  at the same time  several points  in  the  callus are forming
ossific matter.  Young people  seem to have a greater disposition
to form ossific matter than  old, but there is a difference even in
those of the same age.  This new substance is similar to the original
bone, and on this account probably is stronger than that from gran-
ulation ;  however,  it is not  so  durable  as the  original bones are.
This process must necessarily be more tedious than in the soft parts,
in consequence of the second process which is required; sometimes
no union takes place for a length of time after the accident, and the
variety of callus is great.
   Treatment in simple fractures.—Parts to be united by the first
intention  are first to be placed in their  habitual  position; but this
cannot possibly be effected in all cases,  nor is it always  necessary
in soft parts and when there is no external wound.  In those parts
which are for the support of the body, the fractured parts must if
possible be brought into their original and natural position, before
they are retained by bandage, &c.; but  in some of these it is impos-
sible, as in the ribs, clavicle, neck of the  femur, &c, especially in
fat lusty people.  In such it is very difficult to say what the case is,
or how the parts are situated.   In the  extremities there is  more
room for the exercise of art, but not in all equally.
   Simple fractures seldom affect the constitution except the soft
parts are much lacerated;  then there is  generally constitutional
affection in proportion to  the degree of inflammation.   Rest of the
part is necessary : in most cases, therefore, splints  and bandages are
used; and when there is much inflammation  expected, a  folded
compress, moistened with some cooling lotion, is applied until the
inflammation  subsides, and then rollers and splints are applied, which
should be tightened as the limb subsides.   Spasms often arise from
the splinters pricking the  soft parts ; I should think that  a solution
of opium would be the best application to remove this  symptom.
The position for the patient to lie in was formerly on the  back ; but
the side is now generally  adopted.  However,  1 think  its whole
advantage is that it has the appearance of novelty, and is not a real
improvement; but time will establish the truth.   I prefer the back
position, with the knee bent, as the patient will  support this for the
greatest length of time, and it is always  the position of debility.  In
this position the limb will  be kept more steady, and will be less liable
to be moved by moving the body.*

  * [The use of fracture-boxes, consisting of two inclined  planes, the angle of
which is regulated by  a rack-work, has led to the almost universal  adoption of
the position on the back in fractures of the lower extremities.  These boxes are
of various construction, but most of them combine the double advantage, first, of 
272
HUNTER'S PRINCIPLES OF SURGERY.
   Period of  Union, and manner  in which this  effect takes place.—
 The time in  which the bone will be united will depend on  circum-
 stances.   In  the soft parts union will often take place in forty-eight
 hours: but it  will require a much longer time in bones.   In  the first
 place they cannot be brought  so closely into contact, therefore a
 larger quantity of new matter must become vascular;  secondly,
 there is the second or ossific process to be  effected; thirdly, there
 is laceration  of the soft parts; fourthly, the state of the constitution
 and restorative powers may be weakened; fifthly, age.   The situa-
 tion too of the bone  will  cause a variation;  the lower requiring a
 longer  time than the upper extremities.  In the middle-aged, and of
 a good constitution, union will take place in three weeks, so as not
 to admit of perceptible motion.   If much longer  in uniting, it will
 be  very  uncertain at what time  this will  take place:  I  have
 known it months,  and yet unite at last.  This slowness seems  to be
 from imperfection in the two first bonds of union, the adhesive and
 the  cartilaginous ; sometimes from a want of disposition to ossifi-
 cation.*
   These two, union by the first intention and that by adhesion, con-
 stitute the two first modes  of union of bone;  the third is where
 these  two have failed, and here the union is effected by means of
 granulations  from the broken ends of the bone and  from the soft
 parts, which  granulations become converted into bone  (see  note,
 p. 203). It is difficult to account for the failure of the first two: often
 it depends neither on  the constitution nor the part; for the constitu-
 tion has often been good, as  is seen by it bringing on new inflam-
 mation on exposure.
   I  have  seen a  simple fracture  where the two first processes,

 an easy position, resulting from the semi-relaxed posture of the principal  mus-
 cles, and, secondly,  of admitting of the application of fresh bandages and
 dressings without being required to disturb the  fractured member.  Mr.  Earle
 and Mr. Amesbury have contrived beds on the same principle, which effectually
 combine these  advantages, and must be considered as most important acquisi-
 tions in the treatment of compound fractures.]
  * [It may be  observed that this want of disposition is particularly manifested
 during the periods of  pregnancy and lactation, which would seem to divert the
 powers of the constitution from the reparation of the injury to the more important
object of nourishing the offspring.  The same  effect will be produced by exces-
 sive depletion, or constant motion of the fractured extremities of the bones.  By
the former the  naturally  weak reproductive  powers of bone are still further
reduced, and by the latter the ossific process  is arrested, and a new disposition
created for the  formation of a bursal structure, similar to what takes  place in
 other parts of the body when friction is employed.   It should  be observed that
constant motion of a fractured bone will  inevitahly lead to the formation of a
false joint; but this will be differently formed  in different cases.  If the process
of union has been interrupted from the commencement, the  broken extremities
will be found rounded off and covered with hard enamelled surfaces, inclosed  by
an adventitious  synovial bursa; but if the interruption has taken  place durina
the ossification of the callus, then the extremities of the bone will be united  by
a cellular or  fibro-ligamentous  structure.   I am not aware that  true cartilage is
ever reproduced when removed from the surfaces of joints by ulceration, or ever
found as a new formation on the extremities of bones  forming a false joint.] 
OF THE DISEASES OF BONES AND JOINTS, ETC.
273
namely, the conversion of the blood into a vascular substance  and
the  deposition  of cartilage, had  taken place, and the  third  had
failed; and  then,  on allowing  the  parts a little motion, they got
firmer, and  at  last perfectly strong.
   False Joints.—Sometimes simple fractures will  not unite at all.
This is a worse consequence than any of the  foregoing, there being
no soft  union even, or, if  there  ever was,  that being absorbed.
Here the surrounding parts thicken and  form  a kind of capsular
ligament, and the extremities of the bone rub against each other at
each motion of the limb, by which stimulus the broken parts are
absorbed,  and  the extremities  become  smooth, and in time are
covered with something similar  to cartilage,  and  at  length the
cavity between them becomes filled with a fluid very much resem-
bling synovia.   In this  case it is necessary to lay open  the new
cavity and irritate the  ends of the bones, and then, by keeping
them in position,  bony  union will often take place.  It has been
recommended to saw off the ends of the bones ;  but all that seems
necessary is to irritate them sufficiently to excite a  fresh inflamma-
tion.*
   Inflammation  of Bones.—Bones  are  subject  to  the adhesive,
suppurative, and ulcerative inflammation, as  the soft parts are.
   The adhesive inflammation of bones is attended with this peculiar
circumstance, namely,  the  formation of new bony matter  in the
inflamed parts, and therefore may be called ossific inflammation.
Soft bones and the soft parts of hard bones are the most liable  to
inflammation and  suppuration.  Whether this arises from the struc-
ture of the bones or from some  other cause, I cannot  say.
   The suppurative and ulcerative  inflammation  is the  same  in
 the bones  as in  soft parts, as is also  the  granulation and cica-
 trization.
   When an injury is done to a bone sufficient to cause inflammation,
or if inflammation arises spontaneously in a  bone,  then, some time
' after, there  appears a swelling.  This state is similar to the adhesive
 inflammation in soft parts.  But pain appears to be the first symptom
 of inflammation in bones, and to precede the swelling a considerable
time, whilst in  soft parts they appear together.  From this slowness
in swelling it would appear to be a  different operation, and  it is
   *  [It has not been found that any plan uniformly succeeds.  Among the least
 severe methods adopted in these cases may be mentioned  blisters over the seat
 of fracture, or lateral  or longitudinal pressure (according to the circumstances of
 the case) of the broken ends of the bone, so as to excite inflammation.  Thus,
 Sir Everard Home procured a fractured femur to unite  by encircling the limb
 with a stiff leathern belt, and making the patient walk.  A seton passed between
 the ends of the bones has  succeeded in a few cases ; but the excision of the
 fractured extremities is much more effectual, although it is attended with the
 great inconvenience  of shortening the  limb.  Mr. Hunter's  is certainly a less
 severe method, and may be applicable to those cases, such as  fractures of the
 tibia, where the bursal sac can  easily be exposed ; although I should mention
 that it has lately failed in two cases in St. George's Hospital.  I believe, how-
 ever, that time and a  well-adjusted apparatus will succeed in the great majority
 of cases, without having recourse to any other method.] 
274
HUNTER'S PRINCIPLES OF SURGERY.
difficult to understand how a  bone can swell from extravasated
lymph or calcareous matter, yet it is impossible to conceive that it
is from any other causes.  A swelled bone is true bone, and nearly
as hard as any other  bone ;* it  is easily  distinguished from the
sound bone  and from swelling  of  the surrounding parts.  A cylin-
drical bone  seems most liable and ready to  swell at its extremity
or softest part, which is the last formed part; and this is agreeable
to what I  have before said, that the latest formed parts are weakest
and  least  able to resist disease.  But in the  bones of the skull the
swelling is generally in the centre.
   Pain in inflammation of bones is more violent than in other parts.
Whether this arises from the  nerves being more compressed, or
from the nature of the  nerves themselves, is not easy to determine.
This is rather a heavy depressing pain than an  acute one, and is
similar to that of rheumatism, generally more violent at night when
warm in bed.  This symptom is common to all inflammations of the
bones and periosteum, though it has been supposed to be peculiar to
venereal affections.
   In this stage the  constitution is  not much affected, except  from
the long-continued pain, which may be so continued and violent that
the  patient  may in the  end become  considerably affected by  it.
We cannot  divide the bones, like the soft parts, into vital and non-
vital ; therefore we have  not two  species of  symptoms.  We  have
oftener, however, hectic  from inflammation of the bones  than  from
that of the soft parts.
   The parts surrounding  the bone generally, if not always,  sym-
pathize with the ossific inflammation ; first producing simply adhesive
inflammation of the periosteum, then of the muscles and cellular mem-
brane.  When considerable, this  adds much to  the  swelling: the
periosteum becomes fixed to the bone itself, so that this seems more
swelled than in reality it is.
   The soft parts contiguous to the bone, besides sympathizing with
the inflammation, receive the ossific disposition.   The cells which
contain the marrow are subject to be affected, so that the cavity is
filled up, and the bone increased in size.  The ossific disposition
takes place in the surrounding  parts much oftener than either the
swelling of the bone or the ossific disposition of the cavity; therefore
it seems an easier operation to  nature.   This ossific  disposition in
the soft parts assists in the union of fractures and in the formation
of anchylosis.
  Here are  bones [exhibiting them] where the ossific or adhesive
inflammation  had taken place in the substance  of the bone, pro-
ducing thickening of that substance; others where  inflammation
has taken place on the surface  of the bone; and here, similar to the
exudation of coagulable lymph on the soft parts, a coat of adventitious

  * [There is great difference in this  respect in different cases.  Bones, in ge-
neral, become spongy and light from inflammation ; but there are other cases in
which they acquire a hardness and denseness of structure little  inferior to that
of ivory.] 
OF THE DISEASES OF BONES AND JOINTS, ETC.
275
bony matter is laid on the surface of the bones by ossific inflam-
mation.  This in some, you may perceive, is laid on so close and so
thin as to appear like ossification of the periosteum ;  in others it is
loose and capable of being shelled off.   In  this bone of a lion it is
laid on in places nearly half an inch thick,  adhering closely to the
bone; and in this it appears, from the little connexion it had with
the bone, that the bony matter had grown from the surrounding soft
parts.
  From  this preparation  of one of the bones of the lion, which had
been injected and steeped in acid, it appears that this newly-added
bone was vascular, and had only lost  its earth by  this steeping, its
form still remaining;  it therefore must be as much an animal sub-
stance as the original bone.   This appearance  on the  surface of
bones, some years ago, before I gave  these lectures, would  have
been supposed to have arisen from caries.  If a bone is bent, broken,
or hurt, &c, the consequent inflammation produces an addition of
adventitious matter, which will  strengthen the part  even beyond
what it  originally was.   In disease of the  bone, when the ossific
disposition does not exist, we may observe that the periosteum is
very slightly attached to  the bone, being as easily raised from it as
the cuticle may from the  skin.
   Treatment.—The swelling  of a bone, if of no  specific nature,
requires  little chirurgical  treatment, but will most probably require
internal  and  external medicines before  it can be reduced  to  its
original size.
  If a bone  be only in  a state of adhesive inflammation,  every
method is to be used that is used in inflammation of other parts, as
bleeding, rest, &c.;  and  if in the lower extremities, a  horizontal
position will add greatly to the cure.   Fomentations will give ease,
especially when near the skin.  However, this treatment is  some-
times ineffectual, and suppuration comes on.
  Suppuration, however,  is  not  always the consequence;  for in
some cases the  bone becomes indolent, and remains swelled for
years.  I believe bones are more likely to take on the indolent habit
than other parts.  The adventitious bone may always be considered
as in a weak state, not being  an originally-formed part, and as it
is often in parts where it  becomes an  incumbrance, must be  consi-
dered as  a disease ; and if it could be removed it would be of ser-
vice ; but in  most cases  this  could not be done without  producing
worse effects.
  When bones take on this indolent  habit, it will be necessary to
rouse the diseased part to action.  For this purpose mercury may
be used internally, and pursued for a considerable time in a middle
dose between what would be used in a venereal affection and what
would be given as an alterative.
  Mezereon  has been much recommended in indolent swellings.
The decoction recommended by Dr. Russell is to be made  as fol-
lows.  Fresh mezereon root one ounce, pure water a gallon  and a
half.  Boil it in  a copper  vessel tinned, over a moderate fire down 
276           HUNTER'S PRINCIPLES OF SURGERY.

to a  gallon.  Towards the  end of the boiling, add  an ounce of
liquorice-root, sliced.  Half a pint is to be taken three times a day,
which is more than most can drink.  This  does not increase  any
of the secretions, except being a  laxative in a  very few cases.
It has been tried with double  the quantity of mezereon, but  was
then too pungent for  the stomach.   Patients using this decoction
are not  confined to  any regimen.  The medicine has been strongly
recommended in the  Medical Observations by Dr. Russell.   The
cases he has described I should not call venereal, though they were
treated  as such, but scrofulous; therefore we may find mezereon a
good remedy in  scrofula.   It cannot be considered as a specific in
syphilis, as it is only useful when the bones are affected.
   Of the Suppurative Inflammation in Bones.—When  the  ossific
inflammation is  not cured, suppuration takes place.  There is no
visible  difference  between  suppuration in bones  and in the  soft
parts; for as bones are composed of animal matter with calcareous
earth, there is no reason why they should not go through the same
process.  Suppuration does not indeed  take place so readily in
bones, the  inflammation  often not reaching so far.   Whether this
proceeds from an  indolent  disposition stamped on them from the
first, or from their structure, I do not know; but whenever suppu-
ration takes place  in them it is a serious piece of business.   The
periosteum and surrounding parts are more ready to take on suppu-
ration than the bone itself,  yet it may originate in the substance of
the  bone.   The consequence of suppuration is ulceration, which
may also  originate from  pressure, or blood lying on the bone.
There is, I believe, no difference between the ulceration of soft
parts and of bone,  the adhesive going on with the suppurative in
the soft  parts; so in  the bone we have the ossific going  on with
the  suppurative.   To repair the loss that  has been made, Nature
sets herself to work to repair the loss with granulations.   The
intention of these is, to fill  up abscesses; to repair compound frac-
tures ; to restore the part lost by trepanning, &c.  Nature sets about
to repair these injuries of bones by the same original principles by
which bone was  first formed: thus, if a cylindrical bone  is to be
restored which was originally formed on cartilage, the first step to
its reproduction will be the formation of cartilage ;  if a bone in the
skull, it will be of membrane.   But we sometimes  have too great
a disposition to  ossification in  the granulations, so as to make the
new part bulky and  inconvenient.   A difference  is observable in
the newly-formed substance which arises from ossific inflammation
and that which  is formed from granulations in consequence of
ulceration.   The former has  a smooth fibrous appearance,  very
different from the latter, the surface of which  is  granulated,  as if
the bone had grown from the centre to the circumference, the grain
being of a  sandy texture.
   Compound Fractures.—These differ from simple fractures in the
first and second modes of union being lost; and therefore the third,
by granulation, takes  place.  The granulations between the ends of 
OF THE DISEASES OF BONES AND JOINTS, ETC.
277
the bone and on the lacerated surfaces take on an ossific disposi-
tion, and the suppuration is always more or less surrounded by the
adhesive inflammation,  so that it extends  pretty far,  and conse-
quently the callus'is large.   Hence these fractures  are so tedious
and  dangerous, especially when  in the lower extremity, which is
their usual situation.  There are no bounds to the mischief done by
a  compound fracture:  the  loss  of  the uniting substance by the
wound, and the loss of the living  principle to what remains by the
exposure, are causes of the failure of the first process; and, besides,
the ends of the bones are sometimes so locked together as to require
to be sawed off, or so denuded of their investing membrane  as to
lose their living principle and to exfoliate, as the dead part must be
thrown off before the  wound can heal.  This  sometimes takes six
or eight months, and is  so extensive as to be very dangerous.  The
inflammation, too, which follows the accident is commonly very
considerable, and may proceed to mortification.
   Treatment.—The only peculiarity in compound fracture by which
it differs from other lacerated wounds is the breach of continuity
of the  bone, which admits of motion in the part where none was
intended.  This singularity it is which requires a peculiarity in the
treatment, as this motion and the operations of nature are in contra-
diction to each other.   A variety of inventions  have been employed
to prevent this motion; but  the dressing of the wound every day
counteracts the effect of every invention that has been thought of,
and it is perhaps impossible  to dress the sore without  motion (see
note, p. 271).  At first the part is generally put into a poultice, but
changing  this must give considerable movement.   Instead of  a
poultice, I would lay  the  leg or arm in cloths, doubled several
times, and wetted with goulard,  and lap them over so as to  come
into contact.  These should be wetted occasionally, and continued
 until the inflammation is over  and  the  suppuration takes place.
 When the wound is on the back  of the leg we  shall be obliged to
raise the leg every day to apply the cloths.   A bit of oil-cloth should
be put under the leg,  and wiped clean every day.
   The time of union of a  compound fracture is necessarily much
longer than that of a  simple fracture, from the processes they have
to go through, and is very uncertain;  but the union of the bones  is
 generally effected long before the external wound is healed up, for
 whatever retards the  cure  of the bone retards also the cure of the
 sore.   When granulations  have been formed and bony union  is
 late  in taking place, and the wound is healed up or nearly so,  it
 should be treated like a simple fracture in the same circumstances,
 and gentle pressure is  of use, as walking, with a machine to take
 off the weight of the body: here necessity acts as a  stimulus for
 bony union to form.
   Compound fractures do not always take on the bony union: but
 there is never a want  of soft union, as there is at times in simple
 fractures ; and therefore new  joints  are never formed, as they are
                               24 
278
HUNTER'S PRINCIPLES OF SURGERY.
sometimes when simple fractures do not unite by the first or second
modes of union.
  Compound Fractures  communicating with Joints.—Joints do not
so readily go through the suppurative and granulating inflammation
when wounded as other parts; and it would be  improper for them
to do so,  as it would produce anchylosis.  If, in a compound frac-
ture, the fracture extends to a joint, the question arises, What shall
we do ?   The injury may be viewed in one of three lights : first,
as a  compouud  fracture;  secondly,  as a laceration  of  a joint:
thirdly, as a compound of both.  If it is such a fracture as seems
impossible to recover, it is not necessary to consider the joint at all,
but amputation must be performed.  If the laceration into the joint
be such that, although the fracture may not be considerable, inflam-
mation and suppuration of the whole joint must come on, then it is
probable  that amputation must also be its fate.   But  if the fracture
appears to be such as may unite, and the laceration in the joint be
such  as can unite  by the first intention; if the fracture be such a
one as we think would do well when restored to its situation, if not
complicated with a wound in the joint,  it becomes  dubious what
ought to  be done.   If the wound in the joint  will admit of being
kept from exposure, then we may consider the case as one of com-
pound fracture only.  This sort of injury most often happens at the
ankle joint, this tibia being very liable to fracture at its lower extre-
mity.   All wounds of the joints should be healed by the first inten-
tion,  if possible.*
   Of Fracture of the Patella,  Olecranon,  and outer Ankle.—The
peculiarity  attending these fractures is,  that they make the  lateral
part of a joint so exposed that the fracture communicates with the
cavity of the joint which  gives an exit to the immediate bond of
union.   The treatment of the patella and the olecranon will be very
similar, because they not only make the lateral parts of joints, but
they  have inserted into them  the tendons of considerable muscles.
Hence the fractured ends are separated from each other, instead of
riding over one another as  in common fracture, and a different
treatment is consequently necessary.
   As the fractured patella is commonly produced by  a contraction
of its muscles,  especially when  opposed by a resistance  of other

  * [The question of amputation in cases of compound fractures, is one which
depends on many circumstances: as, for example, the  implication of the great
joints; the degree in which the soft parts are bruised and injured and the bone
comminuted ; the injury of the principal vessels or nerves of the fractured limb,
as well as  the age, previous habits, and  present conveniences of the  patient.
Without, however, going into the subject further, it maybe sufficient to mention
that surgeons are now more in the habit of trusting to the efforts of Nature than
used  formerly to be the case; so  that cases which would certainly have been
condemned by Pott and Hunter are frequently saved in the present day. Where
youth and a sound consiitution exist, the surgeon  should be especially careful
 not hastily to condemn a fractured limb because the joint happens to be impli-
cated, or on account of any other  simple  circumstance; but should reflect how
 extensive  the resources of Nature are, and that an attempt to save the limb in
the first instance will not necessarily preclude his having recourse to the remedy
 of amputation in a later period of the case.] 
OF THE DISEASES OF BONES AND JOINTS, ETC.
muscles, the fracture is then transverse, and  then the muscles are
at liberty to contract  to their full extent, and  consequently the
broken part of the bone above is drawn  up the thigh with  them,
for the rectus muscle has more than a simple power of extending
the leg, namely that of bending the thigh on the pelvis.
   Treatment.—When the ends of the fractured  bones are pretty
soon brought tolerably close together, I can  conceive that  union
may take place as in simple fracture.   Before  the year 1750 it was
the practice to endeavour to bring the broken ends of the bones as
near together  as possible, with little  or no motion allowed; but
after that  a fashion arose (for we have fashions in surgery as in
everything else, arising perhaps from a person  happening to do
well who had not been treated in the old way,) of letting the parts
separate, and of not forbidding motion so strictly; but  now caprice
has I believe had its day, and we  are taught by reason and experi-
ence that the parts  should be, when cured, as nearly as possible
in their natural situation.  To effect this,  the upper portion of the
patella should be brought down as much as we can, and the com-
mon bandage be applied.  It may be imagined that in  the treat-
ment  it is not  only necessary to extend  the leg,  but to lay the
thigh at right angles with the body; but from a complete knowledge
of all the circumstances, it will appear that this  practice is not at
all  necessary; for as the rectus has a greater power of contraction
than extending the leg, so it must also be granted that it  has a
greater power of relaxation; therefore it is not necessary to place
the leg at right angles with the body.
   Fracture of the  patella  seems to  be cured by Nature, in the
manner of  the simple  fracture, by granulation,  because the first
and second bonds  of union have  escaped into the cavity of the
joint and have  been absorbed.  But,  perhaps, if the ends  were
brought together earlier, they might be  united by the same means
as the common simple  fracture, especially as we sometimes see a
luxuriance round their edges, which  is  probably  owing  to the
ossific disposition having taken place in the coagulum.   But if the
first and second modes  fail, I conceive the  third, by granulation
takes place: the ends of the bone and ligaments exuding coagu-
lating lymph, which coagulates immediately, and, taking vessels as
in other granulations, becomes not bone,  but a kind of tendinous
or ligamentous substance; which seems a wise provision  of Nature,
because if they were united by bone, this might be of such a length
as would prevent the  motion of the joint, except with the leg at
right angles with the femur.
  When union is formed it would be proper to give some passive
motion; but voluntary  motion is always better, because  the will is
always  sensible how far the powers of  a part extend, and will
attempt no more; but if  force is used  to extend  a part, all the
muscles of which have not their due power, it may be thrown into
such a situation as to give an  improper  action to a  weak muscle:
the will alone is proper to perform those actions she has determined
on herself. 
280
HUNTER'S PRINCIPLES OF SURGERY.
  The method of cure by ligament only is very tedious; but there
are other things to be done after this union has taken place.   First,
the accommodation of the  muscles to their new situation, where
less length  is  necessary, from the  patella having become  longer;
secondly, the  new contraction in  this  new situation;  thirdly,
acquiring sufficient strength in it.
  We  have reason to believe that  the greatest contraction in a
muscle is somewhat greater than the joint will  allow of; for we
find  them firm when  the limb is  stretched as if the power was
greater;  and when the part is deprived of this firm band  we find
the muscles draw the  bone up higher than they should.  Thus the
upper part  of the  patella is  always  drawn  up when  the bone is
broken.  While the union is  taking place, the  muscles are accom-
modating themselves to  the great length of the bones.   After this
it will be necessary to bend the limb and keep it so, in order that
the muscles may be thus enabled to admit of an elongation equal to the
flexure of the limb, by  which means the patient will be enabled easily
to bend the limb.  Extension will not be so easy ; but still by perse-
verance it may be acquired, as the following case will show.
   I called with a friend to  pass a day or two with  a family in the
country.   The lady of the house had had her knee fractured, and
had been treated according to the maxims the  surgeon had learned
while attending the London hospitals, which  at  that time were to
leave the whole unconfined, and take  no measures to  bring the
portions of bone together.  She recovered from the accident, but
was totally unable to  use the limb, and had to  be wheeled  about in
a chair.  Her  leg was  made to swing backwards and forwards
as she sat on a high  table  or chair, but still she had no power of
contracting the rectus muscle, and as soon as the  force that gave
the motion ceased, the motion ceased with it.  It was not until
several years after the accident that I saw her;  and, having spent
a whole  night  in  considering the  probable cause  of her  loss of
power, it appeared to  me that the space between the two attach-
ments of the  rectus being much shortened, while the muscle con-
tinued of the same length, the utmost degree of its contraction
would scarcely be able  to straighten itself, much  less move the
patella and leg also.   I advised her to sit as before, but instead of
having her leg moved, to move it  herself.  This she  could not in
the least  effect at first.   I considered, however,  that the power of
contraction which the muscles possess beyond that necessary for
the mere purpose of extending and flexing  the limb, as mentioned
above, is probably obtained by the  mind's influence on the  muscle;
and that, in this case,  if the  influence of the  mind  was frequently
exerted on  the muscle, it would gain this power  of  contraction, in
which it would probably be  aided  by the interstitial  absorption
taking place, and  actually shortening the  muscle  and suiting its
length to the  office  it was to perform.  I therefore advised her
ladyship to repeat  her exercise, as  often as she could, every day
for a month, assuring her that if at  the end of the month she had
obtained the least power of motion, I had not a doubt that she would 
         OF THE DISEASES OF BONES AND JOINTS, ETC.     281

again be enabled to walk by a  regular  exercise of the muscle.
The event proved as fortunate as I could wish: the lady, at the
end of three or four months, being able to walk, although she had
not walked for years.
  Fracture of the Olecranon.—The olecranon may be considered as
a fixed patella, the inserting-point of a considerable muscle, and
when broken is drawn up as the patella.  The immediate treatment
is the same; but  the consequences are often different, as  it should
always be united by bony union.   The arm should be extended, and
kept so ;  and the upper portion brought  down, if up, and retained
by a bandage, which will be somewhat similar to those used after
bleeding.   When soft union has taken place, and bony is beginning,
passive motion of the joint  should be made.    As the union  gets
stronger, the motion should be increased, but  should not be very
great till bony union is completed, as  before this it will  bend the
olecranon over the lower end of the os humeri,  and  occasion it to
make a smaller curve than  it should do, even an angle; by which
the full extension will  be prevented.   This,  by proper attention,
may be avoided.
  Fracture of the Ankle Bones.—It is possible for these  to unite in
general, like simple fractures, as  the displacement can hardly be
very considerable, unless great injury has been  done, here being no
muscle fixed to them, the contraction of which would draw up the
parts ; so that the extravasated blood and juices may be  sufficient
to unite them by the first intention.
  Suppuration in Bones.—I shall first  consider  that on the  surface
of bones, or on the periosteum ; secondly, in the  substance ;  thirdly,
in the medullary parts ;  fourthly, may be reckoned that in the joints,
which is similar  to that of a bone;  but, as  it is  attended with
consequences peculiar to the nature of the  part,  I shall treat of them
after.
  When inflammation attacks the surface  of a bone, the first effects
are adhesive ; and when suppuration takes place, the periosteum is
separated as far as the suppuration extends, making underneath a
cavity for the matter.   As the adhesive state takes place some way
round the abscess, there is in many cases a circle of adventitious
bone formed in  the  periosteum round the abscess.  This  will be
more or less, according to the  rapidity of the suppuration: if it
takes place soon, there will not be time for the ossific inflammation;
if slowly, a ridge will be formed, as is often the  case in the cranium
giving the appearance of bone being wanting  under the muscles.
As soon  as ever it is known that  suppuration  has taken place, it
should be freely opened, to prevent as much as possible the  separa-
tion  of periosteum ;* granulations will form, and in proportion to

  + [The propriety of this direction cannot be questioned as regards those cases
where collections of matter between the periosteum and bone give considerable
pain, or where, suppuration not yet having taken  place, the suffering  from the
periosteal inflammation cannot be subdued by the ordinary antiphlogistic and
mercurial treatment.  It should be recollected, however, that  considerable col-
                              24* 
282
HUNTER'S PRINCIPLES OF SURGERY.
them will the ossific disposition follow, which ossific  disposition is
often not confined to the granulations, but exists in the surrounding
cellular membrane, &c.;  so that, around the bone, ossific matter is
deposited which increases it very much in thickness :  this is seldom
the case when the granulations are healthy, but almost always when
unhealthy.  The oftener bones have undergone inflammation and ul-
ceration the thicker they become, and also much more subject to it, as
we evidently see in working-people's legs, &c.  Often, from the sepa-
ration of the periosteum, part of the bone dies, and must exfoliate.
   The second Species.—This is of greater consequence,  as more of
the bone becomes diseased.  When  inflammation attacks the  sub-
stance of the bone, it is seldom that the whole diameter of the bone
swells, generally only on one side, w-here the suppuration is.  This must
at first be much  confined, from the solid parts around, and  ulcera-
tive inflammation is obliged to take place early; and  accordingly,
as in common abscesses, the ulceration  goes on towards the soft
parts, and until it arrives  there it is impossible  to tell whether there
is abscess in the bone or not.*  It will burst, as usual in abscesses;
 but this probably does not so quickly take  place here  as in  soft
parts.  When near the external surface, and so near the periosteum
as  to give it the stimulus of adhesion, then the adventitious substance
is formed on the external part of the  bone, while its  substance is
gradually lessening internally by absorption; but the  addition  ex-
ternally is not in proportion to  the  internal loss, and  therefore it
bursts externally.   [Preparations of this were shown where suppura-
tion and ulceration  had taken place in cylindrical bones, as in the
tibia, Sj-c.']   This used to be called spina ventosa.
   The  third Species.—Inflammation in the  medullary part  is  still
more serious in  its  consequence than the last.  The body of the
bone thickens from  the adhesive disposition,  and also the ossific  dis-
position takes place in some degree in the periosteum all round, so
that the external parts are much increased in bulk;  this only takes
place in the bones of the extremities, where strength is necessary,
and never in the scalp, &c.   The ossific disposition in the medullary
parts takes place at all points of the abscess; and by this the other
part of the marrow is saved.  When suppuration takes place, there
being no vent obliges the  ulcerative inflammation to take place: on
 all sides and on the  outside additional matter is deposited.  Nature
intending to keep up  the strength which it  is losing internally; the

lections of pus, arising from  a venereal cause, are  frequently dispersed  by an
appropriate treatment  directed  to the cure  of the  original disease; especially
when such collections are situated on the frontal bone.]
  *  [Notwithstanding the great obscurity which involves the early existence of
these cases, yet it is not always impossible to discover their true nature.  In the
clinical lectures delivered by Sir Benjamin Brodie,  that gentleman has related
several cases in whioh he has detected and given exit to circumscribed abscesses
 in the heads of bones entering into the composition  of the larnre joints.  Such
oases are marked by a  fixed deep-seated pain  in some determinate spot, unat-
 tended by any considerable swelling of the parts, or disease of the  neighbouring
joints.] 
        OF THE DISEASES OF BONES AND JOINTS, ETC.     283

newly-formed bone is itself disposed to the ossific inflammation, by
which it  in many  parts  becomes much thickened, so that the
remaining shell is often entirely new.  Where the two opposite pro-
cesses do not bear a proportion to each, the bone becomes often so
very thick as to resemble  a  compound fracture.  In the two last
mentioned we  have often exfoliations, as well as  in  the  first;
they  are  less  favourable, from  their situation  being different,
and are  called internal exfoliations.   The head of the  tibia is
more  subject to abscess than any bone in the body. The medullary
arteries and membrane, which furnish nourishment for the internal
laminae of the bones and marrow, is the seat of the inflammation
producing it.  \_A preparation was shown where it was very large, but
only a mere shell remaining.]
  Treatment.—When  the adhesive or ossific inflammation does not
stop, but goes on to suppuration, it must be treated as inflammation
in soft parts.  When the suppuration is superficial, so that the bone
only makes  one of  the sides of the abscess, the matter will come
immediately to the surface.
  All the soft parts  are to  be laid freely open, or entirely removed.
This is necessary in all wounds, where healing does not take place
from the bottom, to expose them and bring on inflammation; and
when there is exfoliation, the opening is more necessary, as it cannot
heal until this is removed,  and it will sooner be  removed and healed
by exposure.  It will often be necessary to remove a part; but when
the skin and bone are  very near, then it must be only a simple open-
ing, without removing the skin, as in such cases  the skin is fixed
very much to the bone, and should not be lost;  and again, here the
granulations have less power to contract  than in deeper and more
fleshy parts, and there is less danger of sinuses or fistulous openings;
but when  deep-seated, simple and free openings are insufficient, and
some  parts must be removed, otherwise the external opening will
close, and fistulous openings  will remain till the bone has recovered*
Bones are very apt to fall into an indolent inactive  state, which
should be discovered, and  stimulating dressings applied.   Oily dres-
sings have  been objected to;  but oil  has  neither  a power of pro-
moting nor  retarding granulations, though  the former has been
imagined to be the case.   By this  means they  are often cured, but
are afterwards very liable to new inflammation;  and this is generally
attended with ulceration, which begins in the skin.  This is owing
to weakness in the part, and is most  frequent in the lower extrem-
ities.
  In some  cases it will be  necessary to apply the actual or potential
cautery to the bone.
  The treatment of these  cases is various, and the cure is generally
very  difficult.  They are seldom understood: at first they may
appear as a common abscess, and are often opened and dressed as
such,  which, proving  generally ineffectual, leads the surgeon to  a
more  particular examination, and he easily discovers  a diseased
bone, if the  opening has been free.  As the bone cannot be dilated
by a cutting instrument, it must be killed  either by the potential or 
284
HUNTER'S PRINCIPLES OF SURGERY.
actual cautery, or sometimes the trepan will be useful.   After exfo-
liation is finished, the same dressing as in caries is required ; but in
many cases it will be necessary to do something more.   The cavity
of the abscess in  some  requires to be exposed,  by removing sur-
rounding parts, as is sometimes done  in abscesses of the  soft parts
before they will heal.
  Of the Matter in Diseased Bone.—The matter  discharged from a
sore where there is diseased bone is seldom good matter, especially
if it become fistulous.  The diseased bone that is bare is often pro-
ducing mechanical effects, such as rubbing the soft granulations, so
that there is a small quantity of blood mixed with the matter, which
gives it a bad colour.  Such matter generally blackens or in part
corrodes silver probes.  This probably arises from the hepatic air
(sulphuretted hydrogen gas) which Mr. Kirwan  has discovered to
be produced by the putrefaction of animal matter.
  Of the Shortening of Muscles of Diseased Joints.—Joints when dis-
eased naturally get into a middle state between flexion and extension;
and, as the joints are passive, this must be performed by the muscles,
and  either by their voluntary or involuntary action.  This stiffness
of the joint depends on the involuntary  contraction of the muscles,
and  is in consequence of the muscles sympathizing  with  the joint
But  this involuntary contraction is not like tetanus; the muscles in
this  state feel like strong cords, and, if  straightening the joint be
attempted it seems to the patient as if these cords  were  breaking.
As  the joint loses its power of motion by the disease, in that pro-
portion the muscles are altered; they adapting  themselves to the
quantity of motion the joint will admit.
  In the artificial extension of a joint which has been contracted,
the muscles which are contracted should never be called into action,
because the parts which ought to lengthen will  thus be shortened.
To  illustrate  this, let  us  suppose the gastrocnemius and soleus
muscles to be  contracted,  and to draw up  the heel, so that the
patient rests on his  toes, his foot being  in a line with his  leg: in
walking he will involuntarily use these muscles to give firmness to
his   leg.   In  this case we should give  support to the  heel in a
degree.  By this means the patient, convinced of his  ability to bring
his  heel as low  as the  support requires, will cease voluntarily to
contract  the  gastrocnemius  and soleus  muscles, and  they by
degrees  will acquire the property of relaxing themselves ; which,
if the heel was entirely supported at first,  they  would  have no
occasion for, and while altogether unsupported they never could.

  Of Sprains.—In sprains  the ligaments are probably often torn ;
for in most sprains there is  a considerable extravasation in the sur-
rounding cellular membrane.
  Considerable pain is felt,  at the time of the accident, of the heavy
dull kind, which often produces sickness, and the blood leaves the
skin of the body generally.  Considerable  swelling takes place, and
this is almost instantaneous.  The swelling arises from two causes;
the surrounding cellular membrane being loaded, and the  increased 
OF THE DISEASES OF BONES AND JOINTS, ETC.
secretion of synovia into  the  joint.   This will be more visible in
the joints where the capsular ligament is loose, as in the joint of
the knee above the patella.
   These symptoms are succeeded by inflammation,  which pro-
duces  great pain  and sensibility on motion.  These parts are very
insensible in a sound state, but they  easily move from a state of
insensibility to one of sensibility.  Nature does not  seem to have
bestowed so  much  pains on these  parts as  on others, for they
have very weak powers of restoration, which produces tediousness
of cure.
   Treatment.—In the first place, rest should  be employed, with
topical bleeding.  Pumping on,  or long immersion in cold water,
and friction with vinegar,  lees of wine, spirits of wine, &c. on the
part have been recommended.  Whether these last reinedies serve
any useful purpose or not  I am undetermined: but we know that
sprains are  at least  seldom perfectly  cured.  I  have known the
effects of a strain continue through life (above fifty years), always
swelling  and becoming painful on the least violence.  Where there
is a perfect cure obtained, I suspect the ligaments only have been
injured, and not the cartilage, which  is extremely slow to restora-
tion.  Though the mechanical strength is recovered, yet a  weak-
ness is often found to remain, which may sometimes be removed by
some application which has not been before applied, as a  pitch-
plaster, opodeldoc, &c, which gets the credit and the name of a
specific: but  these  often  fail.   The  same  applications are  often
recommended in the second stage as in the first,  but to use it in the
same way must  be improper.   In  the second stage cold  water
should be  applied no  longer  than to excite heat.  Sprains  often
remain very painful  after the original symptoms have been removed;
this pain is often removed  by giving the part motion, as if  some
part was moved into its place  by that motion; but it  is most pro-
bably by the motion's giving the parts  an  opportunity of adapting
themselves to  each other's action.
   On Dislocation.—This  term generally is  applied to bones, and
probably might also be applied to  cartilages, when any two bones
forming a joint are  displaced.   Probably the articulating substance
or  ligament  is torn; but  this circumstance is not yet well  ascer-
tained.  In many joints a lateral motion must be applied to produce
it, the muscles being at right angles with the bone that they  move,
&c.  When  the  head of the bone has  moved beyond a certain
point, then the antagonist  muscle  is  unable to bring it back, and
then it requires some passive motion  to bring the bone so far back
that the antagonist muscle can replace it.   A lady had the tibia
brought  too much below  the  os femoris, by too great  flexion: the
surgeon attempted to replace it, by bringing the  foot forward, and
so to  replace  it by the  extensor muscles: but I  thought the tibia
was got beyond  the centre of motion; therefore I conceived that
the above means would make it worse : he  then, by  my direction,
raised the head of the  tibia a little upwards, by placing the  hand 
286
HUNTER'S PRINCIPLES OF SURGERY.
in the ham, and the reduction of it was then finished by the extensor
muscles.
  General observations on the Reduction of Dislocations.—As joints
are composed of two parts, one more moveable and the other more
fixed, the more fixed might be  called the reactor, and the moveable
part the actor.  When a violence has been applied to the actor there
is a deformity occasioned, as if this was out of its place, yet both
are equally so.   In dislocations the powers are generally applied to
the actor, and though in most cases the reactor does its office spon-
taneously  yet it often  requires assistance.  In most joints of  the
body the  reactor  can  be made more  fixed, as, e. g., the  body in
dislocated hip, but in the shoulder there wants a counter resistance,
or reactor, the scapula being so very moveable, and hardly to be
fixed by art: hence extension  is obliged to be more on the muscles,
as the latissimus dorsi, pectoralis, &c, than on the ligament where
it should  be; therefore, to  reduce it, it is necessary to  make  the
scapula a fixed point, to do which often requires  much labour  and
some art.   When  you stretch  the shoulder as far as it can,  the sca-
pula is  brought forwards as  much as possible,  but the latissimus
dorsi and pectoralis major prevent the os humeri from being extended
on the  scapula beyond a certain point, which is  much against  you
in the reduction.
  In reducing a dislocation the bone should be returned exactly in
a retrograde motion, overcoming that  effect first which was pro-
duced last, and then a lateral  motion is to  be made in a contrary
direction to that motion which occasioned the dislocation; in doing
this  the most immoveable part is to be the fixed point if possible,
and the moveable  is that which is to  be extended.   This  is to be
done as soon as possible after the dislocation, as afterwards  the
parts will become  adapted to  their new situations, and render  the
reduction  more difficult, and sometimes impracticable.
  New  Joints produced in consequence  of Dislocations.—We have
sometimes new joints produced in consequence of dislocations when
the bones are not  reduced, which brings the parts into somewhat
of the condition of simple fracture ; and there is  the same  disposi-
tion between the two  surfaces  in  contact  as in simple fractures
which do  not unite by the soft continuity of parts.  But this  can
only be when the  dislocated bone comes in contact with  another
bone, as the thigh-bone with the  ilium.   When the two bones rub
and press on one another absorption of the external surface takes
place, the adhesive ossific inflammation goes on around the edges,
a fluid is secreted in the cavity, and thus we  have the new joint.
These joints  of necessity oftenest take place in the thigh-bone than
elsewhere, but sometimes between the os humeri and the scapula.
   The effects of Accidents and Inflammation of Joints.-—They being
circumscribed cavities, are subject  to the same  diseases as other
circumscribed cavities, as inflammation, &c,  but their peculiar
structure sometimes renders their  consequences different.  Nature
is very little disposed to take on the adhesive inflammation, because 
OF THE DISEASES OF BONES AND JOINTS, ETC.
the necessary  consequence would be  loss of motion  in  a part
originally intended for  motion.   This makes inflammation in joints
so much worse than in  any other circumscribed  cavities, for, as
before observed, if  adhesive inflammation does not  come  on, the
inflammation and consequent suppuration must spread through the
whole cavity.
  The joints are mechanically strong;  yet this is  not that sort of
power which resists disease; but they have sometimes  a greater
disposition than other parts to disease ; and sometimes they become
diseased from the violence of accidents.  They are slower of cure
from  their composition,  than other circumscribed cavities  are;
besides, they are also subject to specific diseases, from the materials
which they are composed of, and  more backward in  their cure.
Inflammation in joints is generally of more  serious consequence
than in other  parts; even when resolved it  is disagreeable; yet
this is always to be wished for.   Inflammation from accidents often
does well without any  adhesion, but not when it arises from other
causes.  In all inflammations of joints  there  is a swelling, from
extravasation, into  the cellular membrane  and cavities, as  in the
knee above the patella, where  there is a  sacculus  mucosus.   In
inflammation from accidents the treatment  must be similar to that
in other parts, but here suppuration is particularly  to be prevented
if possible.  Rest, topical bleeding by leeches and  cupping, fomen-
tations, blisters, purgatives, &c, are  here  to be  particularly em-
ployed ; but as joints are very apt to become scrofulous, the patient
should go to the sea when the swelling becomes chronic and appears
to be at all stationary.  Another  cause of accidents here, besides
strains, is extravasation of blood.
   Of loose Substances found  in Joints.—These are ligamentous,
cartilaginous or bony.   Though there are often extravasations into
joints, yet they seldom  produce  adhesions, although  sometimes
there are appearances  as if blood  extravasated into  a cavity of a
joint had become vascular.   To explain  this we must  have recourse
to the living  principle of the  blood.   This,  I suppose, when it is
extravasated into a cavity, adheres to the cavity, and is not absorbed
nor loses its living principle, but becomes vascular, and afterwards
membranous, cartilaginous,  or bony, according to circumstances.
Its attachment  being rendered  small by motion, it becomes easily
broken off,  The treatment of these cases we have before mentioned
when the joint was sound ;  sometimes there  is  more than one  of
these substances.  I know a gentleman  who has four; therefore if
an operation was to be performed  we must take care to manage it
so as to extract all of them at once.
   They may often  occasion lameness  in  other joints where they
are not discoverable ; but they are most liable to form in the knee-
joint, from its  greater size, and other joints might not so readily
show their existence.  These loose bodies can only be removed by
making an opening into the joint, and this  should  only be done
when  they are  evident.   On the  inside of the upper  end of the 
288
HUNTER'S PRINCIPLES OF  SURGERY.
patella is the best place; the loose pieces should be squeezed to that
part, and then carefully surrounded by three or four fingers of an
assistant: the incision "should be longitudinal and in length propor-
tionate to the size of the loose bodies.  The wound should be closed
immediately by adhesive plaster and the uniting circular bandage,
and the patient kept in bed for some days to procure the first mode
of union if possible, the leg being kept quiet and extended, and  the
occurrence of inflammation carefully watched.
  Anchylosis.—This is an union of bone with bone which ought
not to be united, and is of two  kinds,—one by soft parts, the other
by bone.  In inflammations of joints we often have adhesions by a
soft  medium.  Very  considerable inflammation is necessary to
produce anchylosis in  joints, and much time is necessary for their
perfection, as we see in white swellings. The adhesions are some-
times partial, sometimes universal.  The soft is from two  modes,
viz. adhesion and granulation.   The soft only can take place when
there is naturally no intermediate  substance, and  the joint  is sur-
rounded by  capsular ligament.
  Bony Anchylosis.—I shall divide bony anchylosis into five kinds,
four of  which are in the surrounding parts, by ossific inflammation,
the other by an entirely new substance, betwixt the extremities of
a bone.  Distinct and separate  bones  are  naturally united, either
mediately or immediately;  that between rib and rib, between tibia
and fibula, and radius  and ulna, is lateral attachment.  The second
is when there is an appendage  for the union  of two  bones, as in
joints in general; this is of two  kinds, viz. 1st,  when the whole
surface is united by soft parts, or ligament, as vertebrae to vertebras;
the other, when only  round  the  extremities by caspular ligament.
These will have different effects.  When there is no continuity of
soft substance, but  only the bones, then the inflammation is  obliged
to shift the ligaments for bone.
   Of the first, from lateral attachment where there is no joint.—This
generally takes place only when the bones are so near as to partake
of the ossific inflammation between them, as in the tibia and fibula.
This anchylosis is of little inconvenience, except between the ulna
and radius, when  their  motions will be rendered imperfect.  [A
preparation was exhibited which showed the union of a tibia  and
fibula, by the ossification  of the  interosseous  ligament; another, the
union between two  ribs; and another, the union between two of ihe
metatarsal bones.]
   The  second, or in surrounding parts.—This often takes place in
bones  united by their whole  surface, as  between vertebras  and
vertebrae, and I have seen it between  sacrum and  ilium;  it often
occurs  in the human species, but much oftener in horses.  The
ossific inflammation would appear in such to  arise from the bone,
as it is found to  be in different  degrees.    Sometimes the ossific
inflammation attacks  the periosteum around  the connecting  sub-
 stance, leaving this  as free from bone as  ever.  In a horse the
vertebrae unite, not by ossification of the  intermediate  substance, 
OF THE DISEASES OF BONES AND JOINTS, ETC.
but by the periosteum covering them becoming ossified.  The same
also occasionally happens in the human vertebrae, the intermediate
substance not being at all ossified.
   Of the third, or between bone and bone.—Within joints,  but with
a continuity of  substance, anchylosis  often takes place in the
vertebrae, by ossific inflammation having existed in the  interme-
diate substance,   These specimens  [exhibiting them] show the
intermediate substance ossified, while the external parts are little or
not all affected.   In the spine of a lion both are  affected.
   The fourth, by capsular ligament.—This is much worse  than the
former,  here the  bones  having  a  considerable motion,  and  this
motion very necessary; but in some of these joints there  is more
inconvenience from anchylosis than in  others; it is from  the cap-
sular ligaments taking on the  ossific  disposition, after strains  and
other injuries; however, this is much less frequent than the others
and very long in coming about throughout  and all  around the
ligament, though a partial anchylosis  may take place which will
render the joint stiff.   [A preparation of the os ilium, anchylosed in
part with the glenoid  cavity, by ihe surrounding capsular  ligament
becoming in part  bony,  was shown.   In  the elbow another  was
shown, of this species of anchylosis.]
   The fifth,  by the whole substance  of the articulation.—This is of
two kinds, and these kinds are the  only ones which  can  admit of
the soft  anchylosis.  It  is somewhat similar  to the  union which
takes place  in soft parts; it arises from  two causes, viz. 1st, from
inflammation of the parts themselves; 2dly, from the inflammation
of the surrounding parts,  the parts  themselves partaking  of it.
Sometimes  the  cartilages are ossified,  and a  new substance is
formed  on  them,  which I rather think arises  from  granulations
without suppuration.  Joints have lost their motion from inflamma-
tion in surrounding parts.  A lady had  an inflammation come on
from the opening of  a  sacculus mucosus on her elbow, which
inflammation was very violent, and extended to the joint, soon after
which  she lay in, and died of puerperal fever.  On  opening the
joint, soft union was found to have taken place,  which, if  she  had
lived, would probably have become bony, and the joint would have
been anchylosed, merely from  adhesive  inflammation.
   Of Suppuration  in Joints producing Anchylosis.—This is of two
kinds, viz. truly inflammatory and scrofulous;  the former  we shall
now treat of principally.  If  the inflammation  is carried on, an
abscess is formed in the cavity, as in any other part; and  the sup-
puration  is more universal in the cavity than in  other parts, being
diffused through the whole.  This  continues to approach nearer
and  nearer  the  external surface, and  either  breaks or  may be
opened:  so far as  they are connected with  bone they are similar
to compound  fractures; but the suppuration  is slow,  and  takes
place with difficulty, and then generally falls into the natural scro-
fulous disposition, which renders it tedious.  The  suppuration is
then imperfect, appearing to  partake  of  both  the adhesive  and
                              25 
290
HUNTER'S PRINCIPLES OF  SURGERY.
suppurative.  The ulcerative  disposition is slow  in  bringing the
matter to the skin, which arises  from the indolence of the prior
suppurative disposition and  inflammation.  The ulcerative inflam-
mation sometimes goes on, so as entirely to alter the  joint, that is,
the receiving cavity becomes larger, and the received part less;
this is often the case in the hip joint.  These cases  then become
very tedious, and generally  very uncertain in their cure.  Before
they are opened they are generally become  so indolent that opening
has very little effect;  and  often when scrofulous such a disagree-
able inflammation comes on as to destroy the patient, and therefore
amputation had better be performed at once if this  disagreeable
inflammation does not take place immediately after opening; yet
a fistulous opening is  generally the consequence.
  Soft Anchylosis from  Granulations.—A joint  so healed  has no
cavity left, the surfaces uniting. A joint coming to suppuration from
not being resolved  in the first mode, but forming granulations, is
more tedious than in the soft parts.  The granulations cannot con-
tract here, as they do in the soft parts, and the powers  of restora-
tion in them are very weak.
  Bony anchylosis takes place when the granulations ossify, so that
the two bones are united into one exactly  similar to  a compound
fracture.  [Preparations were shown; one,  of the thigh united to the
acetabulum;  another, of the  ulna to the os humeri; and another, of
the metatarsal bones.]  But when the  suppuration is healthy the
joints sometimes recover: in such cases the  matter is  sooner dis-
charged, and the parts are more disposed to return into their origi-
nal state.
   The modes of cure.—The  first attempt should  be to resolve the
suppuration without opening.  In  some the  cartilages have been
destroyed (which may be known  by the bones rubbing against each
other,) and replaced.  This I have  seen  in  the  knee.  When a
healthy process is going on, the joint should be attended to.  Rest
should be prescribed, both  before and after  it has  taken place;
when it is recovered pretty well, a little motion, and gently repeated,
should be allowed; thus  a cartilage will  gradually  form on the
parts moved.
   The second mode of cure is the formation of granulations, which
makes anchylosis complete  by their  union.
   Of Muscles losing their Action from injuries done to Joints,  Ten-
dons,  and Ligaments.—It  is remarkable that an injury done to ten-
dons, ligaments, fasciae, &c, especially of the strain  kind, impair
the muscles more than when the muscles themselves are injured, so
that these muscles appear to  sympathize with those parts  of  little
action, and become wasted  and weakened in consequence.   I think
this arises from sympathy, or a consciousness of  the parts being
unable to answer to the action of the muscles, and it comes nearest
to human reason of  any  thing in the body.  If  the  affection be
temporary, as in common inflammation, the muscles do not waste,
being then conscious  that  the parts will recover.   If one tendon  is 
        OF THE DISEASES OF BONES AND JOINTS, ETC.     291

materially weakened, the muscle will also; and then, if the motion
of the joint depends on that muscle, lameness will be occasioned,
and the other muscles will become also affected.  If a joint recovers,
the powers of the muscles begin to recover in proportion.  This is
the case after injuries of the joints, as fractures, or ruptured  ten-
dons ;  and the first intelligence of recovery in a  joint will be the
enlargement of the muscles.   This is the case in paralytic parts,
from the cutting of a nerve ;  the wasting is not occasioned by the
deprivation of the nerve depriving it  of nutriment, but from the
muscles losing their power of exertion.  If the hip is  affected, the
muscles of the leg or knee will waste, whilst those of the foot will
not be altered, which would be the case was their wasting owing
to want of nutriment from the nerves.  If the elbow is affected, the
muscles of the  arm surrounding it will waste, whilst those of the
hand will not be affected.  When the muscles waste, in consequence
of a disease in the joint, the surgeon will often say it is from want
of action ;  but if he will only observe the other leg, he will find the
muscles  nearly of their full size, though they have had no  more
motion than the mnscles of the diseased leg.  The mind, likewise,
loses its power over the muscles, for the will has  never any power
over muscles while the parts they move are unfit for motion, even
although the muscles are not wasted.
   The effects which a disease of a part has on distant parts.—Many
diseases of this class produce diseases  of debility, as for  example,
involuntary contractions  of muscles,  oedema, inflammation, and
sometimes mortification in parts beyond them ; thus, in a disease of
the  loins some of these  effects follow in the lower  extremities.
Though they only  arise while a disease is present,  and is  in its
height, yet the disease may be cured, and the inability in the joint
remain, as is the case in anchylosis.   But here I may observe, con-
cerning the contraction of muscles just mentioned, that it may take
place together with these diseases, as in white swellings of the knee.
But  then it is  very different from these diseases, the contraction
proceeding from an endeavour of the muscles to  adapt themselves
to the state of the  joint, whilst these  are only like symptoms  of
beginning  dissolution in the parts.  This debility is not like common
paralysis; the latter is a wasting of power in the muscles, from  a
want of stimulus; but this is a real disease from irritation.   It  is
perhaps reducible to a species of sympathy similar to general hectic,
 from  a  local disease, and  it  may be called local  hectic;  but  it
 sometimes goes beyond  hectic, even to mortification.
   Effects of local diseases on Joints.—Joints that have a secondary
 motion with the diseased part, from having muscles common with
 it, may be included  These joints gradually creep into  the middle
 state of motion, but sometimes beyond this, so as to be more bent.
 Thus, the thigh is often bent forward, and also drawn more inward,
 so as to be immoveable, from diseased loins or hip.  The knee also
 is frequently affected, even as if it was itself diseased.   The limb
 first wastes; next is oedematous; and  afterwards often inflames and 
 292           HUNTER'S PRINCIPLES OF SURGERY.

 suppurates, which is sometimes very extensive.  From continuation
 of one position, and want of action in the antagonist muscles, the
 joints, from  necessity,  become unfit for motion, and  are after-
 wards often very imperfectly restored.
   Exfoliation.—This is the separation of a dead bone from the living,
 and  is not  generally  understood.   By the  term we should be
 led to suppose that only the common separation of scales  from a
 bone was meant, for the other exfoliations are not answerable to the
 term.   We  have many  opinions of this  process from different
 authors, but all very imperfect.  The bone  that separates  cannot
 come away by rotting, for it is only dead, and not in the least putre-
 fied.   Bone is composed of two parts,—an  animal substance, and
 an earthy substance intermixed with the animal.   Hard bones, and
 the hard part of bones, have  a larger proportion of earth than the
 soft or spongy bones; they have also fewer  vessels.
   When apiece of bone becomes absolutely dead, it is then to the
 animal machine as  any other extraneous body, and adheres only
 by the attraction of cohesion to the machine.  The first business of
 the machine, therefore, is to get rid of this cohesion and discharge
 it.  For effecting this separation there are several  natural and suc-
 cessive operations going on.
   The first effect of the stimulus is on the surface of the living bone,
 which becomes inflamed ;  whether new vessels are formed, or the
 old ones become larger, is undetermined; but by injecting the sur-
 face of the part it appears evidently much more vascular than the
 other parts.   The surrounding parts also inflame, as the periosteum
 and cellular membrane, and  often  take on ossific  inflammation.
 This produces another process: first, absorption of the earthy  matter,
 and all the surface between the living and  dead parts of the bone
 become as soft as if steeped in acid, while the dead part remains as
 hard as ever.   To complete the separation, the absorbents continue
 their  office, and absorb the living parts also, and the first process is
 in a small degree attended with the second.   The operation of sepa-
 ration does not take place equally;  it begins  at the circumference,
 and continues on to the centre; and before the centre has begun the
 absorption of  the earth, the circumference has begun the second.
 This progressive process in the suppuration causes the exfoliation to
 be tedious, so that the centre is  the last place that separates.   In
 pretty broad exfoliations, long before the centre has gone through
 the operation, the living parts perform  their office,  in producing
 granulations  from  the surface,  and continue, in proportion to  the
 waste, to fill up the space. When the dead part is wholly loose,'it is, like
 all extraneous bodies, pushed  up to the surface.  It often happens
 that the  granulations ossifying, the exfoliation is locked in at  the
 edges, thus giving it the appearance of internal exfoliation.   Thus,
while Nature is busied in getting rid of that part of the bone which
is dead, she is  laying on additional bone on the outside, the intention
of which seems to be  that of keeping up the  strength of the bone,
which would, without this addition, be lessened by the loss of sub- 
         OF THE DISEASES OF BONES AND JOINTS, ETC.     293

stance.  This  opinion is, I think, supported by this circumstance
seldom occurring in this manner in any bones but those of the lower
extremity, which support the animal.  If this is true, it is a curious
process, by which  Nature endeavours to support the strength  of
these bones during  a loss of substance, by throwing on the outside
bone in proportion  to the loss of substance within.   Nor is the
process by which this adventitious bone is afterwards removed less
curious, and the piece of dead bone set at liberty ; for from all that
living bone adjacent to the dead piece, granulations arise, which push
up the dead piece against the upper sides of the cavity; and in con-
sequence  of this pressure  against the  newly  formed  bone, the
absorbents are set to work to remove it, and  in proportion as this  is
absorbed the piece  is pushed out, the granulations filling the space
behind it.   That in  the separation of a dead piece a part is absorbed,
I think is  very evident; and that there is a loss of substance at the
time of separation is obvious from this circumstance, that if a cir-
cular  piece is taken out of the skull, and  the  circular edge of the
remaining bone has its life destroyed by the actual cautery, to any
distance, this deadened part will separate and come away, which  it
might not be able to do without a loss of substance between the living
and dead bone.  Another proof of the loss of substance in this sup-
posed case is, that the side of the circular piece which is  separated
will retain its spiculae, while the edges of the remaining bone, so far
from  corresponding with them, are quite  smooth.   Now, as there
is room in this circular hole to allow the ring of bone to  come out,
its regularity cannot be the effect of new matter added between the
spiculas, but is in consequence of the absorption of those spiculae.
It appears from this last supposed case that it is my opinion that the
absorption is of the surface of the living  bone;  but I by no  means
wish to be understood that  no absorption of the dead piece can take
place ; for, on the contrary, I believe that Nature sometimes finds it
necessary to the completion of her process;  it generally takes place
when the separation is slow, and the granulating process is quick,
This  absorption of  the  dead bone takes place in the fangs of the
shedding teeth.  [See note, p. 50.]
   The first appearance of separation is an alteration in the part
round  the exfoliating piece.   This alteration is first  a sponginess ;
next,  its becoming fuller of little holes; then a small groove is pro-
duced, a  kind of worm-eaten canal about  the thickness of a shil-
ling, becoming gradually deeper and deeper: and the depth is irre-
gular, according to the extent of the  original cause.  The small
holes appear at first in the surrounding parts, and these appear more
vascular,  the  more so  the nearer the diseased bone.  Sometimes
parts become  dead without any change of colour, dying  almost
suddenly,  perhaps by exposure or a blow, and the surrounding part
becomes spongy; the dead  portion then looks the soundest; but
when killed by previous diseases it is black.   It is astonishing  to
see what little curiosity people have to observe the operations of
Nature, and how very curious they are about the operations of Art.
                              25* 
294           HUNTER'S PRINCIPLES OF SURGERY.
  After exfoliation, the living surface still continues soft until bone
is formed.   If it be a cylindrical  bone,  it has the appearance of a
foetus's bone deprived  of its epiphysis: it is hollow, but fills like a
growing bone, in every respect,  by bony matter deposited.  Hard
bones exfoliate quicker than soft, and the harder parts of soft bones
sooner than the  soft:  the bones  of  full-grown people  sooner than
those of the young.*   If you lay a hard bone bare to any extent, it
always  dies, but not  always if  the soft ones.   Situation has the
same effects as in other diseases: in the foot or leg it is slower than
in other parts less removed  from  the centre.  In exfoliations we
often find considerable pulsations  in  the  matter, lying in a hole
which communicates with the granulations, which are formed under
the exfoliating bone;  sometimes it  is hardly  perceptible; this will
depend much on the state of the granulations, their health, fulness,
&c.; if all these are joined, the pulsation is very considerable : also
according to the proportion which the  size of the hole bears  to the
granulations underneath.   After trepanning,  the  whole expansion
of  the arteries  of the brain becomes visible, by being seen at one
point: so it is with granulations, when the  quantity is  considerable
in proportion to the hole.   This depends on mechanical principles;
so it is with mercury  in a thermometer; we see it rise when in the
stem, while in the ball it would be invisible.
  Exfoliation from accidents,—as from  a blow, which  is often  of
sufficient force to kill  a sound portion of a  bone, as  in compound
fractures, gun-shot wounds, at the ends of bones after  amputations,
&c, all  of which do better than when it  arises from diseased parts,
the  common processes of separation being carried on more vigor-
ously.
  Exfoliation from Disease, as Caries.—Disease is often carried  so
far as to produce death in a part of a bone, and exfoliation is often
very salutary, but  not always so.   Surgeons have endeavoured  to
cure a  diseased bone  by killing  it:  but this is often not so salutary
as when it is spontaneous;  for in the latter the whole diseased part
generally  dies;  but   it is  often the contrary, or  partial,  when
it  is  produced  by art.  The actual and  potential cautery  have
been used for this purpose, and the practice probably arose from an
idea that all diseased  bones were disposed  to separate  by exfolia-
tion, and that this would hasten it; but  exfoliation  is not, as has
been supposed, a necessary  consequence of disease in a bone, but
it is the  death of the  bone which makes exfoliation necessary,  to
separate the dead piece. Now caustics  neither hasten the process of
separation  either here  or  in soft  parts; but the  actual cautery,
indeed, often has the power of inflaming the  living surrounding
parts, which invigorates and stimulates them  to what they were

  * [The  great attention which  Mr. Hunter bestowed on all matters connected
with diseases of the bones entitle his opinions to the greatest respect. Believing
however, that  the  bones afford no exception to the general principle, that the
actions of parts are vigorous and  rapid in proportion to  their vascularity, I am
compelled to dissent from the fact expressed in this paragraph.] 
        OF THE DISEASES  OF BONES AND JOINTS, ETC.      295

before incapable of, its use in this, and its superiority to the poten-
tial cautery not being commonly known.   When the actual cautery
can deaden the whole diseased part, a cure may be expected ; when
art is to be used it is uncertain, as the quantity of disease in a bone
can seldom  be known : however, at times it may be guessed at,  and
as  the seat and thickness of the bone vary, the cautery must be
varied also.   If the bone is diseased deeply, the cautery should be
much  heated, and very thick, so as to retain its heat longer:  but
these  means are often insufficient, and the disease goes on teazing
the part a long time, particularly in the lower extremities.  In cau-
terizing, it is  better to  burn beyond the diseased part  than  not
enough.  But its frequent failure has occasioned the use of it to be
much laid aside.
   Situations of Exfoliations.—There  can only be two species of
exfoliations, viz. external  and internal;  but they are  often mixed,
and then  admit of a third kind, which I call  the  inclosed exfolia-
tion.  The external arises  from internal causes, and  is  in  many
parts a simple operation, meeting with  no obstructions, as in the
head,  ribs, &c.   But in the  extremities it is often complicated,  and
becomes inclosed, and then  appears as an internal exfoliation.
   Internal Exfoliation.—These  less frequently arise from accidents
than the former ;  but may arise from the two last suppurations of
bones.  The part which is to be exfoliated loses its  life, and ulcer-
ation goes on in the internal surface of the surrounding living bone,
to  make room for the exfoliation.
   In internal exfoliations a  part of the centre of the bone becomes
dead, while the enlargement  of the cavity lessens the substance of
the surrounding part, and  consequently weakens that part.   But
Nature wishes to furnish a substitute ;  for the stimulus  of  weak-
ness being felt, the surrounding  parts become affected, and undergo
the ossific inflammation, by which the bone is  thickened;  and
this continues in proportion, and as long as the internal part is
 unremoved, or not cast off.
   Mixed Cases of Exfoliation.—The first is when an  external one
 appears to be internal; the second  is an exfoliation  of the whole
 thickness  of the bone in one part;  the third of the whole bone.
 These I call inclosed, or incased exfoliations, generally occurring
 in  the lower extremities.  These three being  different at  first, are
 not very easily conceived.
   First species of Inclosed.—Sometimes when  the  surface of  a
 bone  becomes  dead, before  the separation  of the piece of bone
 takes place, the ossific inflammation comes on, and entirely covers
 the exfoliating piece, leaving only a  little hole for the discharge of
 matter.  This takes place, first, when the periosteum is inflamed,
 and  the granulations from the  edges of the  exfoliated pieces also
 ossify; but the process for freeing  the  portion  of bone  has been
 described already.
    The second species is when a piece of any given length becomes
 dead  throughout; the appearance of internal  exfoliation is here 
296
HUNTER'S PRINCIPLES OF SURGERY.
still stronger than in the last case.  Exfoliation or separation begins
on the  living  surface of contact, at the two ends of the dead bone
or piece, and  ossific inflammation comes  on in the surrounding
parts, so that it becomes incased.  This rarely happens, but when
it does, the separation of the exfoliated piece is very tedious, as the
stimulus is given to all surrounding parts.
  The third species is where  the ossific disposition takes place  in
the soft  parts,  from end to end, and the whole becomes inclosed  in
a case of bone.  The difficulty lies in  conceiving  how  it becomes
inclosed at the ends where the joints are constituted;  but probably
it is from these ends  being  alive, and exuding coagulable lymph
from  their surfaces, or else  from lymph being exuded from the
surrounding ligaments, and that becoming a  basis, so  as to keep
the joint complete.
  Of extracting Exfoliated Bones.—As it is uncommon for parts  to
heal before the exfoliated pieces are extracted, or if they do heal,
not to break out again, their  extraction becomes proper, if practi-
cable ; but this is often difficult  in many cases, from the situation,
as also from the obscurity respecting the real circumstances, of the
exfoliated piece: but in internal and in the incased kinds it becomes
still more difficult, even though all the  circumstances  attending the
exfoliated  piece were  known  perfectly.  The surrounding  soft
parts render many things respecting bones obscure; but wherever
the bones  are found  loose and bare, attempts should be made  to
remove them.
  The pressure of a probe on a piece of bone will generally satis-
factorily inform you if the part is detached, by  its  mobility.   If
detached, we  may often gain time by  removing it, and in general
this  is proper and the best  practice.   If  it does not  allow of a
removal from  its extent, it is best to break the exfoliated part into
pieces:  though it  may be  often difficult to ascertain this, as the
edges are often covered with  surrounding soft parts.   The internal
exfoliations, and also all the mixed species may be often assisted:
but the difficulty lies in ascertaining the state of the incased piece,
without which little can be done, nor should much be  attempted.
In the internal and mixed, which are  not only covered  by soft
parts but also  living bone, it will be difficult to  ascertain. In mixed
cases it  may  be evident that exfoliation  has taken  place, and  is
incased by bone; and for such, a dilatation must in order to expose
some of the living bone.  The next thing is to separate the dead
bones; probably some of the living bone must be sawed through,
(the  best saw for which purpose will be one  in form of an  axe,)
to allow of the extracting the dead pieces and such living parts  as
are broken off, which often happens; or the dead  must be broken
into many pieces.   Both these I have done, as I will illustrate by a
case.
  A young gentleman  had an abscess form about the middle of the
arm: when this was opened, the  bone was found bare.  It  was
opened  in two places;  first, on  the outside of the arm  above, and 
        OF THE DISEASES OF BONES AND JOINTS, ETC.     297

next on the inside below.  The openings did not heal, and the bone
could plainly be felt at both.   He had been in this way some years,
when he came to London.  On examining the parts I could plainly
feel the bone with a probe, and move it upwards and downwards a
little, but at the extent of each motion it seemed to be fast.   It was
plain that  the bone should be removed, if possible ; but how was it
to be done?   I chose to expose the bone at  the upper and outer
orifice, this being less  engaged with the nerves, vessels, &c, and
also being more convenient  to operate upon.  An  incision was
made on the bone downwards and forwards on the outside of the
biceps flexor; the end of the exfoliation was  exposed, as also  the
upper  part of the bony case.   I  followed this downwards and
obliquely inwards, and  when  I had exposed the whole, I sawed it,
in the direction of the exfoliated bone, to the exfoliation itself; but
as this did not open so  as to allow the disengagement of the bone,
I put in the spatula to force it open, but could not; however, I did
it in part,  so as to  get a  wedge of wood into the  opening, which
kept its position.  The  next time I  forced it open a little more, and
pushed in  a thicker wedge, and in two or three trials  more  I was
able to bring out the exfoliated bone.  It was a piece of the middle
of the os  humeri, about three inches long, and of its whole  thick-
ness.
   Of Rickets,  or the Constitutional Defects  of Bones.—This com-
plaint would appear either to be a fault in the general constitution,
or in the principle of the formation of bones themselves ; but as it
is peculiar to one  class of  constitutions, which are all weak ones,
it might be thought to arise from weakness.   If weakness is  neces-
sary to produce this disease, it must be one attended with a peculiar
disposition.  And  this is probably the  case; for we can hardly
suppose that such a disposition in the bones could produce  this
species of constitutional  weakness.  However, as it is a weakness
attended with a disposition of a particular kind, it is possible it may
arise from this fault in the bones, so far as the constitution sympa-
thizes with the state of the bones.  It is of a  particular kind, as all
weak people are not affected with  it.  This peculiarity of disposi-
tion, I suspect, is somewhat of a scrofulous nature, at least the  two
effects are often found  in the  same subject,  whether the causes are
the same  or not.  It would  appear to be a  want of power in the
bones, or of disposition in  their vessels, to form calcareous earth
and animal matter, but less of the last than of the other.  It is most
common in young subjects, and is generally attended with enlarge-
ments, and the bones often bend from the incumbent weight.  From
the increase of size in  growing  subjects, it would appear that the
proper  quantity  of earth is the  cause  of the limitation of  size of
bones, or  that  the bone has a greater freedom of growth when not
checked by a due quantity of earth or its own solidity.  This is
more perceptible in the joints, as they are there softer than in other
parts, and hence these  parts are most subject to this disease.  It is
only in young  and growing bones that this increase of size from the 
298           HUNTER'S PRINCIPLES OF SURGERY.

deposition of the two  substances can take place, it being only an
effect;  but a full-grown person may be rickety without any increase
of size, their bones not admitting of it.   The definition of rickets,
then, is a deficiency of  earthy matter  in  growing or full-grown
bones.   In the adult we  see  the bones  bent by the action of the
muscles.
   But  the cause in the  adult is different, it  being a disposition to
remove what is already formed and deposited by absorption ; how-
ever, a disposition to absorb would appear very different to a want
of  disposition to deposit, and may probably  arise from a  very
different  remote  cause;  for though the  effect  is similar, yet I can
conceive both to have the same  original cause.  If a softening of
the  bone is  to be the disease,  it is only taking  place by two differ-
ent means ;  for as there is probably a constant replacement of the
earthy matter, this disease may arise  in  adults from a  want of
power  or disposition to supply the  place of that which the absorb-
ents remove.
   Of  Rickets in Adults  [mollities ossium*].—The  disposition to
absorb the hard substance of a bone, or  the disproportion  between
the process of deposition and absorption, which produces rickets in
adults, is often in a much greater degree than in young  subjects;
for in the most rickety child I have always observed some earth in
the bones, but in adults I have seen the bones become as flexible as
a tendon almost.   In  different parts of the bone we  find  different
dispositions ; but the disposition of absorption gets the  better of the
ossific  disposition in other parts of the bone, or of the disposition to
deposit earth.
   Of the Effects of Mechanical Pressure and Muscular Contraction
on  Rickety Bones.—The  bones are  often bent  by mechanical pres-
sure of the body, and by muscular actions, into  very peculiar forms,

  * [Mollities ossium differs from rickets in respect of the age at which it occurs,
being a  disease of adult age affecting the  whole of the bones, whereas rickets is
a disease of childhood which  is principally manifested in the bones of the lower
extremities and spine, and but rarely in the bones of the pelvis or upper extremi-
ties.  They agree, however, in this, that when a section is made, the bone is
found to be more cellular than usual, the cortical part is  reduced  to a mere shell,
the cells are filled with a bloody or gelatinous-looking  substance, and the defi-
ciency of earthy matter is such that the bone is easily divided with  a common
knife.  Dr. Bostock found in some instances of mollities ossium that the quan-
tity of earthy  matter was not more than one-fifth, instead of being two-thirds of
the weight of the bone. It may further be observed that the disposition to molli-
ties  ossium is rarely overcome when once formed, but the disposition to rickets
is generally worn out as children grow up ; and, in proportion as this happens,
the long bones at the seat of  curvature are found to be flattened laterally and
strengthened on the concave side, where the support  is required.   Fragilitas
ossium,  depending on the superabundance of the  phosphate of lime in old people,
accompanied with a disposition to ossific  deposits in the different structures of
the body, may be considered as a vice of  nutrition of the opposite kind.   A re-
markable case of this sort of ossific transformation of  the muscles  and  other
structures is preserved in the  Hunterian Museum, in which the movements of
the patient must have been as effectually manacled as by the enchanted wand of
Comus.] 
OF THE DISEASES OF BONES AND JOINTS, ETC.
299
and  often impede  the  actions of other parts.  The joint forms a
more acute angle than  it would in health, and then the muscles get
a greater power of action.   It is  most frequent in the  back-bone,
pelvis, and  thigh-bones, in the angle made by the cervix femoris,
knee, tibia, &c.  In these it  is most frequent, from the two powers
acting (viz.,  weight  and muscular action).  The  ribs are made
straight, or rather bent  inwards, by the pressure of the atmosphere,
so that the child can  hardly  breathe ;  a bad formation of the skull
will  affect  the  senses;  crooked  spine will affect the health from
an alteration in many of the viscera.  In  the female pelvis many
dreadful  consequences  occur in  delivery.   When a bone has  ad-
mitted of a bias, a disposition takes place  on the side unnaturally
pressed, for a deposition of bone, so that we find a bony substance
formed there which acts as a prop.
  In the leg the  bone is bent forward from the muscular action
behind.   We have seldom these bends in the upper extremities, as
only one of the powers  is acting, viz. that of the muscles : however,
they are sometimes bent, as an example of which an os humeri was
shown.   In the thigh the curve is generally forwards and towards
the upper part, as was  seen in an os femoris in which Nature  had
deposited a quantity of earth on the concave part.   Rickety people
are generally knock-kneed, from one  condyle being less  than the
other; it always is somewhat less, unless in bow-legged people.
Bow-legged people are in fact straightest with respect to the bones,
the femur and tibia in  them  being in a straight line.
   Of the Cure.—The cure is not yet discovered, nor is the prevent-
ative^ of absorption in the adult yet known.  The original cause
being the same in both, the treatment should be the same.  The
indication is to give strength and tone to the system  by bark,
sea-bathing, &c.; but  these only  seem  to  give  general  health.
However, I  have the  greatest opinion  of sea-bathing, bark,  and
chalybeates.
   Of Exostosis.—This  is in  a great measure peculiar to youth.  It
is an increase of bony  matter in particular parts of bones.   It is of
two  species: one  is  local, and may  be supposed to be similar to
many tumours growing in  the  flesh, and probably may occur in
any  constitution;  the  other requires  particular constitutions,  and
seems to be constitutionally  interwoven with the formation of bones
in such people.  They are principally connected with the  soft parts
of bones, appearing generally at their extremities.  When universal,
the whole soft parts of the bone| are affected.  It sometimes appears
suddenly, and is of  various figures,  sizes, &c.; but sometimes it
comes on gradually and increases gradually.  These protuberances
often sWell to a  considerable thickness  beyond  their origin or
attachment, by which  means a small neck is formed.  Sometimes
they have a power of  growth within themselves, and do not in all
cases continue  to grow  from their  origin.   Sometimes it affects
only one bone, at  other times almost every bone in the body.   It is
a shooting out of bone from a  bone,  as the horns of  a buck's 
800
HUNTER'S PRINCIPLES OF SURGERY.
head.  It is not the effect of ossific inflammation.   The substance of
the bones in these constitutions is often enlarged  in the _ soft parts,
as in rickets, which leads me to suppose the same original  cause is
common to the two diseases.
  When near the joints it often produces lameness, and disturbs the
action of the muscle so as to alter the motion of the joint.  The
cases of a gentleman and lady were mentioned who  were subject
to the former of these processes, which was very troublesome; the
lady was evidently scrofulous.
  Cure of Erostosis.—As it appears to be more connected with the
natural formation of bone than  with disease, it is of  more difficult
cure than if it arose from disease;  for disease  is always producing
action tending towards a cure.  It  is  hardly ever to be cured by
medicines either external or  internal;  but as it is sometimes spon-
taneously removed, we should endeavour to promote the  absorption
of it, by rousing up this power.  If, however, we are not masters
of this  power, and we know of no  such, they  may be removed by
art, if this can be done with  safety.   The situation  first should be
well understood, and the parts covering it well  known.  The instru-
ment must  be adapted to the kind of exostosis  and to the situation;
the common ones are a saw, cutting pincers, and chisel.  First lay
the part bare, either by removing a part of the integuments, or by
making the incision somewhat longer than the tumour,  so as to
make more room, after the separation of the lips, for its removal.
If anything more than skin covers the exostosis, as muscle, it should
be  only divided, not removed.  When there is  a hard root, and
deeply situated, a cutting pincers or chisel  is  necessary;  but if
superficial, as on the tibia, it may be sawn off.   I have removed
them from  under the deltoid muscle, and also from the tibia.  The
immediate dressings must be suited either for  healing by the first
intention or by granulations from  the bottom of the  bone.  If the
first, exfoliation may take place ; but this is of little consequence,
therefore it should generally be  attempted, as it frequently will suc-
ceed ; and if not, suppuration ensues,  and it is easily and  speedily
thrown off.
  Diseased  Exfoliations  of  Cartilages.—Cartilage   is  a  peculiar
animal  substance,  and composed  wholly of animal  substances,
coming nearer  to horn  than any other structure.   I divide them
into two kinds: first,  such  as constantly change into bone at a
certain  age;  secondly, such as do not change into  bone, as that
of the nose, ears, &c.  They appear  to have  but weak powers.
  When there is a fracture,  the union is bony  by ossific inflamma-
tion in the  cartilages, which  change into bone;  but in the  permanent
cartilage there is a renewal  of  its own substance.  Sometimes the
inflammation goes on to suppuration;  but they seem  to have insuf-
ficient power  to admit of ulceration: yet they may be absorbed
by the  absorbents of  other parts; as in white swellings, when
suppurated, the cartilaginous ends are removed by the  absorbents
on  the surface of the ends of the bones that the cartilage covers. 
        OF THE DISEASES OF BONES AND JOINTS, ETC.     301

It may be ulcerated in this manner in other joints also; in the knee
we find all the different stages of absorption of cartilage; granula-
tions will shoot from under, through  the  cartilage, and sometimes
when there is not much matter in the joint, these granulations will
inosculate and form a bony union.  [Preparations of cartilage were
shown peeling off the ends of bones.']
  Changes of Cartilages  of Joints  by exposure.—The only effect
seems to be that they become softer,  which is occasioned by inter-
stitial absorption, which  sometimes proceeds so far as  to  remove
the whole and leave the bone bare;  a case of which was given in
the finger after amputation.  When  the cartilage  is exposed, the
surrounding parts granulate and surround the cartilage like a purse,
not adhering to it for some time after the wound is healed, for
cartilages will never  heal by the first intention.  A woman had
her arm amputated at the  shoulder-joint, with a flap by Mr. Brom-
field ; and in two years afterwards she died of a fever in St. George's
Hospital.  Upon examination, I found that the  cartilage had  not
adhered to the flap, which in that part had a smooth surface ;  nor
had  any granulations arisen from the  surface, which appeared
unaltered.
  Exfoliation of Cartilages.—The separation  of a  dead part is
called  exfoliation, for there  can be no ulceration  of cartilage.
However, this  is  very uncommon, as  the absorbing powers  are
very deficient  in  cartilages  to  remove  dead parts.  I have never
seen it.  I have  seen them  black  and  dead, but then the whole
cartilage came away, together with the end of the  bone ; therefore
it could not be called exfoliation of cartilage from cartilage, but of
bone from bone.   But the cartilages  are capable of being absorbed
from the granulations formed under  them on the surface of bones.
The permanent cartilages are just  similar in their  separation, &c.
I have seen  them separated  in sores  of the  part, as the nasal
cartilages.
26 
302
HUNTER'S PRINCIPLES OF SURGERY.
                       CHAPTER  XIX.

                 of hemorrhages  and  aneurism.

Causes of hemorrhage.—Hemorrhage:  1st, natural;  2d, diseased;—arising
  from  irritation ;—stimulating styptics to be avoided ;—occurring on mem-
  branous surfaces;—3d, from wounds;—checked by contraction of arteries;
  —artificial modes of checking hemorrhage ;—oil of turpentine.—Coagulation
  of blood;—stretching of arteries;—ligature ;—modes of applying it.—Second-
  ary hemorrhage.
    Of aneurisms ;—true and spurious ;—different kinds of each according to
  authors ;—divisions fanciful;—definition  of an aneurism.—Cause of aneurism;
  experiments on coats of arteries.—Situation of aneurisms.—Action of heart
  not the only  cause of aneurism ;—local  disease  in the artery; and want of
  equable support round the vessel.—Natural cure of aneurism from  obstruction
  of the artery;—oedema of the limb ;—sloughing of the skin over an aueurism.
  —Treatment of aneurism.—Objections of Pott and Bromfield to operations for
  aneurism.— Strictures of the latter on Mr. Hunter's operation.—Necessity for
  early operation;—improper practice of waiting for the dilatation of collateral
  channels.—Mr. Hunter satisfied of the propriety of his operation ;—arteries on
  which it might be practised.—Mode of  operating where a tourniquet cannot
  be applied ;—when it can.

From what we have said of the blood, it must appear to be of great
consequence  that it should be distributed to every part of the body
in its due proportions ;  but  in  disease  a much  nicer proportion is
necessary than in health.
   Effusions of blood  arise  from three causes:  1st, from  natural
causes ; 2dly, from disease ; and 3dly, from violence.   Of the first
species is the menstrual discharge.   The second kind arises from
many diseases  both constitutional and local: those  from  the con-
stitution are  numerous, as  bleeding  at  the  nose, &c, which  often
appears to be a species of derivation, or the effect of a  diseased
action on this part, as is sometimes the case in piles, where they
may be  considered as produced  by the constitution ;  those from
local causes  may be  called spontaneous, as bloody flux,  bleeding
from piles,  vomiting or spitting  of blood, diseased  menses, &c.
The third  proceeds from violence, destroying the continuity of the
vessels, among which must  be classed aneurism.
   Of Hemorrhage from  Disease.—At present I shall only speak of
the second  and  third  hemorrhages, from disease : these  I have
divided into constitutional and local.   The constitutional should in
general be encouraged rather  than checked;  but the local are next
to  our present purpose.   The local arise  from two  causes:  1st,
from a peculiar irritation, which can be cured only by quieting the
irritation; or, secondly, from  a species  of relaxation, or want of
power or action, in the vessels of the part.   The first I have seen
in  many operations,  when a  new irritation  had  taken  place; as 
OF HEMORRHAGES AND ANEURISM.
303
when the divided vessels had contracted and checked the bleeding,
they have opened again on the application of a cautery near them.
The intention of this would appear to be the removal of the extra-
neous body;  it also occurs in many wounds  and sores which do
not secrete good pus, but pus mixed with blood.
  For the cure of this species, instead of styptics, we should apply
sedatives, the best of which is opium;  and sometimes, probably,
solutions of lead.   The effect  of these will be  according to the
peculiar irritation.  A boy, for instance, had a bloody sore on his
shin from an accident, for  which he first used a common poultice;
but as it still continued to bleed and not to heal, I ordered a  poultice
made with poppv-head decoction, under which it went on well, and
soon healed.   Nothing  affects  the system  more  than too  great  a
loss of blood; the body becomes  languid and cold, and the heart
seems disposed to suspend  its action, as if a natural method was
instituting to stop the bleeding, and also to keep the actions of the
 machine proportionate  to its power.    But I know not what the cold
 sweating is to do.  An animal cannot subsist long  in this state but
the constitution will begin  to rouse up its actions again;  there will
be a full pulse and seeming strength;  but if the  weakness is  very
great, this apparent action or reaction of the system does  not long
continue.  When the pulse is strong and the body warm,  it would
 appear an indication for  bleeding;  but this is  improper, and the
 loss of a small quantity of blood at  this time would probably kill
 the  patient.*   The  rising of the pulse  in hemorrhage is often an
 effort of Nature  to  live, and  cannot be  reduced,  although it still
 further increases the irritability of the system.
   Hemorrhage from the second cause always exists in the  small
 vessels, and commonly in the membranes  of some outlet or excre-
 tory duct, and also in sores which have become in some  measure
 like  those secreting surfaces.  It probably arises from a want of
 disposition to contract. The cure is the same as that from violence
 viz. the application  of powdered resins, oleum terebinthinae, and
 other styptics.
   Of Hemorrhage from  Violence.—All wounds do not admit  of
 union  by the first intention, as when a large vessel is wounded,
 when the second mode of union is  necessary.  But large vessels
 are sometimes wounded without much harm, which either depends
 on the mode of division, or their situation with respect to surround-
 ing parts.  The  bleeding from vessels has in many cases a good
 effect, as  in fractures, and is then  in  small quantity; but  when
 copious  it hinders this salutary effect, as  is sometimes the case in
 simple fractures, and commonly in compound.
    The suppression of Hemorrhage is effected by three modes, viz.
 the natural, the accidental, and the artificial.

   * [Dr M. Hall has  amplified on this  observation in an able paper in  the
 seventeenth volume of  the Medico-Chirurgical Transactions, in which he has
 pointed out the dangerous consequences which may arise  from mistaking  the
 reaction consequent on repeated losses of  blood for an indication  for  further
 depletion.] 
304
HUNTER'S PRINCIPLES OF SURGERY.
   The first is from the contraction of the muscular coats of the
arteries:  this power is  one of the natural ones, and the accident is
the cause of this contraction by its  stimulus.  It is most powerful
in the small vessels, as  the blood's motion is less in them; but even
in large vessels it is considerable.  I am of opinion that an ampu-
tation below the  knee in  most cases would not kill  by its hemor-
rhage, even if left to itself; but this experiment  can only be ascer-
tained by accident.  The artery in  the thigh of a  boar stopped
bleeding  before the animal was at  all weakened, and  the carotid
artery of an ass  also stopped  bleeding after  being divided:  but I
believe that the  arteries of most animals have more of this power
than those of man.  It sometimes  appears as  if this  contraction
was not permanent, but relaxed and  contracted at intervals; but
when vessels repeatedly bleed there is probably a want of contractile
disposition, for then the whole  surface is  bloody, and the patient
becomes very weak from the loss of blood, and often  dies.   This
contraction of the vessels can be increased or diminished according to
circumstances.   The first cause of  increased  contraction  is  expo-
sure, which is very evident in  operations;  for when the wound is
dressed it will bleed again, and  again cease when exposed, so that
here  the  contraction  must be  from exposure.   1  conceive  that
leeches occasion a  free discharge of blood by their having a specific
power or acting  as a poison on the vessels, so as to weaken  them
and prevent their contraction thereby.
   The assistance which may be given to the natural  contraction
is by means  of  stimulants, which,  however,  can only affect the
small vessels; their action is simply stimulating them to contrac-
tion.  Whatever stimulants are used, they will  be  assisted by the
power of the vessels and their sympathy with each other.  A dossil
of lint dipped  in oil  of turpentine, after having first wiped the wound
clean in order that  it may reach the vessel, is the best, and may be
renewed pretty often.   I have seen it immediately stop vomiting of
blood from the stomach after all other means had failed [see p. 254],
given internally with white of egg  as often as the stomach would
bear it.   In  external hemorrhages  where  it had not the desired
effect applied externally, I would give it internally:  it is the best, if
not the only true styptic; thus, in a case of nasal hemorrhage which
nothing would stop, I  gave ten drops  of oil of turpentine  in  a
draught, and  repeated it every  two or three hours, which  entirely
stopped the bleeding in less than twenty-four hours, and it never
returned.*

  • [It is scarcely necessary to observe, in the present day, that this  eulogium
on the oil of turpentine is unmerited.   Of external styptics,  (if any really de-
serve that name,) a  saturated solution of alum is  much  to be preferred ; and
certainly no internal medicine has equally  acquired the  general confidence of
medical men as the superacetate of lead conjoined with  opium.
  The arrest of hemorrhage  is attended by the following circumstances : 1st, the
retraction of the artery  within its sheath ; 2d, its diametrical contraction ; 3d, the
effusion of blood into the cellular spaces between the vessel and its sheath ; 4th, 
OF  HEMORRHAGES AND ANEURISM.
305
   The second, or accidental, mode is of two kinds: first, the coagu-
lation of the blood as it flows, not within the mouths of the arteries,
as has been always described by authors, but around  them.  This
can only take place when the arteries can contract a little into the
surrounding cellular membrane by which the blood is  divided, and
this assists its coagulation; and the pressure of it on the mouths of
the bleeding vessels assists in stopping the hemorrhage.  This dis-
position can be  increased by spongy bodies applied to the mouths
of the vessels; in  some cases lint is sufficient, and flour will assist
the lint;  cobwebs also  are useful  on the same principle,  and  the
process of coagulation  will also be increased by agaric, from its
increasing the surface of coagulation, as well as by its pressure on
the vessels ; but these can only be useful in wounds of small vessels,
where the circulation  is slow, so  that the blood can coagulate,
and are improper in wounds of the larger vessels.  The tourniquet
may be applied here, but it should not be twisted too hastily.
   Another mode arises  out of, the natural,  and may be considered
in some degree as natural.  It is a property in flexible bodies to have
their diameters contracted as they  are lengthened ; in  arteries this
might be  carried to  a great degree when permanent effects are  to
be  produced.   It  is necessary that they  should  be lengthened  so
much as  to  destroy  the contractile power;  for  this is  the way
Nature takes to stop the bleeding of ruptured vessels.   Thus we see
that arteries which  are  lacerated will more readily stop bleeding
than  if cut with a sharp  instrument, as was proved in the  case of
the miller related by Cheselden;  and this is the wray Nature takes
to stop the bleeding of the navel-string in beasts.  Surgeons do not
take advantage of this; but farriers and gelders do, as their practice
of tearing the artery through in gelding animals shows.*

the formation of a coagulum or plug within and around the vessel;  5th, the
effusion of lymph; and, lastly, the contraction and obliteration of the cavity of
the vessel to the next principal branch,  and its final degeneracy into a ligamen-
tous cord.]
  * [The principle of torsion, as practised by several of the French surgeons, is
precisely the same as that  which is  here laid down in  respect of lacerated
arteries ; that is, the extremity of the artery is drawn  to a point, and does not
return to its original calibre, in consequence of the destruction of its elasticity.
We may also further add, that the rupture of the internal and middle tunics,
which generally happens on  these occasions, will tend to occlude the mouths of
the vessels still more completely by entangling the  blood among the lacerated
fibres and promoting its coagulation.  But how far the first of these effects, or
the obliteration of the calibre of the vessel, depends on the destruction of any
vital property, as of muscular contractility, may well be questioned, since the
same effect takes place on dead arteries when similarly treated.
  A preference is given  by some surgeons to this means of arresting hemorrhage,
inasmuch as it obviates the necessity for ligatures, and does away therefore
with one cause of obstruction to union by  the first intention.  Torsion, however,
is objectionable : 1st, because it cannot generally be depended  on where large
arteries are concerned ; and 2dly, because it requires a considerable isolation of
the vessel from the surrounding  parts, and sometimes leads to  a sloughing of
the extremity of the artery, which must operate as a much more dangerous
foreign body in the wound than a simple ligature.]
                               26* 
306           HUNTER'S PRINCIPLES OF  SURGERY.

   Of lateral Wounds  in Arteries.—The lateral wounds in arteries
are  commonly, though  improperly, called false aneurisms,  on
account of the formation of a tumour with pulsation; it having been
supposed that only the external coat of the artery had been wounded,
and  that the internal had given way in consequence of having lost
the support of the external coat; but the fact  is that the blood
escapes into the cellular membrane, and, coagulating there, forms
a kind of sac,  cutting off all communication with the other cellular
membrane, and, assisted by external pressure, may stop the bleeding
for the present;  nay,  the wound may heal up by  the first intention;
but by constant and  increasing pressure, the surrounding cellular
substance, containing  the Mood, by degrees gives way and forms a
perfect cyst.   These  may be divided into two stages;  first, while
the case is yet recent; secondly, when the cyst is formed.
   The first of these will  either kill  or come to  the second, if not
operated upon;  after  which, if the operation  is not performed, the
patient must die; therefore it is best to perform the  operation as
soon as possible, as the second will also kill if not operated on.  In
the first stage, then, if possible, the artery should be taken up.  The
operation is very simple: first  apply the tourniquet, then lay the
artery sufficiently bare, and  tie it above  and below  the wounded
part; the part included between the  ligatures will, when it becomes
dead, slough off, therefore does not require to be cut out.   The liga-
ture should be  first made on that side of  the artery next the heart,
and the tourniquet then slackened a little, to satisfy the surgeon of
its safety; afterwards  the whole should be dressed as  a recent
wound.
   Of the artificial Means of stopping Hemorrhage.—The method  is
to stop the mouths of the bleeding vessels; but  this is often  very
difficult, on account of the vessels being hid by being deeply-seated,
and is made more so  by the continuation of the bleeding, especially
in a part where a tourniquet cannot be applied.   I  shall  consider
the artificial means employed for this purpose under two heads:
1st, chemical;  2d, mechanical.  The first acts by destroying the
natural texture, and of course the life, of the mouth of  the vessel.
The most powerful of these is heat,  viz. the actual cautery,  which
should not  be too hot, nor  should it  indeed be  used  at all  unless
other means fail.  It acts  by drying  and coagulating the blood, and
destroying the life of the part to which it is applied.*  The iron
should be thick, not too short, as large as the part will admit of, of
a reddish heat or approaching to it.   Concentrated acids have been
applied with success, and whatever assists in coagulating the fluids,
as ext. saturni;  and I have  sometimes thought  of trying boiling
water.
   The mechanical method of stopping bleeding is by compression,
and is the  most secure: we therefore have  recourse to it when
  * [Besides this, the actual cautery corrugates and shrinks the animal textures,
by which the bleeding orifice is obliterated.  A similar but less powerful effect
 s produced by the mineral acids.] 
OF HEMORRHAGES AND ANEURISM.
307
every other means has failed.   It consists in inclosing the vessel in
a ligature.  The spasms and convulsions which appear  after  ope-
rations, have been attributed to the nerve being  inclosed with the
artery in the ligature;  but this seems false,  it being only in parti-
cular habits  that  such  symptoms occur, patients  more generally
recovering after the use of the ligature with no bad symptom  than
otherwise.  I have sometimes tied nerves  on purpose  along  with
the artery, particularly along with the radial artery in amputations
of the fore-arm, and  never observed that  any bad symptom  suc-
ceeded.*
   There are two methods of applying the ligature, viz.  the  needle
and the tenaculum ; the last cannot be employed on all  occasions,
only  under particular  circumstances.  But the  needle  admits of
application on  almost all  occasions.  It has been objected to as
taking up surrounding parts ; but this is essentially necessary in old
persons, where the arteries have lost their elasticity.  An artery in
the centre of a muscle  should be taken up by the needle.   The
tenaculum should only be  employed where we have sound arteries
to deal with, and when these are situated in the interstices of mus-
cles.   If the artery is in the substance of a muscle, the  tenaculum
would take in more of the surrounding parts than  a needle would
do, and the ligature will be less secure.   I think the ligature should
be larger than it  generally is made : the  proper  tightness is not
easily ascertained ; but it  should be drawn more tight in proportion
to the bulk of the parts inclosed.  The degree of force used  in this
case would cut through the artery alone.   The  size, consistence,
and roundness of the  artery,  and quantity of  surrounding flesh,
must direct us in the force which is necessary to make the ligature.
The thicker the ligatures,  the  greater surface they compress.  In
small  arteries  the ligature need not be tight, slight  compression
answering the purpose.
   Of secondary Hemorrhage after Operations.—This happens more
particularly to the  large vessels, and generally occurs  a few days
after the operation, owing  to some circumstance or accident there-
in : the ligature not  having been  made tight enough, or else too
tight;  or from  much  surrounding parts being included, and some
of these ulcerating, the ligature gives way.   If there is not  a loose
tourniquet about the limb,  the patient may soon bleed  to death, or
the bleeding lays  the  foundation of future disease,  as lingering

  * [It can scarcely, I imagine, be necessary to warn the reader against so
slovenly a practice, which may  be attended with the most painful and dangerous
consequences.  In every case it is desirable to secure the extremity of the vessel
as distinct  from the surrounding parts as possible, which will not only lessen
the irritation, but be  the best security against the occurrence of secondary
hemorrhages.
  The ligature should be of as small a size as possible consistent with strength,
and be drawn with sufficient strength to cut through the internal tunics, which
will then  heal as incised wounds in other situations : but  an artery which is
diseased or  inflamed becomes  brittle, and  will not bear the same strain as a
healthy vessel. 
308           HUNTER'S PRINCIPLES OF SURGERY.

weakness or dropsy.  This secondary bleeding is  very difficult  to
be stopped, especially when granulations are formed, as the  artery
at the bleeding part cannot be  seen.  However, an anatomical
surgeon will not be at a loss to know the situation  of the vessels;
but admitting  this, even then, the taking up  an artery far above
the surface of the wound will be a considerable operation.   It will
be right however, especially if the extremity of the artery be  sup-
posed to be diseased, to lay it  bare above  the diseased part, and
then take  it up where it is sound.
  A. B. came  into St. George's with a white swelling, for which it
was thought necessary to remove the limb.  Instead of granulations
ulceration came on: the artery bled at times; but before any one
could come  to his assistance it would stop : at length, however, the
bleeding was so great that he was considerably weakened, and soon
died.   Upon examining the limb the artery appeared sound,  till we
got within an inch of the stump, when it appeared black, and seemed
to have lost its elasticity: the circumstance of the bleeding stopping
and returning  again, I am inclined to attribute  to the patient's being
low and faint at the time he was losing the blood, but returning again
on the recovery of his strength.   In these cases a diseased  artery
should be  suspected ; and I think it would be best to dissect for the
vessels, and see whether it be so or not, and if found diseased, to take
it up in a sound part.  It is recommended by some surgeons to make
a strong compression on the stump, which may be done by  means
of a thick pad, covered over with tin, and applied  to a screw tour-
niquet, to  prevent bleeding; but  I would  observe that the long
pressure of the tourniquet is painful and inconvenient.   Exposing
the  stump to cold air will at times stop the bleeding.   These second-
ary bleedings as far  as my observation goes, happen oftener to the
radial and ulnar arteries than any other.  The artery not healing
by the first intention may be attributed  to  various circumstances,
as ossification, extreme weakness, or the neighbourhood of a con-
siderable branch.
                         Of Aneurisms.

  The injuries and diseases of arteries, called aneurisms by authors,
are so various as to render it impossible to give a definition of them.
They have been divided into  true, and false or spurious aneurisms.
The true, by Le Dran, are divided into  three kinds, and  Heister
multiplies the division greatly.  Le Dran's first is a regular dilata-
tion of the coats of an artery;  2d, where one coat has given way,
and the other coat, unable to sustain  the  force of the circulation,
allows itself to  be dilated; the third is a  mixture  of  these two.
The false are numerously divided by Heister and others: one is a
true aneurism burst;  another is a wround in an artery,  which will
produce  various effects according to the  treatment, all of which 
OF HEMORRHAGES AND ANEURISM.
309
are called  so  many aneurisms; but I do not consider a wound in
an artery an aneurism, even if an aneurism itself.  Heister gives
us the size of aneurisms as described by authors, which  is only
showing us the  ignorance of those  authors in  allowing them to
come to such a size before the operation was  performed; but I
wish never to  see one that can be made the subject of an operation
larger than a walnut before  it is operated on.   I have already
shown that a wound into an  artery is not an aneurism ; so that I
conceive there is only one disease which is properly to be called
an  aneurism,  viz.,  the  first,  or  true :  nor is this  divisible  into
different kinds ;  the second kind is only ideal; and the third is the
consequence of one part of the sac giving way sooner than another.
   By an aneurism, then, I understand the dilatation of the coats of
an artery,  arising probably either from disease or accident,  pro-
ducing weakness, which becomes the remote cause, while the force
of the circulation  is the immediate cause.  It probably may also
arise, however, from a disproportion in the blood's motion, and  then
the disproportion between the force of the circulation and strength
of the artery is both the remote and the immediate cause ;  but this
is probably only in the larger arteries, where the force is greatest.
However, whatever may have been either the remote or immediate
cause, it must in fact in all  cases arise  from a disproportion be-
tween the force of the blood and the  strength of the artery, the
coats  being weakened  so as not to be able to support the force of
the blood in its passage along its canal, which therefore gives way.
This weakness of the coats of the artery would appear,  in  most
cases, to depend on disease; for  accidents, cateris paribus,  have
generally the powers of recovery.  As a proof of this, I will relate
an experiment made to ascertain the truth of the existence of the
mixed kind, which was supposed to arise from a partial destruction
 of the coats of an artery, and that  the remaining coat being too
 weak to sustain  the force of the  circulation, gave way,  and dis-
 tended.  That the artery might have the full force of the blood's
 motion, I chose the carotid artery, as being near the  heart.
   One of  the carotid arteries of a dog, for an inch in length, was
 laid bare,  and its coats removed, layer after layer, until the blood
 was seen through the remaining transparent coat, and I had gone
 as far as  I dared; I then left the  artery alone  for  three weeks,
 when I killed the dog, expecting to find a dilatation of the artery, as
 had been asserted ; but to my surprise the sides of the wound had
 closed on the artery, and the whole was consolidated to and over
 it, forming a strong bond of union, so that the whole was  stronger
 than ever.
    Mr. Cruickshank has, I think, produced an experiment  in  oppo-
 sition to mine, where, after the artery was denuded and  thinned,
 the parts surrounding it were kept from uniting with it, and  an
 aneurism formed : but this experiment does not  apply here ;  for in
 yvhat instance could such an alteration be made in the artery, and
 the surrounding parts not unite to it ?  So  that the blood's motion 
310           HUNTER'S PRINCIPLES OF SURGERY.

was insufficient to produce the proposed effect.  The force of the
heart, however, has some power in  operating  as a remote or first
cause of aneurisms.  Aneurisms are most  frequent in the larger
arteries, as at the arch of the aorta ;  and more frequent in the
second  order of arteries than in the third ; but  they are sometimes
found even in the  fourth or fifth.  I  have seen an aneurism of the
arteria  pudica where  it was passing  out of the pelvis,  and in which
we must suppose a previous disease of the artery, as the force of
the heart is small.  The nature of the artery contributes likewise,
the structure of the  large arteries being chiefly of elastic matter,
and not near so muscular as the small ones, which have therefore
greater powers of resistance.  It would appear that there must be
a specific disease of  the  artery in most cases, for dilatation is too
local for so general a cause as the force of the heart.
   As aneurisms have hitherto been allowed to go on  till they have
either destroyed the use of the part, or killed, little has been known
with regard to their  nature or manner of appearance at first.  In-
stances discovered in dissection have given us the only insight into
their original appearance.  In several which I have seen there was
a pretty regular dilatation of the coats  of the artery;  but in many
there was  great reason to believe it  began at one side.  If we were
to form our ideas of the first formation from the appearance of those
of long standing, we  should suppose  the dilatation always began on
 one side;  for when  we open an aneurism that is very  large, and
examine the internal  surface, we find that  the coats  of the artery
 are commonly still remaining on one side of the sac and not on the
other;  but I suspect  that the appearance arises from  the  dilatation
going on faster on one side than on the other  after the artery  has
been considerably distended, which  may arise from the vessel being
not equally diseased all round, or being more exposed to the force
of the  heart on one  side than another, or  less supported by sur-
rounding parts.
   From the knowledge of the greatest force of the heart in the dif-
ferent arteries, and from the knowledge of those arteries which are
not equally supported on every side, let us  see if we could not, d,
priori,  say where the  swell would be, if such and such arteries were
diseased on every side  equally, and became considerably dilated.
First, in those arising  from the force  of the  blood's motion;  for
instance, when an aneurism takes place at the curve of the aorta the
dilatation is upwards, because  it is there that the blood pushes with
most force, passing in a straight line when in the ascending aorta at
the fore part, and when in the beginning of the descending at the
back part. When in the carotids, the  swell is outwards and forwards,
because there is less resistance; in the subclavian, forwards ; in the
axilla,  downwards;  in the  abdomen and thigh, forwards; in  the
ham, backwards; but in the leg, on which the pressure on the artery
is equal on all sides, it is difficult to say on what side the swell would
be, and hence it is that the bones of the leg are so often diseased
when aneurism happen there, caries  or ulceration ensuing when the 
OF HEMORRHAGES AND ANEURISM.
311
dilatation increases to a considerable size.  Even in the last-men-
tioned situation the force  of the heart directs, in  some degree, the
swell of the tumour;  but that is  not until the sac is  a good  deal
enlarged.  The force of the blood against the most distant part of
the sac endeavours to carry it on further in  the direction  of the
motion of the blood, which in time makes a pouch; therefore  it is
elongated in the direction of the sound artery.  The  sac often, by
its increase, presses  on the sound part of the artery,  and becomes
the cause of its obliteration, as I have seen more than  once. Hence
the blood becomes irregular in its motion, and has time to coagulate,
till the sac becomes filled  with coagulum, which  is strongest and
densest on its external surface.  The coagulation takes place at the
most distant parts from the direct current of the blood; the firmness
and colour of the laminae in different parts of the  tumour are  such
that it is easy to distinguish an old coagulum  from a new one ; the
external laminae are of a dusty brown  colour, and  these laminae
grow gradually redder as we advance inwards towards the current
of the blood.  As the  dilatation increases, the coats of the  artery
are either thickened by the thickening process, or the cellular mem-
brane already thickened  becomes firm, and  adheres  from a  con-
sciousness of weakness.   When the aneurism proceeds to this  state
it generally gives way to the circulation.
  It must be observed that the force of the blood on the sides of
the sac diminishes in an inverse ratio to  the  increase of its sides,*
which therefore are longer in dilating than might be imagined; but
after proceeding to a certain length the adventitious coat, gives way,
and the blood  is effused  into the surrounding cellular membrane,
producing distention; and when the artery is a considerable one,
there is an obstruction to the blood's motion in the collateral branches,
producing mortification.   When  the artery opens externally, it is
always on that side where the artery gives way most.  The ultimate
effect of such events  will  vary somewhat, according to the situation
of the aneurism ; thus, if it be of the carotid artery the effusion on
its bursting will soon occasion suffocation, &c.  When an aneurism
is in an artery whose dilatation brings it  to  the skin,  the coagulum
comes  first, and  obstructs  the  circulation in the skin: the skin
inflames  and  mortifies, forming  a black slough,  which dries and
adheres to the coagulum.  As  the slough  separates, there is an
oozing of blood at the edges, which becomes more and more,  till at
last in a large artery, as the aorta, the plug may be  wholly pushed
off, and  the patient die  instantly.   If in a smaller artery death
will be more gradual.

  *  [The author does  not seem to have been acquainted with the hydrostatical
law'^of equal pressure contained in the following  words; viz., that when a quan-
tity of fluid contained in a vessel is submitted to compression,  the whole mass
of the fluid and the whole surface of the vessel, however large, is similarly and
equally affected : consequently the enlargement  of the  sac can make no diffe-
rence as to the quantity of pressure which any given portion of that sac  has to
sustain.  See Arnott's Physics, Vol. I., p. 242, 4th edit.] 
312
HUNTER'S PRINCIPLES OF SURGERY.
   Of the Method of Treatment, with the Opinions of Messrs. Brom-
field and Pott.—This disease, if not attended to, is as dangerous as
 any that  can affect the human body, because  it is such as must
 always,  even in the  smallest arteries, kill; for  as it arises from
 disease, the artery has neither the disposition nor power to relieve
 itself.  Death must therefore  be the consequence, either from  the
 bleeding,  or the consequences arising in the parts into which  the
 blood is effused.  Nor does it appear that the artery, either above
 or  below the swelling, where it is sound, takes the  alarm, or is
 stimulated to action;  so that  there  is no resource, and death is  the
 consequence.  However, this disease is often capable of removal.
 When increased to a large size it is a very difficult operation;  but
 I should wish it to be performed when the tumour is small.  Messrs.
 Bromfield  and Pott having  written  on  this operation,  and  their
 opinions  being different  from mine,  it is necessary  that I should
 defend those opinions which I  have adopted,  and which I have
 spread abroad.
   Mr. Bromfield objects to every operation, either amputation, or
 for the aneurism ; this would be  just if what he  asserts was true,
 viz., that the whole of the arterial system is in general diseased, which
 however is certainly  not the case.   He says, too, " that the inject-
 ing of parts in dead bodies having shown that in particular subjects
 the branches sent off have now and then formed anastomoses with
 other branches given  off lower down, has led to  very extravagant
 notions of  the smaller branches being always able to  carry on the
 circulation; and an extravagant proposition has been suggested by
 some people to tie up the principal  trunk of an artery in the extre-
 mities.  I  once saw an attempt of this  kind in a true aneurism of
 the ham, in which 1 shall only remark that the patient died; and I
 do believe  that the embarrassments which occurred, as well as  the
 event of the operation, will  deter  the gentleman" (meaning me)
 " who performed it from making a second attempt in a similar case."
 Now, unfortunately either for Mr. Bromfield or  myself, this is  the
 very case from which I have formed favourable  ideas of the suc-
 cess of future operations of a similar nature.  Mr. Pott, after  de-
 scribing the disease in its last and most violent stage, just preceding
 dissolution, and when it has done all the mischief it can do without
 destroying the life of the patient, says, " If a man was to be asked
 how the disease  was to be treated, he would answer, from theory,
 that the artery should be tied above and below the tumour, and the
 coagulated blood be evacuated;  but  that  the artery is  generally
 diseased  some way above the dilatation,  especially the popliteal."
 He also observes, " that the want of collateral branches of sufficient
 size to carry on  the circulation is another powerful impediment to
 the operation."
  When the aneurism has  arrived at the stage which Mr. Pott
 describes, perhaps the only thing is to amputate  above the dilated
 part of the artery: but Mr. Pott should have considered, that before
these threatening symptoms there is a stage when all the surround- 
OF HEMORRHAGES AND ANEURISM.
313
ing parts are sound. If this be true, would any man allow a disease
in a part to go on till  the surrounding parts are diseased and past
cure ?
   The events of all diseases  are of two kinds : first, where the ter-
mination is certain; 2d, where it is dubious.   The aneurism is of
the first kind ; its event is certain.  Now I do aver, then, that there
is a stage of the disease in which the operation is safe.   I do  not,
certainly, know how to judge of this state from the external appear-
ance, but from what I have seen of aneurisms, I believe it will allow
of considerable  latitude.  My opinion is, that the operation should
be performed, 1st, when the  disease has done no mischief  to the
surrounding parts; 2d, where  it  is distinct and circumscribed, not
connected with  parts which may not be curable  when exposed, as
bones;  3dly, when there is  a distinct  pulsation.   How early the
operation may be performed I do not certainly know, but my opi-
nion is that it may  be done as soon as the aneurism is known to
exist.   By some  it has been recommended to permit the disease to
exist some  time first, because,  say they, as the circulation becomes
obstructed, a freer  communication  will take place  between the
branches above and below; but this would not be until the obstruction
had  subsisted some time, and  I would not wait for this, for fear of
the consequences described by Mr. Pott.
   When the disease is in an advanced stage, I agree with Mr. Pott
in thinking amputation necessary and preferable, but not  under the
circumstances above mentioned.   The earlier, therefore, the opera-
tion for the aneurism is performed the better, not waiting with the
expectation that an increased size of the aneurism will produce an
increased size of the collateral branches.  That the popliteal artery,
according  to Mr. Pott, is oftener diseased above  the aneurism than
other arteries, I cannot well determine, but can see no reason why
it should be so.   If the artery, however, cannot be  tied above the
aneurism in the  operation, where can it be tied if the limb be ampu-
tated ?   Why not tie it  up higher in the sound parts, where it is tied
in amputation, and preserve the limb ?
   The circumstances to be regarded chiefly turn upon the collateral
branches being  sufficient to  carry on the circulation.   The  only
arteries which admit of this question are the popliteal, femoral, and
brachial; the other arteries either having a very free anastomosis,
or being out of the way of any operation.
   In this account it may be supposed  that I  carry  my notions too
far ; but it  is to be understood that I only give my own feelings upon
this subject, and I go no further in theory than I would perform  in
practice, if patients, being acquainted with the consequences of the
disease, would submit to, or rather desire, the operation; nor do I
go further than I now think  I would have performed on myself were
I in the same situation.  Not that I would have  it supposed that  I
would  recommend this at large :  I would have no one perform an
operation that he is  not clear  about the propriety of himself, espe-
                              27 
314           HUNTER'S PRINCIPLES OF SURGERY.

cially when it requires more anatomical skill than falls to the share
of most practitioners.
  Of those Arteries which admit the  Operation.—These are, first,
the carotids above the  sternum; 2d, any of  the branches of  the
external carotids; 3d, the subclavian  (after  having  passed  the
scaleni muscles), and of course its  trunk and branches down  the
arm ; 4th, the crural, immediately after having passed  Poupart's
ligament, and given  off the  large  muscular  artery.   How far it
would  admit of an operation above the giving off of that artery I
do not know, but I have seen one instance of that branch and  the
vessel  itself being obliterated  by an aneurism, and yet the limb was
supplied with blood.
  Some of the branches  of some of these  arteries which I  have
mentioned  will  be  very  difficult  of access: therefore, if not in
parts that will admit of amputation, the patient will be likely to  die.
It will be very difficult to take up the anterior and posterior tibial
and interosseous arteries,  and it will be often necessary to ampu-
tate, from the difficulty attending taking them up, besides that  the
bone will often be diseased before we discover the disease, and  this
will make amputation necessary.
  If an aneurism should take place in the axilla, I should  doubt of
the propriety of taking up the artery above the  clavicle, because I
should doubt of its  being sound.   The same  with the femoral
artery, where it passes from  under Poupart's ligament; unless  the
aneurism was lower down, and I might expect  to find  the artery
sound.
  In dissecting  tumours from the neck I have frequently laid bare
the carotid  artery;  now,  if by any accident during the operation
the artery had been wounded, I should certainly have taken it  up
with a ligature ;  or if the tumour  had  been  so  engaged with  the
artery that  I could not disengage it, I should have tied it above  and
below the tumour, with  every hope of success.
  The operation will be easiest, both to surgeon and patient, while
the disease  is in its infancy.  Although I would perform the opera-
tion on all the arteries I have mentioned, and if I  laboured under
them myself would have them performed on me, yet I would wish
every  person to judge for himself, and not attempt an operation if
he is fearful.
   General  Observations  on  the Operation*—In  performing  this

  * [It will be observed that the operation Hunter here describes is not the one
which goes by his name, but that which was usually practised previously to the
general adoption of the Hunterian operation.  The first case in  which Mr. H.
operated according to the latter method occurred in December, 1785, rather more
than a twelvemonth before the delivery of this lecture ; and he  did not as yet
feel sufficiently sure of its superiority to the generally received method to recom-
mend it strongly to his pupils for their adoption.
  I gladly avail myself of this opportunity of referring to Mr. Guthrie's able and
elaborate exposition of this department of surgery, in his  work " On the Diseases
and Injuries of Arteries,'''' in  which the extent and accuracy of Mr. Hunter's la-
bours are set  forth with great judgment.  The Hunterian operation for aneurism 
OF HEMORRHAGES AND ANEURISM.            315
operation the first attention should be paid to preventing the flowing
of blood during its performance, which alone leads to two methods
of performing it:  1st, where the tourniquet  can be  applied;  2dly,
where it cannot.
   Where the tourniquet can be applied, this should  be first done.
In the next place make a longitudinal incision in the  course of  the
tumour, of greater extent than the tumour ;  cut gradually into this,
scoop out the coagulated blood, and sponge  the  inside of the sac ;
we should then slit up  the  sac, to discover the  openings of  the
arteries into it.  The inferior orifice will be most readily discovered,
as it will throw out some little blood of a venous appearance.   To
discover the superior orifice the tourniquet must be slackened ;  the
artery then should be tied, at  least  an inch from the  sac, at  the
superior part; but it is not necessary to observe this  rule with  the
inferior part.
   When a  tourniquet cannot be  applied between the  heart and
aneurism, as  in the carotids, an incision  is to be made through  the
integuments ; the sac is to be laid bare, but not opened  ; the artery is
to be searched for, and tied  above  and  below on  the sound  part.
The sac is then to be opened, and the coagulum scooped  out;  and
after being cleansed and spunged, the sac may be left to slough,
and the wound  dressed as other fresh wounds.
   The blood  which comes from the lower orifice has become dark
by stagnation, or slow motion: hence also the dark colour of blood
when an artery is wounded below, while the tourniquet is applied,
the blood  not being  venous, as some  have thought, but arterial,
which has taken a retrograde course.   I believe we should not be
anxious about the collateral branches;  I have  lost several advan-
tages from this  mistaken delicacy.  I believe  the circulation will
always go on after the femoral artery is secured by ligature.
   Cases of Aneurisms.—1st, a young man had for two years a pain
in the calf of his leg, similar  to  cramp; at length he received a
blow  in the  ham,  and a swelling,  with pulsation, appeared  soon
after.  I gave it as my opinion that the operation should be per-
formed, and if it did not succeed, then to amputate.  The  operation
was performed, and the patient apparently was going on well, till
the fifth day, when the ligature  giving way,  the artery burst above,
either from its being tied too tight or too loose.   I was now obliged

was not the result of fortuitous discovery, but of accurate and minute knowledge,
derived from a laborious investigation of the morbid anatomy of the arteries,  and
of just reasoning upon the data which he thence derived.  The preparations  and
drawings relating to this subject contained in the museum of the Royal College
of Surgeons, convincingly show that Mr. Hunter anticipated the greater number
of modern discoveries, at the same time that they evince  the indefatigable zeal
with which he pursued his researches on professional subjects.  By referring to
the valuable work above mentioned, I shall save myself and the reader a great
deal of trouble in these notes ; and I am very happy in having  the opportunity
of expressing my acknowledgments to the worthy author.  I also beg leave to
refer the reader to Sir Everard Home's paper on the same subject, and to the
remarks in "the Life."] 
316
HUNTER'S PRINCIPLES OF SURGERY.
to dilate the wound still higher, and take up the artery higher up;
but, apparently from the loss of blood before the tourniquet could
be applied, the patient died a day or two after.   The leg and thigh
were both found to be putrid and emphysematous, and that was the
case even above the aneurism.  When  I saw this man dying from
the loss of blood, it struck me  as a proper case for transfusion, and
if I had been in his situation I would  have had the blood of a sheep
or hog transfused into  my vessels.  I do not know exactly how to
account for the failure of this operation,  whether from the unsound-
ness of the vessel, or the tightness or the smallness of the ligature;
but from the appearance  of the limb before the bursting of the
artery,  and the injection of  the  vessels  after  death, all seemed
favourable for  the  operation.   The  artery also was  sound  above
the part where the first ligature was  applied.   From these  consi-
derations, I should certainly be encouraged to perform the operation
again, though this was the case which  led Mr.  Bromfield to con-
demn the operation.  The second was a case of femoral aneurism
in the middle of the thigh, in which  the operation was  performed
by Mr. Bromfield, jun., in presence of Mr. B., sen., after his publi-
cation.   The tumour was oblong, and  extended five or six inches
in length, and the  operation was  performed in a  short time, and
with success.   In the third, where the operation was performed by
Mr. Martin for the popliteal  aneurism,  the patient soon got well,
and was able to dance.   The fourth was an aneurism in the gluteus
muscle.  In cases where the arteries in  several parts  had  the dis-
position to this disease, or, in other words, where many aneurisms
were formed, the operation would not be advisable.
  In December 1785, I performed the  operation at  St. George's
Hospital, in a case of popliteal  aneurism, in a manner different
from that ordinarily practised, and with success.  The particulars
of this case are given in the  London Medical Journal.   I would
only observe, that in future I would  advise only tying the artery
in one part, and not  to endeavour to unite the wound by the first
intention.   In that case four ligatures were applied upon the artery. 
OF SPECIFIC DISEASES, ETC.
317
                          CHAPTER XX.

           OF  specific diseases, tumours, hydatids, ETC.

 Of Ulcers and the causes which retard their cure.—Abscesses___Specific dis-
   eases.—Irritable and  indolent  dispositions.—Hypertrophy of  parts from
   chronic inflammation.—Varicose veins.—Corns,—Chilblains.—Of the unnatu-
   ral growth  of parts.—Preternatural accumulations of fat.—Elephantiasis.—
   Observations on the cure of indolent  dispositions.—Tumours.—Encysted tu-
   mours.—Tubercles.—Solid tumours.—Warts.—Polypi.—Tumours in the cel-
   lular membrane.—The removal of  tumours.—Tumours  of bones ;—their
   varieties.—Encysted  tumours.—Hydatids.—Cuticular tumours.—Of the in-
   flammation  of adventitious  substances.—Fistulas.—Fistula  lachrymalis.__
   Fistulae of the buccal glands.—Fistula? of Cowper's glands.—Fistula of the
   parotid gland.—Fistula in ano—Fistula in perineo.—Cure of Fistulae.—Of
   the treatment of contracted joints___Of tetanus.

 I come now to speak of what  I  call specific  diseases, but before
 doing so I shall notice the  causes which retard the cure of ulcers
 in sound parts.
   These often arise from circumstances not at all connected with
 the  soundness  of  the parts,  as their situation, depth,  nearness to
 tendons, or vicinity with respect to the heart.  The situation  may
 make it tedious, though the parts are otherwise strongly disposed
 to heal, which is often the case in deep-seated abscesses; 'the nature
 of the parts may retard the cure,  as when abscesses are situated in
 parts endued with slow or weak living powers, as bones, ligaments,
 or tendons.   In such cases  the  matter goes  a considerable way
 before it reaches the  skin, while  the superficial parts  are more
 disposed to  heal than the originally diseased deep-seated parts, so
 that abscesses  soon become fistulous.
   The cure  depends  on removing the  obstacle of depth by free
 opening, exposing, as much as the nature of the part will admit of,
 the bottom of  the wound,  and preventing the healing up  of the
 superficial parts;  but this  must  not be done unless  or until  the
 deep-seated  parts  are as much disposed to heal as the superficial,
 so far  as respects  their natural power, as in  cases of exfoliation.
 Many are slower in healing from the nature of the parts themselves,
 as bones; but the  treatment  in such  indolent-  dispositions is very
 different from that of acquired indolence; for in these there is a
 disposition to  act, whilst in  indolence,  which is natural, this is
 wanting.   Hence it is dangerous to rouse these  parts much, and
 accordingly we find that the mildest treatment is generally the best,
often employing sedatives to lessen the consciousness of danger, as
opium,  which has  often the best  effect on parts naturally slow or
 indolent in disposition, as tendons.
   Many sores  which go on well  at  first take on afterwards a
                               27* 
318           HUNTER'S PRINCIPLES OF SURGERY.

quality contrary to health.  All kinds of sores are subject to this
change ; but in specific and poisonous ones, the poison must first be
destroyed before a good disposition can take place.  The causes
of this change of disposition are many, but few of them are visible.
The most visible is their situation in the body, as in the legs, which
are far removed from the heart, and where the healing is prevented
by much walking.  The  slowness often arises from exercise and
intemperance, which  are  first to  be  attended  to in the  cure.  A
horizontal  posture, with  temperance, should be  the first thing
advised in sore legs in general, as removing the accidental impedi-
ments to healing.
   When sores do not heal, after having removed the above causes,
some other cause must be  remaining, as either an indolent or irri-
table disposition, or some specific quality, which is frequently to
be discovered by experiment.  If irritable, sedatives are to be used;
if indolent stimulants ; but if it is not known which of the two exists,
first try one, and then the other; if neither of these is effectual, a
variety must be tried till you find that which agrees best.  Some-
times one of these does  good for  some time  and  then  loses its
efficacy, the sores becoming stationary, when we must change the
application.  When  sores are indolent in  healing, there is a sur-
rounding  thickening, but this is  seldom  the  case  when healthy
granulations arise;  in such compression is proper;  and if walking
cannot be avoided,  then light  bandages,  and  sometimes a  thin
plate of lead, which is also often useful when the granulations are
loose and there is a disposition to thickening.  But these sores are
very apt to return, which points out some particular remote cause,
which I will presently  describe.  The sores  of poor people are
often in a bad condition from bad living, much exercise, or cold, and
are  often mended by rest, a  horizontal position, fresh provisions,
and warmth in hospitals, and the change is  generally very speedy.
If they do not soon improve I always suspect that something  more
is  operating, as irritability or indolence, when I try experimentally
different remedies till I pitch on one that is  serviceable.
   The surface of the sore will  easily discover if there is disease
beneath, as of  the bones  or  periosteum.  If the  granulations are
broader than the disease  underneath, the  granulations  over the
diseased part are unhealthy, whilst those not so are healthy, and
heal so that the sore  becomes smaller and smaller by the gradual
contraction of the granulations.
   Sores  are often forced, as it were, to cicatrize, but the cuticle is
not good, and the part removes it, and removes it again and again,
till sometimes at last it becomes a good one ;  at other  times the
cuticle becomes  very thick, and  irritating the cutis  underneath,
which is very tender, it is  then thrown off like a scab, and leaves
the  skin underneath  ulcerated.  These cases must  be treated as
they were before they were cicatrized ; that is, they must be kept
moist, and  any cuticle  which is unnecessary and thick must be
scraped off.  The medicines that  first healed the sore,  combined 
OF SPECIFIC DISEASES, ETC.
319
 with water, should be applied to the sore ; as, when tar agrees, tar-
 water should be applied.
   Abscesses.—In all abscesses we should consider, in the first place,
 whether their seat is on or in the  part at which they appear, for
 often they are abscesses of parts that are distant from that in which
 they appear.  Thus, the  external appearance of lumbar abscess is
 in the thigh, the loins, or between the ilium and sacrum.   Abscesses
 of the liver also make their appearance externally; likewise spurious
 empyema and abscesses of the  kidneys, which last often resemble
 lumbar abscesses, although their seat  has been ascertained by the
 extraction of a urinary calculus.  All these generally pass through
 and between some bands, as tendons, ligaments, or bones, and their
 first passage is  small; but the abscess, getting into  the  cellular
 membrane, spreads,  and  gives the appearance of a large  abscess of
 that part.  None of  these, however, penetrate so far as the lumbar
 abscess, owing to the position of the  body, and the disposition of
 the  inflammation having  no tendency to set bounds to the spread
 of the matter.
   Treatment.—Little can be done for these  cases ;  they should be
 opened  slightly or not at all.   In the lumbar  abscess opening is
 often productive of hectic fever, much sooner than if left to itself,
 and consequently death  takes  place  much  sooner.  But when
 internal  abscesses, whether  pointing at  a distance from the seat of
 disease  or not, are likely to  heal, as those of the liver,  they should
 be opened as freely  as possible, in order to know the extent of the
 disease.   If they  cannot be traced to the bottom, injections may be,
 used, as they are apt to become indolent.  I have used stimulating
 solutions of caustic, infusion of myrrh, lime-water, and  injections of
 decoction of bark.

                    Of  Specific  Diseases.

  I  am  now to  treat of dispositions and  actions which are not
productive of restorative  actions;  those which we have hitherto
treated of, where  a  salutary disposition  is put on, in consequence
of violence done  to a part, I do not call  disease.  This  is the most
complicated part of surgery, as it  requires a knowledge of sores
and of every local action that can be in a part: it is the physiology
of surgery, as a knowledge of the constitution is of medicine.  The
diseased sores alluded to will admit of being divided into local and
local constitutional; but none  are entirely constitutional.  The
first includes many  diseases, as cancer, chancre,  mortifications,
and  many others, which  have simply some  specific quality.  The
second, all the poisons and  some mortifications.  All  uncommon
actions, commonly called  diseases, are  divided into common  and
specific.   The common I have treated of.  The irritable and indo-
lent  may be thought  improper to be placed among the following,
which  are the specific,  because either of  them may attend all
specific  diseases; but almost all uncommon actions are in some 
320
HUNTER'S PRINCIPLES OF SURGERY.
 measure specific, all arising from a specific tendency, or suscepti-
 bility, brought into action by some leading cause, and therefore not
 taking on the restorative process as they ought to do.
   Every specific  disease must  have some peculiar action distinct
 from another.  A true  specific  disease  is that which has only one
 peculiar action.   Some have many causes, as gout, yet have only
 one specific mode of action; others, as the morbid poisons, have
 only one specific cause.  The first is divided into two ; regular and
 irregular.   The  regular are truly specific, as agues; of the irre-
 gular  there are  many which show disturbed modes  of action, as
 inflammation  in  scrofulous  habits;  but these  always  are  very
 imperfect, from the specific action hindering  them from going on
 properly.   These are the  opposite to the salutary dispositions  for
 restoration.
   Unsound dispositions may be divided into two classes;  such as
 have too much action, and such as have too little action; or better
 perhaps, into irritable and indolent.   The remote causes are many,
 but the immediate cause may  be the same in both: few of the
 remote causes are known.   Irritable and indolent might be classed
 amongst the common diseases, and not  with the specific, as every
 specific disease may be accompanied with them, and all  specific
 diseases are generally attended with one of them ; but some specific
 diseases are  more irritable  or  indolent than others, and are also
 different in different constitutions.
   Of the Irritable Disposition.—Irritability is that disposition which
 Cannot remain at rest under an injury either in a part or the whole,
 nor can it  set  about  a  restorative  action.  This depends on  some
 peculiarity both of the nerves and living principle, for there is often
 much  sensibility as well as irritability in a part; or, on the contrary,
 it may be confined to one only.  The one wrould show that  there
 is an affinity or connexion between these two principles;  the other,
 that this is not absolutely necessary.
   Irritability  is  of various  kinds, but  generally may be called
 passive; as even in the most irritable  constitution  there must be
 some other disease or some violence  to  bring this disposition into
 action. Thus, convulsions, are induced by tickling the skin. Many
 constitutions are thrown into violent actions from injuries, produ-
 cing irritable inflammation.  But all inflammations  are not  to be
 called  irritable; those which are exactly sufficient for restoration
 cannot with propriety be called  irritable.
   Irritability is most commonly  constitutional, but not evidently so
 altogether, as one part is often irritable, while other parts are not:
 for example, a lady had a vesication on her  shoulder, which  all
throughout its action gave amazing pain; yet at the  same time she
had one in the arm which gave very little inconvenience.  And we
find disease producing irritability in parts which were not irritable
before; therefore it cannot be said to be  constitutional altogether.
  Irritable inflammation  most frequently arises  from injuries  done
to an irritable habit.  A local disease may produce irritability in a 
OF SPECIFIC DISEASES, ETC.
321
part, whilst the constitution is not irritable at all; it is then entirely
local.  But the constitution may be rendered irritable from a local
cause, as in bubo.  An irritable disposition is generally known by
a disposition to inflammation, and that inflammation not termina-
ting in any crisis.  It would appear to be a mixture of the suppu-
rative and erysipelatous, at least the erysipelatous seems to attack
irritable  constitutions most frequently; but probably the  erysipe-
latous attacks  when there is weakness, and erysipelatous  goes off
as in  other  habits.  The effusion and extravasation in irritable
inflammation is more watery, so that the swelling is rather  cedema-
tous and  more diffused; the continued  sympathy is very strong, so
that it spreads often to a very great extent, and sometimes becomes
universal.  In many of the  irritable  inflammations of the  skin,
excoriation takes place, and the water  exudes like a blister. When
it is local it  is very circumscribed, terminating  all at once; in
many cases  it cannot be distinguished  from common inflammation
terminating  soon, but  here the irritability is  slight.  These often
terminate in the indolent, as those arising  from cold.
  Of the Cure by Resolution.—To cure  irritability  is  extremely
difficult, as lessening sensibility is more difficult than exciting parts
when indolent.  Whilst the parts are only inflamed, we  should first
avoid every thing which would irritate or hasten suppuration.  A
cataplasm of bread  and milk is the most simple resolutive appli-
cation, and the best till we know how further to proceed.   But
when from any accident there  is too much irritability, something
to lessen susceptibility should be used,  as opium  in the  poultice, a
fomentation of poppy-heads, or the preparations of lead.   However,
I think preparations of lead may do harm, as they lessen the resto-
rative power as well as the irritability.
  If suppuration takes place, it should be suffered to go on to the
true suppuration.   Cutting is very disagreeable to these  irritable
parts, for the irritability still remains, and they will not heal kindly.
Caustics  are much better adapted for opening abscesses in such
constitutions, and should always be preferred, and more especially
if opium  is joined to them, as  either with or without opium they
irritate much less than cutting.  The matter is generally of a con-
sistence little more viscid than  serum.   There is often  coagulable
lymph on the sore, in which  case there is little discharge of pus,
which is  also often the case in  the indolent.
  The milder the after-dressings are the better;  none is preferable
to the opium poultice, as they are apt to ulcerate and spread, which
opium prevents better than any other dressing.  When they begin
to have a healing disposition, a mild  cerate is preferable to dry lint.
Bark internally, as lessening  irritability and giving strength to the
system, is of considerable service, together with the exhibition of
opium ; but in some we find a treatment directly opposite necessary,
the mildest  dressings giving the greatest pain,  whilst warm dres-
sings, as  oleum terebinthinae,  give agreeable ease, although at first
they give great pain in such sores.  There is some peculiarity in 
322
HUNTER'S PRINCIPLES OF SURGERY.
  the part which is removed by these stimulants; but unfortunately
  all these fail  at other times, and we  do not possess  a sufficient
  number for the variety of constitutions we meet with.
    Of Indolent Dispositions and  Actions.—Local diseases attended
  with indolence  produce generally the  following effects,  viz., an
  increase of the parts diseased, which is of three kinds:  1st, increase
  of growth of the  natural parts; 2d, a  thickening of the diseased
  parts: 3dly, an entirely new-formed substance.
    The first has no variety; the second is occasioned by adventitious
  matter extravasated and effused into the cells, which I call interstitial
  increase, which will produce two different effects: either  general
  swelling, which I  call  the  diffused  interstitial; or circumscribed
  increase, which I call the circumscribed interstitial.   But the last has
  two causes, and is of two kinds; therefore the first owes its figure
  to the  part being  circumscribed, the other is from the nature of
  the disease.   The third is always circumscribed,  which I  call the
  circumscribed adventitious.  They are often spontaneous in their
  origin.
    Indolent dispositions may be either with or without inflammation,
  and also suppuration; they  arise from  either a disposition of the
 constitution or part.  This  is more rare than the  irritable, and is
  seldom carried so far.
    Few constitutions are so  quiet as  not to call forth their powers
 when a part has received any injury.  But specific affections  may
 sometimes  prevent them, and then the common powers have no
 effect;  for in lues and scrofula thickened sores are very frequent.
    There may be indolence without any known specific cause; yet I
 suspect that there must be something specific concealed, which arises
 from peculiar constitutions in different complaints, as when tumours
 that are indolent are formed in glands.   All constitutions, however
 indolent, are susceptible of inflammation, and very few diseased
 parts are  exempt  from  it; yet sometimes indolent sores are not
 inflamed  by the  common causes of inflammation, as  exposure;
 sometimes, in the irritable, sloughs are  formed, which is a cure by
 the disease itself.   After indolent  parts are once inflamed, they are
 very apt to become indolent again, when the inflammation is removed.
 When indolence is  in a diseased  part it cannot be totally consti-
 tutional, but sometimes local, as in cancer and scrofula.   When this
 indolence takes place in a part, the cause often steals on gradually,
 so that the part is not roused by it.  Indolence is natural to tendons,
 ligaments, and bone, and when all these causes cooperate, the dis-
 ease is worse;  but  indolence may take place in other parts, from
 some visible cause,  as in muscles, and skin producing thickening.
  Many  thickenings are owing to specific causes, as the induration
 of cancer, venereal diseased  glands, sometimes affections of gout
 and rheumatism, and bone is  subject to the same disease  as in exos-
tosis.  Thickenings of parts are either from visible or invisible causes ;
the first arise from some  external inflammation; the second from 
OF SPECIFIC DISEASES, ETC.
323
some diseased action in the part.  The remote cause may be predis-
position, climate, or way of life.
  Local indolent diseases are generally confined, yet they sometimes
spread; but here the  cause must be more diffused.   They spread
but little, because indolence is but a small cause of sympathy; the
sympathy is more continued when the sympathizer is of the same
indolent disposition as the diseased part.  Indolence in local diseases
is attended with an increase of the part,  sometimes  similar to that
produced  by  adhesive  inflammation:  this  effect  attends  many
unnatural actions of parts as well as inflammation.  The parts swell
more in this disposition  than in the others ; for in this there is neither
any disposition to suppuration or resolution, and therefore there is
an increase in the thickening disposition.
  The division of  this thickening  is of three kinds, as before
observed.   The  first is most visible in the adipose membrane; the
second, as  before;  the third, adventitious,  and which  forms  a
tumour.  The immediate causes are: 1st, a preternatural  increase
of the part itself:  2dly, interstitial increase ; 3dly, the formation of
an entirely new part.   The first consists in an increase in the figure
of a part, as of a gland, a cell, any whole limb, or other  whole part;
the  second is often circumscribed in cellular membrane, appearing
to be newly formed ; but it is not so, but  interstitial, as  scirrhus in
a glandular or cellular part, which becomes loaded with cancerous
coagulable lymph formed by inflammation: the third is an original
circumscribed swelling,  arising in  common cellular  membrane,
skin, bones, &c, and which should be called true tumour.  In some
of these diseased parts another disposition or  mode  of  action, viz.
ossification, arises; whether from  a peculiar  disposition arising
from  this disposition, or to  increase  the strength of the part, I am
uncertain.   The first  is most probable, as strength  is unnecessary
where it is generally formed, viz. on the  edges, &c.  I shall lay it
down as an axiom  that  all thickened parts are to be accounted
new-formed parts, although they may be in original parts. The idea
of their  being all new  parts shows why they  should  be  disposed to
form calcareous earth.
  Thickening, which is generally the first  symptom of indolent com-
plaints, often gives little or  no  pain;  so that the sensibility is often
not  observed  till  some time after.   The thickening gives so little
pain as hardly to be communicated to the sensorium : but the heavy
dull kind of pain afterwards often becomes very disagreeable, pro-
ducing sickness, which is more peculiar to some parts  than others.
The colour is of no particular kind,  which shows a languor of the
blood in them. The hardness is sometimes so  great as to become
cartilaginous.
  The  causes of this thickening are with difficulty assigned.  In
common inflammations  there is increased action, and this is proba-
bly  the case in indolent inflammation: but this  increased action is
of a peculiar kind, which may be called indolent inflammation, which
is a peculiar  mode of  inflammation.  The immediate causes are 
324          HUNTER'S PRINCIPLES OF SURGERY.
various ; but what the final intention is in most cases is very obvious.
In  common  inflammation it is to form adhesions  and limit the
disease, but in the indolent it is to give strength.
   The visible causes of indolent disposition are various.  1st, The
thickening may depend on a diseased part being accustomed to an
irritation, till this irritation,  losing its power, leaves the part in an
indolent state and incapable of recovery.   Probably all may be first
ranked under the irritable.  2dly, From effects being produced by
a disease not indolent in itself, but violent at first, as the gout. 3dly,
From a slow alteration in structure taking place, in consequence of
gentle irritation, as gentle pressure,  which will take place in every
part.   4thly, a long application of cold,  which produces weakness.
5thly,  Peculiarities in climate: as bronchocele in Derbyshire, and
swelled  legs in Barbadoes.  These, and  especially the four first,
have no  connexion with the constitution, yet may be assisted by a
constitutional predisposition.  They are  seldom very diffusive, from
their confined sympathy.  The first of the first division are most
frequent in the lower extremities, these parts being most frequently
interrupted in their salutary actions.   The second,  arising from a
disease in itself  violent,  as the gout, are apt to be very indolent.
The third cause is mechanical and very  extensive, even universal,
and seems to be  the consequence of a  stimulus, as  if increase of
strength was wanted, as  in the tunica vaginalis, from the increased
quantity of water in hydrocele, cysts of hydatids, &c.  Veins from
this cause become  varicose, and the cuticle is often thickened by
this in working people ; but this is frequently  carried too  far, and
produces corns, or it may produce ulceration if the pressure exists
in a still greater  degree.
   Varicose Veins appear  to arise from pressure.   A long column of
blood  presses along the inside of the veins of the lower extremities,
and the veins being weak are stimulated, which  increases their thick-
ness and strength to resist  this distention; sometimes they are so
much  thickened  as to obliterate the whole cavity.  The smaller
veins are more or less affected, probably in the same manner as the
large ones are in the legs, and hence the whole leg is indolent: they
often suppurate, when it is  almost impossible to heal them.  This
disease is in general too extensive for extirpation, although when it
can be done this practice is very proper.
   Corns.—The cuticle admits of being thickened from pressure in
all parts of the body:  hence we find that on the soles of the feet of
those who walk  much the cuticle becomes very thick; also on the
hands of labouring men.  We find this wherever there is pressure,
as on the elbow, upper part of the little toe, ball of the great toe,
&c.   The immediate and first cause of this thickening would appear
to  be  the stimulus of  necessity given to the cutis by this pressure,
the effect of which is an increase of the  cuticle to defend the cutis
underneath.  Not only the cuticle thickens, but the parts underneath,
and a sacculus is often formed  at the root of the great toe, between
the cutis and ligaments of the joints, arising from the same cause, 
OF SPECIFIC DISEASES, ETC.
325
to guard the  ligaments below.  Sometimes, when the pressure is
uncommonly great, inflammation takes place in this part, especially
if there are corns, the sacculus suppurates and opens externally, and
this  forms what I believe is called a bunion.  The sacculus then
closes again, and leaves the parts much as they were before.
  The  cuticle is  not only thickened from pressure for  salutary
purposes, but it is also carried  to  disease.  A  corn is a thickened
cuticle arising from external pressure, which is preternatural and
continued.   Uncommon or preternatural  pressure  on the  surface
must always affect the cutis more or less, producing a  disposition
in it to guard itself; but pressure is capable  of producing  another
effect, which is according to the amount of pressure: when applied
in a moderate degree, it gives a disposition to the cutis to continue
the growth of the cuticle, forming layer upon layer.  By this con-
tinuation of growth the cuticle becomes thicker; but if the pressure
is too violent, then  a  diseased  increase of the  cuticle takes place,
commonly in a very small portion of the  part pressed, often in a
point.  This thickened part being pressed from without commonly
sinks its own  thickness into the cutis, which  is the  cause of  the
pain  and troublesome  symptoms.   The  cuticle being  formed in
layers peels off in  layers, and  if  inflammation attacks the cutis
underneath, this takes place : and hence  the term ' onion,' which
has been applied to these corns.
  There is often a sort of joint formed by a sacculus mucosus under
the cutis allowing of motion in the corn: if this inflames and suppu-
rates, a cure is often  effected.
  When corns are of long standing and run pretty  deep, they gen-
erally produce a degree of indolence in the healthy actions of the
parts pressed on, which makes  the cure tedious.
  The cure of corns is of three kinds, viz. natural, palliative, and
radical.   The first is by removing the  primary cause, or pressure,
which is done  by leaving  off shoes, or  by introducing a soft sub-
stance, as  plaster, between the  corn  and shoe.   Two  plasters
are necessary, one with a hole  opposite the corn, and another to be
applied over this; and these should be continued  as long as  the
cause is continued.   Leaving off the pressure is the best mode, and
then the  effects are  easily removed.   The palliative  consists in
removing as much as possible  the external surface, which relieves
the pressure.   This is  done by holding  the corn  half an hour in
warm water, when it swells, and then paring off as much  as pos-
 sible of it.  It is difficult to remove  the whole  without injuring the
 surrounding cutis, which  is often of bad consequence in old people,
 where fatal inflammation and mortification have been caused by it.
 The radical cure consists in removing the whole corn or thickened
 cutis.  The cuticle may be raised here, as it is in every other part,
 by blisters:  but its thickness  prevents this effect  taking  place so
 early.  Warm stimulating plasters will  in general be sufficient.
 The causes of corns  when carried too far often produce inflamma-
 tion and suppuration, and whichever way the suppuration is  pro-
                               28 
326
HUNTER'S PRINCIPLES OF SURGERY.
duced, it is liable, if not attended to, to  become very tedious:  for
the skin having a greater disposition to heal  than the parts under-
neath, produces a fistula ; so that such sores  should be dressed to
the bottom, and if they are indolent at the bottom should be stimu-
lated by appropriate dressings.
   Indolence  from  Cold.—Cold  is  a  powerful  obstructor of  the
natural animal powers, whilst at the same it is exciting action, pro-
ducing irritable  inflammation and death.  It  is a  true  cause of
mortification.  Indolent swellings from cold arise from two different
modes of action: 1st, when  so gradually applied as not to excite
irritable inflammation, but a gradual sluggishness ; 2d, when it pro-
duces irritable inflammation from the parts being weakened.  Cold
does not immediately obstruct the natural actions of the whole or
part, but excites the whole or part to another action, viz. the pro-
duction of heat.   The extremities, from their great  distance from
the seat of  the  living power, and from being smaller, are  most
liable to this.  Thus these parts become  first  irritable and then
inflamed; but it is an increased  disposition  to  act, with lessened
powers.  Hente the effects  of cold are greater or less, according
to the constitution.   The weakly, the fair, and  the  delicate  have
the least power of generating heat.
   Chilblains are the common effects of these causes, and from  the
foregoing effects of cold we  are  led to a rational  cure;  first, to
remove the  cause, then to  apply warmth, or  rather  to keep  the
parts temperate.  Chilblains  commonly get w7ell  in summer.  The
cure, perhaps, should be  divided  according  to the two stages of
the disease, viz. the irritable and indolent;  but  how  far the treat-
ment should correspond  in  this way I cannot  say.   The}7 have
bee» cured when they looked purple and livid by gentle stimulants,
as  oleum terebinthinae,  or  camphorated  spirits of wine.  Such
applications bring on the florid red of inflammation, which generally
terminates well,  for they seem to counteract  the stimulus or irrita-
tion of cold.   Steeping the parts in warm  vinegar has done much
good ; when they ulcerate, the  same  exciting  mode seems best.
But they are sometimes  so irritable as to  require quieting;  for
which purpose a poultice or decoction of poppyheads is equal to
anything.  When  the itching begins, rubbing the feet over with
powdered chalk will be effectual to prevent it: the rubbing is useful,
and the chalk keeps  the  feet warm by  being  a bad conductor of
heat.
   The invisible causes of indolent dispositions are also  various.
The 1st of the spontaneous is a  diseased increase of growth ;  2d,
interstitial  swelling;  3d,  new formed  substance.  This  division,
according to the mode of increase, is into three kinds, viz. increase
of natural parts, the interstitial, and the tumour.   All these are liable
to happen in every part of the body.   These increases are either
known by the sight or by the feel.
   Of the unnatural Growth of Parts.—These  often form what mav
be called a species of monstrosity of parts, either diffused or  cir-
cumscribed.  They are. generally situated in the cellular membrane, 
OF SPECIFIC DISEASES, ETC.
327
and feel doughy and soft, and are usually superficial, extending to
the skin till it hangs as if by its  own weight, sometimes having a
broad base, but often hanging by a small neck: they appear to be
in the cellular membrane what exostosis is  in  bone.  These parts
are less ductile than the natural parts.  I  have  seen  the  double
chin become one of these; I have seen them on the belly.  Perhaps
they produce absorption in the parts on which they press; for the
bones underneath have been sometimes found deficient.
   Preternatural accumulations of fat take place in the  same man-
ner ; not depending on a deposit of interstitial substance, nor being
adventitious, but a preternatural growth ; and are common to every
part of the body, not excepting  the  internal parts.  People have
died of fat on  the  pericardium, and sometimes it is found  in  the
bellies of cattle, as sheep.  In the human subject  these accumula-
tions acquire an immense size, being composed of very solid fat,
and in some degree moveable, being in separate parts, or lobulated,
when between the skin and muscles.  They may in  general be
distinguished by the former  being  of a regular uniform softness,
whilst the latter appeared to  be composed  of solid pieces  of fat,
having a surface irregular to the feel.
   The interstitial or diffused  thickening of  a part arises from  the
interstitial deposition of matter in the cells of the part, and is of three
kinds.
   Elephantiasis.—The first,  or  diffused, is very slow in  increase,
forming gradually.  A whole leg will become stiff and feel tight by
a loaded cellular membrane.  It is most frequent in the legs, and
almost peculiar to some countries and to some peculiar constitutions.
A similar increase occurs in the thyroid gland : but this is  of the
second  kind.  The diffused is very common in the legs of Barba-
does' people; I have also seen it in this country, but very rarely.
The legs of young people I have seen  so swelled  as to be  all  of a
size. It arises from an extravasation of coagulable lymph  equally
diffused ; the parts become firm and similar to dropsy, only there
is no pitting:  it may be a kind of  dropsy,  for dropsical  swellings
often degenerate into this kind of swelling; yet the cause  of the
two may be very dissimilar: it  is  most frequent in young  people.
From its being so diffused and general, and in the legs, and most
at the lower parts, I should think one of its  immediate causes was a
depending situation, with a weakened action of the system in general,
as a simple bandage to support these  parts often prevents it.  [A
preparation was shown in which a thickening of the leg put  on the
appearance of brawn.]  There is no fixed cure.   In the case I saw
I recommended mercurial ointment to  be rubbed into the parts, and
a slight bandage.   The ointment was omitted ; but the patient got
perfectly well in a few months.  If these had failed, I should have
sent him to bathe in the sea.  Pressure hinders the extravasation of
more fluid, and we see that tight boots make the legs thinner.
   The second kind is an original disease, though it may be attended
with pain and inflammation.  It is not circumscribed, though  con- 
328
HUNTER'S PRINCIPLES OF SURGERY.
 fined to a  spot, but gradually lost  in  the  surrounding parts.  It
 spreads in proportion to the power of continued sympathy.  A node
 is similar in appearance to what this is of the soft  parts, and per-
 haps is of the same kind.
   The  pain of indolent swellings is very little or none at first, which
 is owing to the slow increase of the part not arousing the sensibility;
 but  afterwards  they have a heavy dull pain, producing sickness.
 This is often from the size, as well as from the tumour itself pressing
 on some other parts;  for sometimes there is more pain in the sur-
 rounding parts than in the tumour itself.  I may also observe that
 they seldom or ever inflame, but continue increasing till they press
 on surrounding parts,  and raise inflammation in these parts and not
 in themselves; they are then often broken down into a curdly sub-
 stance, but appear not to  be dead, as they do not give the stimulus
 of extraneous matter : though the surrounding parts become thick-
 ened, yet they cannot properly be called encysted.   If it appears
 to be scrofulous, the cicuta, sea-bathing, sal  sodae, sea-water poul-
 tices, &c, are to be tried ; but  these  are sometimes useless, and
 extirpation becomes necessary ; or sometimes cutting into them is
 sufficient.  They sometimes suppurate,  and then the sores are very
 difficult to heal.
   The third kind consists in the  interstitial increase of a circum-
 scribed part.  This is it when the swelling keeps to  the original
 part, that part being circumscribed, as lymphatic glands, and  also
 tumours or enlargements of the liver or spleen.   They seldom affect
 the cellular membrane till  they  suppurate, and often not  then  at
 first, which shows  they have something specific in them; for if
 merely  indolent  the surrounding parts would  sympathize with them,
 as is often the case in  the mixed cases.   Although  these diseases
 are interstitial increases, yet they often become similar to a tumour,
 and  are understood as such.
  Observations on the  Cure of Indolent Dispositions  in Diseases.—
 We  must  first  inquire whether they are  wholly  constitutional,
 partially so, or merely local, as upon this rests our treatment.  We
 must not be satisfied with the  present  symptoms, but  inquire into
 the constitution,  whether it is indolent or irritable.   Such as  arise
 from  the constitution  are generally more diffused, and  are  often
 in many parts: and such constitutions as produce local complaints
 show something  wrong in them; however, the  symptoms are not
 always  satisfactory.   I suspect these indolent  dispositions of the
 constitution require  a specific  stimulus, having  something specific
in their  nature.  They do not  spontaneously take on steps of cure,
as inflammation  does;  and if they suppurate, they do not suppurate
kindly;  and a variety of  things are required to  assist them.   The
first thing to be done is to remove the cause, if practicable, which
it often is  not,  as changing  the country and  situation.  In all,
resolution should be preferred if possible,  by absorption; for suppu-
 ration will  do much  harm.  To procure  suppuration in such, a
particular mode is  required, for we are not to lessen the living 
OF SPECIFIC DISEASES, ETC.
329
powers, as in adhesive inflammation that is healthy, but to increase
them.  The earlier the treatment is pursued the better, before the
habit has suffered, or the surrounding parts have  sympathized:
sometimes  a constant  application of mercury  to  the part, which
produces a  kind of irritation short of inflammation, is advanta-
geous ;  if this is insufficient, fumigations with cinnabar, or  with
plants which have essential oil in them, may  prove  serviceable.   If
these fail, we must remove the indolent disposition by exciting an
action which they are incapable of taking on themselves.  Salutary
inflammation in surrounding parts will produce other good effects
in indolent  diseases, for indolence arises from a want of predispo-
sition to healthy action;  thus, blistering the  parts, and giving
cordials  internally, are often of use; but  the more violent the
inflammation, the more effectually  is the  indolence of the part
removed, if it can  bear it.   Many indolent swellings are  content
with their own natural actions, as natural parts are  with theirs: but
this is not so always; but they take on an inflammatory action, not
salutary, but leading to a bad kind of suppuration.   The means  of
restoring the thickened parts is healthy inflammation, which as it
goes off, does not leave them in their former  state, but occasions an
absorption of the extravasated matter; nevertheless the  part, after
healing, often retains somewhat  of  the original disposition.  This
treatment will not do either in cancer or scrofula.
   Of the Suppuration of Indolent Parts.—Resolution cannot  always
be effected, and suppuration will take place, which suppuration seems
to arise from defective animal powers, and not from exerted powers.
The matter is glairy, and the superficial parts are so  little susceptible
of this that the matter is long in coming to the skin;  so that stimu-
lating medicines must be applied to bring on,  if possible, good suppu-
ration, which can seldom, however, be done. Quick ulceration is best
effected by exciting and hastening the inflammation; this is neces-
sary in sound abscesses even, but much more necessary in indolent
ones.  The next thing  is opening them, which should not be done
too early, as the matter which remains in may increase the inflam-
mation, which is necessary to the cure.  When an  opening  is made
it should be as large  as possible;  and even crucial incisions are
frequently necessary;  in  many cases  scarifying the sides of the
abscess is proper, to excite quick inflammation, and if there are any
sinuses  these should be traced  to  their full extent:  the  parts then
feel a greater necessity of action.   But this  is not always sufficient,
for  after good  granulations are formed, the indolent  state  often
returns, the granulations becoming  dark-coloured, and  the matter
thin and glairy, according to the specific nature of  the indolence;
this  is the case often in old sores which have become habitual from
bad  treatment.  In old  indolent parts and encysted tumours the sac
is often thickened, and even ossified, and the inflammation then is
sometimes so violent as to threaten  mortification.  But  these parts
often become insensible to the common causes of inflammation, and
when inflammation does arise it is sluggish.  In such, nothing can
                             28* 
330
HUNTER'S PRINCIPLES OF SURGERY.
cure but dissecting out  the  parts.  Many abscesses, if out of the
reach of surgery, or  ill-treated, run into an indolent state.  Many
means are necessary in  treating them, but we know of few useful
ones: balsams and warm dressings are commonly used; sometimes
they do good, at  other  times they have no effect;  and when they
agree they lose  their powers by continuance,  when it  becomes
necessary to change them, or increase their power.   These balsams
should often be  mixed  with red precipitate.  Tincture of myrrh
also is often very useful in  indolent sores, requiring to be applied
often, as it soon  loses  its efficacy; solutions of alum, tincture of
bark, solution  of  lunar  caustic,  aqua  camphorata,  &c, are often
useful, and require to be applied as often as three  times a day, or
oftener if the disease is  considerable.

                          Of Tumours.

   By this  term is generally understood  a circumscribed enlarge-
ment in a part from disease, not strictly  a disease of a natural
circumscribed part, as a thickened diseased gland.
   Of circumscribed  interstitial  enlargements in common  parts.—
These seem to depend on an accumulation of extravasated coagu-
lable lymph, either in the adipose or cellular membrane, or both.
They  are of  two kinds; one  is  probably scrofulous, and not so
circumscribed as the other.   The  wen is commonly found in the
cellular membrane of every part, but  how formed  it is difficult to
explain; perhaps there  is an absorption of the natural original parts
underneath.  The increase  of cancer is much in the same way; a
good deal of the cancerous  matter appears to mix with the natural
parts; but these  natural parts appear to be  lost as the cancerous
matter increases.  The specific quality of wens  is  not yet known.*
They retain their living properties, and sometimes swell to an enor-
mous size; sometimes they remain stationary, and  sometimes  they
become solid throughout, so  as even to be as hard as cartilage; when
cut into they  look like  a lemon, but not  so  regular; they seem to
have no leading cause, constitutional or local.  Calcareous earth is
often deposited in them.  The first mode of preventing them, if we

   * [Sir Astley Cooper has  described a species of encysted tumour or wen of the
common integuments, which evidently depends on an obstruction of the follicu-
lar ducts of the skin, in  consequence of which  the sebaceous follicles become
distended by the accumulation of morbid secretion.  Ranula, and  the enlarge-
ment of the labial glands, are analogous cases, and it is extremely probable that
many other forms of tumour, such, for instance, as the serous cysts which are
developed in the viscera, and the solid tubercles which occur in similar situations,
owe their orgin to a like cause, that is, to an obstruction in the primary branches
of the excretory ducts.   In general, however,  the origin of adventitious growths,
(see note, p. 150,) and the  distinction  of their  specific natures, is involved in
much obscurity,  so that every attempt which has yet been made to classify them
according to their natures has failed.  The truth of this observation respecting
the classification of tumours has been generally felt, and will be perceived in
the ensuing observations of  the author.] 
OF SPECIFIC DISEASES, ETC.
331
had any, would be by resolution, both by topical and internal appli-
cations ; but we have none of much power in  this respect.  For
those which are external, as in the cellular membrane, such remedies
as were recommended in  the diffused  are proper; but  these are
more difficultly removed than the diffused, and, being circumscribed,
are less capable of sympathy, and more indolent; perhaps mercury
is the best resolvent for them; electricity is not so much  to be
depended on as mercury;  suppuration of them, by cutting, or any
other mode, will do  no good.   They produce  a  sore which it is
impossible to heal, and which often becomes cancerous;  therefore
suppuration should  be avoided, as  it diffuses the cancerous dis-
position.  Extirpation is the only remedy, so that the earlier this is
acceded to the better.  Their situation makes caution necessary, in
the avoiding to  wound surrounding parts.   I have laid bare the
carotid  in the necks of women, also the temporals for two inches,
and often  have laid  the trachea bare.  By care and attention these
operations are very easy and safe.   The jugular  vein I have also
laid bare; but I would tie its two ends, as it is afterwards very apt
to slough.
   Tubercles may be classed under the head of  spurious  tumours :
they are most frequent in  the viscera.   They  are mostly of the
lymphatic kind, and are often formed in  the lungs of young people,
and sometimes grow to a considerable size:  they are often on and
in the liver, the spleen, the uterus,  the coats of the intestines, the pe-
ritoneum, and sometimes on the epiploon: the lungs are frequently
full of them, and they are the cause of  most consumptions.  How
they are formed, and whether glandular or not, I cannot determine;
but I think they arise from scrofulous dispositions  taking place in
the lungs : their texture is  often smooth.
   Solid Tumours.—Tumours may be divided into solid and encysted,
which are very different diseases.   Solid tumours differ from wens
in being an entirely new-formed substance, and of new  structure.
Their situations are three: 1st, on the skin, forming warts, which
are also sometimes seen  on  the mouth, lips, and  oesophagus;  2d,
in the inside of membranes, or canals, which  are  termed polypi;
3d, in the cellular membrane of  every  part of the body.   They
commonly arise from one fixed point, as a root, and then spread out
in all directions, if the surrounding parts allow of it.  These tumours,
formed  in solid  substances, are perfectly circumscribed; they are
generally more detached from the cellular membrane than the lym-
phatic glands.
   1st.   Warts are  external  or superficial: they also  form on the
inside of the lips, beginning of the  vagina, and prepuce.   Warts
differ, according as  the cutis and the cuticle differ, in different parts:
when these parts are firm,  the warts are hard, as on the hands ; but
if soft, the warts are soft, as on the mouth or lips.   They appear to
arise from the true skin of the parts, and generally arise from, and
are fixed on, a  small extent of surface,  projecting considerably, so
as sometimes to be  even pendulous,  with a  narrow neck.  In hard 
332
HUNTER'S PRINCIPLES OF SURGERY.
parts they arise only to a small height, and appear to split into many
parts, and  often by accident become  painful, bleed, and inflame.
Those on the penis sometimes have a broad basis,  and rise not so
high, and divide into  points.  On the inside of the labia pudendi
they often grow very large.  It is difficult to assign their cause, but
sometimes we see an  immediate cause, as the venereal disease in
the genitals.
  2d.  Polypi arise on the canals, or passages, each of which seems
to produce a kind peculiar to itself, as the nose,  vagina, uterus, &c. ;*
they are supposed also to arise in the urethra,  and I have seen them
in the rectum in men.  They have generally small necks, and require
extirpation; those from the Schneiderean membrane  are generally
in a cluster,  numbers  arising from the same root; internally they
consist of a reticular membrane, whose interstices are filled with a
watery fluid, and, besides this, an external covering, both of which
coats are vascular, but more particularly the  external.  They are
inconvenient  according to their size,  often causing a tickling in
the nose, which excites sneezing;  when large, they are evident to
the eye, either externally or internally, appearing to be semitrans-
parent bodies within the nostrils; but when protruded so low as to
be exposed to the  air,  they become opake, &c, and are then some-
times supposed to be cancerous ; and, indeed, we should be cautious
in extirpating them, as cancerous tumours are sometimes found in
the nose.  The best mode of removing them is with a forceps, but
seldom more than one can be removed at the  same time.   If the
polypus  is forward, it must  be  extracted anteriorly by the nostril,
the patient blowing the nostril as much as possible, to bring it for-
ward.  When the operation is simple, it is merely necessary to twist
it off by a rotatory motion of the forceps.
   3d.   Of the third species.—This is an entirely new substance in
the cellular membrane, often irregular, attached by loose cellular
membrane to the surrounding parts;  wre have also  often  such in
bones which have been diseased : they seem  to occasion the ab-
sorption of natural parts.  Pressure often hinders their growth, and
sometimes even  occasions their removal by  absorption; but this
is not always efficacious, and then  extirpation is the only remedy.
When in soft parts, we use the knife, and each incision may go as
close to the  tumour  as possible, the surrounding  parts  not at all
sympathizing ;  but if there is a root, then a little deeper: if the root
goes  to the surface of the bone, we cauterize it.  On the bone,
  * [It is questioned by some  pathologists whether polypi,  analogous to those
which arise from other mucous membranes, are ever found in the  uterus ; at all
events, those tumours which are usually called polypi  of the uterus are ascer-
tained to be of a different kind.  These latter are in  fact precisely similar  in
structure to the fibrous or  fleshy tubercles so frequently found imbedded in the
tissue of that organ, which vary in their appearance according to their situation,
which allows them sometimes to assume the pedunculated form.   This I think
is rendered  quite  certain, from the fact that they occur en the outside of the
uterus as well as on the inside, and in that case hang into the cavity of the pelvis
just as in other cases they do into the cavity of the uterus.] 
OF SPECIFIC DISEASES, ETC.
333
pressure will keep them down, or even make them lower than the
common surface  of the surrounding bone.   Tumours often arise
and shoot out from the alveolar processes, and the alveolar process
often takes on the ossific disposition along with them: sometimes,
but not always, they have bony matter in them.
  On the Removal of Tumours.—We should first consider the kind
of tumour and part; if a simple body, the knife is the best mode of
removing it.  The  first difficulty in the mode of opening it is, at
first setting out, to  know whether one or two incisions should be
made in the skin.  One incision is often sufficient, and two are often
necessary; one is sufficient where  the tumour  is  small, or very
loosely attached to surrounding parts;  but two are necessary when
the  tumour is large, or where the skin is diseased over it, so as to
confine it much,  even if small, as on the head, or sole of the foot.
A simple  incision is sufficient in fatty tumours, except when very
large.   In the dissection of common tumours we  need not be at all
nice about the tumour, nor in removing any of the  surrounding
parts ; but in  scirrhus, or cancer, the  incision must be extended to
surrounding parts, and this  is not for convenience, but for the  suc-
cess of the operation.
  For these wounds there are two modes of treatment; some heal
by the first intention,  others by suppuration.  The first, when the
skin will cover the whole  sore,  bringing the ligatures out at the
under  angle, when any  are required to secure the vessels ; but
when  the  sides  cannot be brought perfectly in contact, or when
sloughing is expected, suppuration must take place; but in many
such cases some part may still be healed by the first intention.
  Of Tumours in Bones.—Besides  ossific inflammation, as before
mentioned, we have sometimes tumours, arising from extravasation
of blood or scrofulous inflammation.
  1st.  Those  from extravasated blood appear sometimes to arise
from the surface of the bone, or else from its substance.  The bone
becomes lost in proportion to the size of the tumour; which arises
from an unnatural  accumulation of matter  pressing on the part,
occasioning absorption : this is most remarkable when the tumour
is on the inside of the bone, which then appears as if scooped  out;
and as the cavity enlarges by absorption, the body is in proportion
accumulated.  This kind of tumour,  arising  from  disease, differs
from that arising from accident, as from fractures, these not exciting
ossific  inflammation in the surrounding parts;  except, indeed, when
in the  leg and thigh,  where, strength and  support  being needed,
Nature forms new bone to supply the deficiency of the old.  I can
hardly tell whether the extravasation of blood is a cause or effect.
Bones  will break  from this kind  of tumour  by very slight causes,
such as by turning in bed;  for before the whole cavity of the bone
is absorbed, the bone generally gives  way,  and  is  fractured by a
very slight  cause:  after the bone  gives way,  the extravasation
increases  from the continued disease and  new-ruptured vessels.
This kind of fracture happened  to the Archbishop of  Canterbury. 
334           HUNTER'S PRINCIPLES OF SURGERY.

Mr. Grindle has many  examples of this in different bones in his
possession.
  2d.  The  second of these diseases in the bone which have the
same appearance, is  an accumulation  of curdly substance ;  pro-
bably it  is coagulable lymph,  and may be reckoned among the
encysted tumours.  The ossific inflammation often goes on here,
till the bone acquires great size, but in these the outer ossific accu-
mulation is not in proportion to the absorption, and therefore, being
only a thin shell, it gives way; this is most common in the head of
the tibia, and  is called  spina ventosa.   Scrofula, attacking bones,
makes them soft, and  also thick, although their  structure often
remains; however, sometimes it is altered, scrofulous matter being
deposited, and then the  natural matter is removed, till at length all
the matter which forms the bone becomes scrofulous.  Such cases
in a bone generally  increase so  much as  to approach the  skin,
which inflames, ulcerates, and exposes the parts ;  and this increases
the internal disease, which neither nature nor art can  possibly
cure ;  and then a hectic, sooner or later, according to the habit of
the patient, seizes and destroys  him.  These  two different causes,
perhaps, have some connexion, yet the  last is most scrofulous.   In
the treatment, we  ought first  to  prevent the  extravasation, &c.;
but we neither know  the disease, nor how to  effect this intention.
If known early,  perhaps exposure and sea-bathing would be the
best cure.
   3d.   These tumours are of two kinds : 1st, tumours simply, which
are often scrofulous to appearance; 2d,  the  cancerous, which at
present I defer.  The first kind I have often  seen, and most fre-
quently in the lower jaw, and upper part of the tibia.  The latter is
probably a species of spina ventosa.   If the  disease seems to be
true scrofula, then sea-bathing  may  cure it, but  this  is more  diffi-
cultly  known than in soft  parts.   When of the soft kind and con-
venient,  pressure should be tried, which often  is of great service, as
in Mr. Squire's case ; but  when this fails, electricity, or the mercu-
rial ointment  and camphor should be used ; and when this also fails,
an operation often becomes necessary ; an incision should  be made
upon it,  and it should then  be dissected out as in scalping, as close to
its root as possible, with  a little of the surrounding parts with it.
If from bone, it is impossible to remove any of it by the knife, and
it becomes necessary to cauterize it.   Sometimes a saw or pincers
are necessary for its removal, and cauterization of the cavity  after-
wards.
   Encysted Tumours.—These commonly consist of  a bag, or cyst,
filled  with a  substance softer and different from the surrounding
parts,  though not necessarily so.  The  cysts are of  too kinds, viz.,
natural and acquired.   Natural, as the  tunica vaginalis containing
a fluid morbid in quality or quantity ; Fallopian tubes; the uterus or
oviducts of animals; when, for instance, their foetus or  eggs are
preternaturally retained; these parts then taking on the nature of
the coat  of an encysted tumour.   Sometimes they arise  from an 
OF SPECIFIC DISEASES, ETC.
335
obstruction of the duct  of some gland, which forms a tumour: I
have seen them on the inside of the lip from this cause.  The second,
or acquired, are in consequence of disease in solid parts, and have
much the feel  of common tumours.  It  might be  supposed  they
were  common  tumours suppurated; but they are  original specific
diseases.  They contain varieties  of matter; and hence  they are
divisible into several kinds: as,  1st, hydatid, from their contents
being watery;  2d, various matters of different consistency; 3d, a
curdly  substance.  The thickened cellular membrane, condensed
by pressure, forms the  coats of the first  and second; but I know
not how the third coat is formed: some of them probably are scro-
fulous :  and if so they are  no more than very indolent abscesses in
those parts, having acquired a strong coat, which I think is some-
times the case.
   1st. Hydatids vary in kind, from the  variety of  their  situation.
All accumulations of water in  cavities,  are  properly  hydatids.
(See note, p. 229.)  The water may either be in a natural cyst, as
the tunica vaginalis,  pericardium,  &c,  or in a  cyst  formed  by
disease.  This  second division  is of two kinds, but both occur in the
cellular membrane.   The  first is filled with  serum, and there-
fore similar  to the above; the  second  is lined  with a peculiar
substance.  Those of the first kind are most frequent in those parts
which  have an enveloping membrane, as the abdomen and thorax;
 and are more  common  to some of these  than to  others, though it
 does not arise from their having a cavity,  but from a peculiar dispo-
 sition of these parts ; these hydatids project into the cavity.  Those
 in the  cellular membrane are very uncertain in  their  situation.
 The first kind, or  simply  watery, are often in  women's  necks, or
 in the thyroid  gland.   I once  saw a large cluster  in the neck of a
 woman.  As they increase in size their coats increase in thickness:
 those in the cellular membrane thicken soonest: for the lining mem-
 branes, or cysts, only thicken  by  a species of adhesive inflamma-
 tion.    The second differ from the former, and are made up of two
 parts :  the strong external coat  is lined by another, of a dusky
 white colour, much like the retina of the eye, and gelatinous; this
 coat is generally as thick as thin pasteboard, and as strong as thick
 wet paper.   In many hydatids there is an additional or  third coat
 on the  inside of this, which is less opake;  and sometimes a fourth,
 and so on, till  at  last nothing is seen but  coats;  none  of which,
 except the external one, is vascular.   It is easy to account for the
 formation of the external coat;  but difficult for the internal ones.
 Whether the external is the first, and the parent of the  others, or
 the consequence, is not easily determined; but the last is most pro-
 bably the case, as when formed, they stimulate so as to produce  a
 vascular coat; but whichever is formed  first, we must suppose that
 it is capable  of continuance.  I  suppose the first formed is the
 nucleus, and  so on; similar  to  a nest  of pill-boxes,  one within
 another.  There is another somewhat similar, but more  irregular ;
 the external  vascular  coat being full of small ones, as shown in 
336
HUNTER'S PRINCIPLES  OF SURGERY.
this preparation  [exhibiting it].   Does  this last species proceed
from indolence?   Many animals die of  them in the liver, in cold
climates, especiallv sheep: it is in  them called the rot.   Hydatids
cause little sensation, and are seldom knowm till of a considerable
size.
   Hydatids of the Uterus.—Those of the  uterus and  ovaries are
generally circumscribed bags,* and generally are  numerous, espe-
cially in the ovaries, and appear somewhat similar to those of the
scrotum ;  forming a species of hydrocele of the part.   At first they
are thin, containing a transparent fluid; but afterwards they be-
come thicker, and the fluid is bloody, or like a  jelly.   They have
when small but  little attachment, but afterwards get to  adhere to
each other, when they grow often very large, and increase the size
of the belly, forming ovarian  dropsy.   The history and progress
only of the case can in general distinguish it from ascites; at first
there is a  partial, moveable  swelling, rolling from side  to  side in
bed.   Afterwards  they become fixed, but  even  then, in thin peo-
ple, inequalities may be felt; when large, they become fixed to the
parietes of the abdomen ; and  if the  person is  not very  fat, a fluc-
tuation may  be felt.  The health  is but  little  affected by them.
Hence the cause is very different from ascites, where the health is
first injured.   Tapping is only a palliative cure, and a large trocar
is required, as the fluid is  generally  gelatinous, and  then only one
cell is opened.   If taken in the incipient stage, they might be taken
out, as they generally render life disagreeable for a year or two,
and kill in the end.  There  is no reason why women  should not
bear spaying  as well as other  animals;  it  would be simply opening
the  cavity of the abdomen, which we  often do without inconve-
nience in  healthy constitutions-!
   Hydatids in the Kidneys.—They are   of  the first species, of the
adventitious, and are generally situated between the first and second
laminae of the external coat; but they are certainly often  in the
internal substance of the  kidney.   Sometimes  there  are a  great
number.   Those in the coats are never detached or pendulous ; the

   * [The hydatid which forms in the uterus is peculiar to that organ, at least in
the generality of cases, being of a pedunculated form,  and  generally grouped
together like a bunch of grapes.  Hydatids in this situation often attain a great
 size in the aggregate, and are expelled  by a parturient  effort.  There is reason
for suspecting that this form of hydatids most frequently arises from impregna-
 tion, in which case the destruction of the ovum is almost universally the conse-
 quence.]
   f [This recommendation has been adopted  in several cases, but the success
 has not been found to warrant its repetition. The difficulty of ascertaining whe-
 ther one or both ovaries is affected, as well as the obscurity in which the disease
 is involved in its earliest stages, are insurmountable objections to the operation;
 for I do not suppose that any one would be so bold as to propose it after the cyst
 has attained any considerable  magnitude.   Besides, it sometimes happens that
 the disease remains stationary for many years;  and in other  cases a cure  19
 effected by the  suppuration of the  cyst consequent on tapping, the danger  of
 which is scarcely greater than that which would attend the operation of extirpa-
 tion.] „ 
OF SPECIFIC DISEASES, ETC.
337
coats are thin, and look like a red grape;  they give no  symptoms
of any kind, nor do they require or  admit of any remedy.  Some-
times those about the kidneys burst into its pelvis, and come away
by the urethra.  A gentleman had a considerable swelling on the
left side of his belly which had  been a long time  collecting, and
evidently contained a fluid ;  on a sudden a considerable quantity of
fluid was discharged from the bladder through  the  urethra, and
along with it  a large  number  of  hydatids; some whole, others
burst; but the swelling of his abdomen subsided and he got well:
however, he afterwards filled again; but he again emptied them by
the ureters, and he is now perfectly well.
  Hydatids of the Liver.—The liver may be said to have none but
those of the second species of the adventitious; they are generally,
but not always, on the exterior substance of this viscus.   In some
rare cases  they have produced ascites by their coats bursting in-
ternally; and sometimes they have been discharged externally by
their coats  adhering to the peritoneum, and inflammation  and
suppuration  coming  on.  When known to be a bag containing
fluid it may be opened, but I  would not be in a hurry to do this.
  Hydatids of the  Lungs.—These are of two kinds : first, a collec-
tion of water simply in one or more  cells; the second, of the ad-
ventitious kind, either external to, or in the substance of, the lungs.
Some open into the trachea, and are coughed  up in abundance ;
sometimes they produce spurious empyema, when they should be
opened pretty early, to prevent their affecting the substance of the
lungs by pressure.
  Hydatids of the  Brain.—These I have never seen  increase so far
as to cause inconvenience.   In some animals  they are common
when young, and  are successfully taken out.  They are very fre-
quent in the plexus choroides.
  Hydatids of the  Thyroid Gland.—Sometimes these are very large,
and produce difficult respiration and deglutition.
  Hydatids of the  Cellular Membrane.—These are generally of the
first  species of the second division of the adventitious, containing a
transparent fluid.   Some parts, and more especially women's necks,
are more subject to them than others.  They are also pretty com-
mon on the inside of the lips  of men.
  2d. The  second kind  of  encysted tumour contains  matter of
various kinds, and are very similar  to hydatids, often containing in
part a watery fluid.  In the  ovaries, fatty, cuticular,  and hairy
tumours are sometimes formed.
   The treatment for the two  first is the same.  From their  situation
we may divide their cure into two kinds ; one admitting of  external
applications, the other not;  but I know  no medicine which will
cause their absorption.  When external, therefore, the only means
is  opening them, when they will inflame, suppurate, and  may be
managed as in common hydrocele; but so much nicety is  not here
required, as the sac,  being generally thick, will  not collapse.   In
some a free opening is  only necessary;  sometimes they inflame
                              29 
338
HUNTER'S PRINCIPLES OF SURGERY.
 spontaneously, but rarely, and even then a free opening is necessary,
 on account "of their  indolence.  If the sac is much thickened, the
 exposure by opening will  generally kill  it, and  cause sloughing;
 yet exposure is not always sufficient, but the whole sac will require
 dissecting out, and especially when we consider that there is some-
 times in these a cancerous disposition.
   Of the Cuticular.*—The adhering  cellular membrane forming
 the sac, takes on the disposition of the  cutis, or more properly is
 changed into cutis, and  is capable of generating an external one
 when exposed; it  is lined, indeed,  with a  cuticle.  These cysts
 often have so much the disposition of the external part, as to have
 hair grow in them, which  is the same as  that which covers the
 animal, as, for instance, wool in the case of sheep.   Every part of
 the body is subject to them, but some  parts  particularly  so.  The
 ovum is subject  to  all kinds of encysted  tumours,  and to these
 more than other parts;  and they probably throw off the cuticle
 every year, or oftener, the  cuticle being filled with hair.   They are
 also filled with various matters;  sometimes with  a  caseous sub-
 stance,  in others  with oil, fat,  bones, &c.:  they occur  also  in the
 eyelids, in the skin  near the eyes, and  in the lips, and all grow to
 a large  size.
   There are  two methods of cure, one dissecting out the tumour,
 the other opening it freely, or taking  off the projecting  part and
 leaving  the basis : on the eyelids, when very superficial, they often
 burst, matter is discharged, and they get well.   On the head they
 are opened and  get well. I  have seen the  external skin only
 taken off, which  gave  rise to  an inflammation round  its  edge,
 which  suppurated and granulated, and healed over, producing a
 cure.
   A gentleman had a large encysted tumour on the muscles of the
 abdomen ;  this was  opened by taking out a circular piece of the
 integuments,  comprising  the fore part  of the sac.  The wound of
 the integuments suppurated ; but the internal surface of the sac,
 which was now fully exposed,  never suppurated  the  least, so that
 the wounds of the integuments  granulated and  healed, tucking
 down the integuments to the thin surface of the sac.   The patient
 has remained well ever since; but has  a  large cicatrix, part of
 which is composed of what was  the  internal  surface of the sac.
 The surface  of the internal coats of these tumours has a skin
 somewhat like that which covers the glans penis, different in some
 respects from  that with which the rest of the body is furnished, but
not of such a nature as to suppurate on exposure.
  3d. Encysted  tumours, in  a part depending on an indolent dis-
position or  suppuration are commonly deep-seated,  and their pro-
 gress is very slow at first; they  appear as an abscess, and might

  * [The  reader is referred to Cooper and Travers's "Surgical Essays," p. 215,
 for an account of encysted tumours forming on the scalp and face.  These strictly
 come under the  designation cuticular, and have been adverted to in  a previous
note, p. 330.] 
OF SPECIFIC  DISEASES, ETC.
339
 be suspected to be encysted,  from their giving no pain.   I have
 seen sometimes a chain of them leading from the skin; that nearest
 the skin appeared to be the original of them.  These often deceive
 the surgeon, who is  either satisfied by opening or  dissecting
 them out, suspecting no more of them; and I know no character-
 istic  mark of their presence when the original one is deep-seated;
 when external, the examination after the removal  of the first may
 distinguish them.
   Of the Inflammation, Suppuration, and Ulceration of new-formed
 parts or substances.—We shall find these parts more liable to dis-
 solve than the natural parts are, having weaker powers of action.
 In proportion, therefore, to the quantity of new matter, is  the part
 weaker;  and these parts go through their diseases much quicker
 than original ones.  When new-formed parts are  under the neces-
 sity  of inflammation,  a very slight cause is sufficient;   and the
 inflammation goes on more rapidly than in original ones; and  it
 requires more attention and care to stop its  progress.  They are
 both  more ready  to mortify and suppurate.  If in the adipose mem-
 brane or skin, and the inflammation is beyond resolution,  then no
 suppuration,  but  ulceration,  takes place, and mortification rapidly
 ensues;  but  it will be confined to the new-formed part, except in
 very  bad constitutions.  When suppuration has taken place, or mor-
 tification, there  must  be  also ulceration, which is very rapid; so
 that an abscess  in parts where  an abscess had been before, will be
 much quicker than before in pointing, or than in  other sound parts:
 if mortification  takes place, the separation will be almost imme-
 diate.  Hence it appears that it is  a  deposit of matter originally
 from the constitution, and she lays a claim to it  in  removing it and
 repairing it again at pleasure.   Simple fractures sometimes dis-
 unite, though stronger than by granulations : in these cases no inflam-
 mation is produced, at least not so much as to produce suppuration.
 Union of parts by granulations often disunite, both  in soft and hard
 parts, hence  old sores  and old fractures disunite.  This disposition
 of fractures to disunite is most  frequent in the  lower extremities;
 the substance appears to be shorter lived than the original part was,
 as in old  sores,  w7hich  so frequently  break out again.   In parts
 united by simple  extravasation,  and adhesive inflammation, which
 again ulcerate, there is no suppurative inflammation, but there will
 be in  parts united by granulations and  suppurations.  Ulceration,
 though frequent after compound fractures, is seldom so considera-
 ble as to destroy  the new-formed bone wholly, though often  in part;
 these are the causes of bad ulcers, and of what are called foul bones.
 It most  commonly occurs from a fault in the general system, as
 scurvy;  and  upon this principle, sloughs take place soonest in new-
 formed parts, the separation depending on  ulceration.
   For the cure of these cases we must first examine into the causes:
if from scurvy, when the patient is at sea; or if from their depending
position and too much exercise, when the ulceration is in the legs ;
in which  case rest and a horizontal posture  are to be used; but 
340           HUNTER'S PRINCIPLES OF SURGERY.
there is something very peculiar in the lower extremities;  they will
become better and yet again slough.
   Of Fistulae in general—The term fistula gives a very inadequate
notion of the disease, the fistulous canal being only the sign of the
disease,—the means of conveying a fluid or extraneous matter to
the surface.
   A fistula is the consequence of the powers of a part not being
able to remove the  original eause, so that  the original cause and
some of its effects remain.
   The causes of fistula are various, but may be  divided into two
classes:  first, the obstruction of the passage of some natural secre-
tion, as fistula of the parotid gland ; or of the canal for the passage
of extraneous matter, as the intestines being strangulated so as to
mortify, or being wounded; but all obliteration of the  ducts where
the fluids make a new passage will not be termed fistulas: secondly,
the  formation of pus  or extraneous  matter in  a part requiring a
passage, as in fistula  in ano, fistula in the joints, and  fistula from
diseased bone.
   We shall first consider the first cause of fistulae.
   1st. The obliteration of ducts, or canals, is the first cause.   This
arises from obstruction of the natural passages, in consequence of
which a new one is formed for the passage of the natural secretion.
These obliterations  often arise from a thickening of the sides of the
ducts, as in the urethra, nasal  duct, &c, from inflammation; some-
times  from the venereal disease or scrofula; and sometimes from
accident, as in the parotid duct.   These obliterations are often very
troublesome, obstructing the  evacuation of the  natural secretions,
which is very teazing to the part, and when complete is very  serious
in its consequences.  In most there  is a new passage when com-
plete, which is made  by inflammation and  ulceration  ; these new
passages are called fistulous: the discharge is the natural secretion,
mixed with the pus from the  inflamed  vessels of the  sides  of the
passage.  If this  new passage answers all the purposes of the ori-
ginal one, it cannot well be called fistulous; when from a mortified
or wounded intestine, it  is called  an artificial anus;  when in the
perinaeum, it is for the passage of the  urine.   There are often accu-
mulations of secreted  juices besides  the  above, arising  from the
same causes, and producing the same consequences, yet not called
fistulous.
   Of the Fistula Lachrymalis.—This arises from  an obstruction
taking place in the  passage of the tears  from the lachrymal sac into
the nose.   The causes are often foreign to the nature  of the parts
themselves, as the small-pox or measles.    This I suppose not to ori-
ginate, as has been supposed, from a pustule at the end or mouth of
the duct, but from inflammation running along the duct and causing
the sides of it to adhere;  it also may  arise  from  ulceration of the
duct from a venereal or scrofulous disposition in the part;  but most
frequently from obliteration of the canal from inflammation.  The
tears not passing, the inner surface of the  sac becomes stimulated 
OF SPECIFIC DISEASES, ETC.
341
by pressure  and distention, and the salts of the tears, which have
little or no effect while the sac is natural, when diseased irritate it
and produce inflammation.  The sac swells, suppurates,  and opens
externally, and discharges the tears by this opening till the natural
passage opens or a new  one is made.   If the os unguis had been
susceptible of  the stimulus and had ulcerated, it would  have been
fortunate, but it only thickens to defend itself from the disease ;  for
we find Nature  has  made internal parts  less susceptible of such
stimuli, the ulceration  only  taking place  next  the skin, so that it
would perhaps be better for us if Nature would sometimes vary from
her usual course.   This internal thickening is sometimes  so great
as to unite the external part of the nose  to the septum, and render
the operation of perforating the os unguis less  successful.   Opening
the old passage seldom succeeds, as it is very liable to become dis-
eased  again, as  in strictures in the urethra, which are so apt to
recur; and here bougies cannot be had recourse to, occasionally,
as in the urethra.   The operation, however, should  not  be done
precipitately, as the duct often clears of itself and the patient gets
well.
   Of the Obliteration of the Ducts of the  Glands  of the Lip.—These
glands  lie  immediately under the skin of the lips, and when there is
an obliteration of any of these ducts, a tumour is formed, which
sometimes bursts of itself.  As the secretion goes  on, the new opening
cannot heal, and it is then, though improperly, called fistulous, as it
does the office of the natural passage, and yet is often stopped again:
sometimes th3y do not burst, and I have  dissected them  out;  for
although they occasion little pain they  are very troublesome.
   Obliteration of the Ducts of Camper's Glands in the Female.—This
may be the case in the male, and probably would occasion fistula in
perinaso.   An accumulation of slimy matter takes place, and  the
ducts swell just under the skin, on the inside of  the labia,  near  the
carunculae myrtiformes.   They increase in size, and sometimes are
mistaken for hernia : they should be opened before becoming very
large, by a crucial incision : and to prevent their union by  adhesion
after opening,  they should be touched with lunar caustic : perhaps a
round  hole made by  the lapis septicus would answer better than an
incision.  They  first appear like  a little  encysted  tumour, which
increasing, becomes so troublesome as to prevent the person sitting.
A lady had a very large one, which  was taken for a hernia of the
foramen ovale. She went to Paris, where it was thought an abscess
and opened.
   Obliteration of the Duct  of  the Parotid  Gland.—The parotid
gland, from its superficial situation as it passes over  the  masseter
muscle, is very liable to  be wounded.   Such a wound  will after-
wards become the orifice  of the  duot, and will heal in part, to a
fistulous size:  the duct itself  going to  the mouth probably closes,
as the  saliva must then be lost;  and  as its  flowing  here is very
inconvenient, it is necessary to  direct  it to the mouth, which may
be done with a needle, threaded with a round thread passed to  the
                              29* 
342           HUNTER'S PRINCIPLES  OF SURGERY.

bottom of the fistula, then directing it  to the mouth  and feeling for
the point internally, pushing it to the finger and drawing it through,
leaving the thread in; and perhaps it will be necessary to bring the
thread out of the corner of the  mouth, and to tie the two ends
externally.  The  thread should be left in till the new duct has lost
its healing disposition, and then heal  the external one;  but it may
perhaps be necessary to make it a new surface before it will heal
by making the fresh surfaces adhere by placing them in contact.
  2d. The second  species of fistula,  or  that from  disease, arises
from the disproportion in the disposition to heal of different parts,
viz. the internal and the external; the skin healing, while the deeper-
seated parts, or seat of  the disease, have no disposition for  it.  It
may arise from two causes : 1st, from any  extraneous substance in
the inner  parts;  2dly, from a diseased  state of the original part,
when the  disease  formed.  The  first  happens in large deep-seated
abscesses, which  are prevented healing at the bottom by the pres-
sure of the matter.  The second has two causes, the first from the
part being naturally indolent, as tendons: the second from a disease
in parts naturally ready to heal, but the disease  being deep-seated,
the skin is more ready to heal than the bottom  of the fistula, and
thus obstructs the necessary free discharge.
  Fistula  in Ano—Generally originates two or three inches  up the
side of the  rectum.  The first  process  is inflammation, and the
formation of an abscess;  then the matter comes down by the side
of the gut, and opens on  the buttock.   Sometimes the gut is so
diseased as  to give way, and  then we  have an  opening  into it,
which being the easiest  and readiest way for the matter, it is thus
discharged, and  then we may have  no  external  opening;  but if
there has  been one, it does not heal.   The cellular membrane about
the anus  is sometimes  the  seat  of encysted tumours, which are
mistaken  for fistula, although they do not proceed from inflamma-
tion.  The treatment differs in  these two very considerably; the
tumour is often opened or breaks, but  the inner surfaces of the two
are very different.  The abscess only requires opening, and then
cures itself; but  the encysted tumour,  when  opened  externally,
generally  becomes fistulous, and opening into the gut will often not
succeed, if attention is not paid to make them heal from the bottom;
therefore  it  is necessary to keep them well open by dressing, or the
two divided parts will unite at the edges  after  opening.  When a
fistula in ano has both an external opening and an opening into the
gut, surgeons are in general satisfied  with opening from one to the
other; but the fistula sometimes runs higher up by the side of the
gut than  the inner opening, and then we should not attend to this
opening, but get to the bottom of the  sinus.
  Fistula  in Perinceo.—In whatever part of the urethra the  seat of
the  disease is, whether  the prostate  gland, or the membranous or
bulbous part, the  external opening seldom heals as long as the seat
of  the  disease has  no  disposition to heal.   This, I  apprehend,
arises in most cases from sympathy with  a  disease in deeper-seated 
OF SPECIFIC DISEASES, ETC.
343
parts: or, in other words, a deep-seated disease is capable of stimu-
lating superficial parts, so  as  to  prevent the natural action for
healino-.   Let us compare this disease with the state of parts after
lithotomy.  If the incision is made in sound parts, and the whole
injury be  a stone, which  is  extracted, the  parts readily  heal, in
spite of the urine passing through that channel.   This, then, shows
that there is another cause of their not healing.   Now if the parts
higher up are  unsound, as the prostate, &c, though the  incision
was made in sound  parts, it does  not heal:  if perchance  it does,
the disease still continuing, you will have probably two or three
fistula?.   If the parts are unsound  beyond the fistulae, you will be
continually plagued with a return of them.  Bougies should not
be kept in too long, as they sometimes make fresh fistulae in perinaso.
Several fistulae may arise from one  disease.  A diseased bottom
may have many fistulous sores leading to it both in the perinaeum
and anus: and if one of these be laid freely  open, so  as to expose
the diseased part, the rest will heal.
   When the disease is in one fixed part, there is a canal leading to
it, which  I have  called  a fistula;  but if  more than  one, these
different ones are called sinuses.   A fistulous  orifice is  generally a
small opening in the skin, having no sore surface in view,  and is
easily distinguished  from  other sores; if the  diseased part is deep
and of long standing, the  external skin will be thickened more or
less near  the orifice, from  the contraction of granulations within
the canal, so that sometimes there is a  protuberance even by the
contraction.  But this  appearance  is also common to all  diseased
parts some way under the skin, when the skin does not partake of
the disease; when it does, this appearance is  less considerable.  If
near a bone, this is suspected to  be affected.  When the seat  of
disease is near the skin, as when on the tibia, then we  may be
certain the diseased cavity below is not large.
   The cure of fistula consists in first removing the immediate cause ;
for frequently they get well by simply removing the obstruction.  In
fistula lachrymalis, a new opening, or the restoration of the old one,
is the cure.  A fistula in perinaeo will often be cured by stretching
and dilating the canal of the urethra by bougies, which  removes
the obstruction.  The cause of our first division of fistulae, arising
from confined matter, is sometimes easily removed, but not always,
by opening the suppurated  part in  the most depending situation,
 when, if  the parts  are readily disposed to heal, a cure takes place.
 The second, from a diseased state, must have the disease  removed
 or extirpated if possible;  but this is often impracticable. A perfect
 exposure is the next object; but the case will not often admit of it,
 and then becoming  incurable it sometimes produces  hectic, as in
 lumbar abscesses, and abscesses of the liver, which open externally
 but cannot be exposed.   The constitution in such cases is to  be
 most attended to, and everything  done to lessen the irritation; but
 in most cases life is miserable, and we only protract it a little longer
 by our best efforts.   Fistulas in the lungs and liver in consequence 
344           HUNTER'S PRINCIPLES OF SURGERY.

of abscess, and in the intestines from old obstruction, can only have
their orifice kept open for the discharge of the matter.   Fistulas in
ano are generally easily come at,  and are then of easy cure.  At
first it is simply an abscess from disease on the  outside  of the rec-
tum ;  if not, it becomes so by inflammation and  suppuration.  This
is  proved by the cure, which is  not simply a free  opening where
the abscess points, but opening the abscess from its original seat is
necessary for the cure: slitting up the gut to the  origin of the  ab-
scess  is necessary in all cases of fistula in ano.*
   Of the attention  necessary in  diseased and  wounded Joints re-
specting their motion.—I shall now speak of the  preservation and
acquirement of motion in joints when diseased, and after  disease.
We must consider in both the necessity of removing  the first cause
of the disease, or we shall be increasing it by endeavouring to pre-
serve or to acquire the lost  motion: nothing can promote contrac-
tion of the joint so much as motion before the disease is removed.
In healing wounds in general, and especially those connected with
joints, great attention should be  paid to the motion of the joint:
when all inflammation is gone off, and healing  has begun,  a little
motion, and frequently repeated, is necessary to prevent their heal-
ing in one position,   Wherever there has been an inflammation, a
stiffness  will remain ; but the parts will stretch, and the motion
again become free, by gradual motion and friction.  But in healing
of wounds by granulations there will be more rigidity.  When there
has been loss of substance, from mortification and gun-shot wounds,
there will be still greater rigidity,  and consequently more attention
is  requisite.  In violent inflammation there is a union, by a broad
surface and close contact, and then motion is sometimes altogether
irrecoverable.  The parts may often be made to stretch by degrees:
this is either by active or passive  motion.  The active or muscular
motion is insufficient, if the  disease has existed long, as the muscles
often lose the power of acting. The passive or foreign power may
be of three kinds: 1st, the hands of another person; 2dly, the addi-
tion of matter to the moving part, so as to increase its momentum;
3dly, putting the moving part into such a position  as to increase its
gravity,  which will  produce the  same effect as  the two former;
but yet the assistance of the muscles  are necessary also.  The posi-
tion is either the middle state of action, which is natural in disease,
or it  is  in  consequence of  gravity.   The arm in diseases of the
shoulder, if in bed, lies a little out; but if up, it hangs  by the side
naturally.   Joints are of two kinds, some with  flexors  and exten-
sors,  with a given power; the other have not only the above, but a
given support, which support acts generally  in  the  centre  of gra-
vity.  This division makes  a material difference in the  position of
joints.  If in the former of  these there is a disease,  the  part natu-
rally  falls into a half-bent state, and  w7ill heal so if not prevented;

  * [The reason of this necessity is the constant action of the sphincter muscle,
which is divided in the operation.] 
OF SPECIFIC DISEASES, ETC.
345
but it is different in the other kind, for in whatever position they are
placed, when there is a weight, the weight becomes the object of
the mind, and not the motion; and the joint must be kept wholly in
this position, which is a  position  rather contrary to that which it
was meant to be kept in.  This is most  remarkable in the ankle-
joint, because the point of  support will not be the natural one:  the
foot will be hanging in a straight line with the leg, which is just
the contrary to that which arises from the elongation of the muscles
of the ankle.  Suppose the  elbow  contracted, and I want to put the
flexor muscles into an elongated state, neither the muscles nor mind
being able to  do this; the hand, apparently, is  not  heavy enough;
but suppose I should then put a little weight into the hand, in order
to assist a little, then the mind will be fixed on  the  weight  to sup-
port it, the flexors will support it, being influenced by the mind; and
thus we shall do harm by increasing the power of the flexors. But
if the mind is fixed on the extensors, and not at all  on the  support
of the weight, then the weight will be serviceable by extending the
flexors while  contracting the extensors.
  In the endeavour to  elongate the muscles in any part of the body,
they should never be allowed to contract, which would  counteract
the elongating  powers.   In  contractions  of  the  gastrocnemius
muscle, the heel should  be always supported, to take off the mind
from the support of the body ; the body should be supported by art,
by supporting the heel, but this should be incomplete, and gradually
made more  so.  When  the  knee is bent, the  above method will
assist when the person is obliged to walk; for when sitting, throw-
ing and swinging the  limb about will assist most, and sometimes
attaching a weight to the limb.   I would advise lying on the face,
and with such a position of the knee that the foot should touch the
plane on which the body was, and then  raising the foot more by
bending the knee more.  When the contraction is in the thigh, we
cannot have all these auxiliaries.  With respect to  the  shoulder it
will be much the worst,  as it will scarcely be possible to assist its
position  by any auxiliary.   I.have thought a pulley might  be con-
trived to raise the arm, with the weight  fixed to  the end  of  the
cord; or the patient might be requested to lay  on that side, having
his arm through  a tube and hanging  out the  other side.   Every
possible method should be  tried:  if a man could walk on his hands
awhile, the arm would then by its own weight  come  to  a right
position with the body, which would be sufficient.


                           Tetanus.

   The symptoms of this disease  are  involuntary contractions  of
the voluntary muscles of the body, and sometimes  of the involun-
tary,  which makes it fatal.   This affection is sometimes only par-
tial, and at other times general.   When on the  muscles  of the jaw, 
346
HUNTER'S PRINCIPLES OF SURGERY.
it is called locked jaw ; when on the fore part of the body, as the
pectoral and anterior muscles of the neck, emprosthotonos ;  when
on the muscles of the back, drawing the head backwards, opistho-
tonos.  Tetanus should first be properly arranged as to class and
species.  It may be  properly  classed with  every unnatural  con-
traction of muscles which may be called spasm, of which there are
many species, most of which have some  specific  difference.  It is
of the same genus as spasmus  cynicus, cramp, wry neck, subsultus
tendinum, &c.  It may be also classed with St. Vitus's dance, and
it seems to have great affinity with ague, as this disease sometimes
attends it; but the  ague is  only the predisponent, or immediate
cause.   It also seems to be allied to catalepsy and epilepsy: these
arise from affections of the brain and nerves, but they may arise
from different causes.  Most of the above diseases are acted upon
by affections of the mind, and this is sometimes the case with tetanus.
This disease sometimes occurs in animals, as  horses, cows, sheep,
&c, from which it might be supposed that these animals were sub-
ject to it from  their way of life being  somewhat similar to man's.
I had a stag which died from locked jaw, from a compound frac-
tured leg.
  Some muscles  are more  liable to  it than others; those  of the
lower jaw are the most so;  but as the  disease increases, another
order of muscles is affected, which  I think arises from a species of
sympathy: other involuntary  actions  have also their predisposed
parts, as the cramp, wdiich  is  mostly  in  the lower extremities.
The muscles of the neck are most liable to that species  of perma-
nent contractions which constitutes the wry neck.
  Of the Causes of Tetanus.—The principal inquiries which have
hitherto been made have been on the cure, and not  on the nature
of the  disease, or its similarity to others.  This part of the subject
I shall now consider,  and also in what climates it is most frequent.
Irritation  from  an injury done to a nerve, ligament, or tendon is
generally  supposed to be the cause,  as it generally occurs from
wounds of tendinous  or ligamentous parts.   This  at  first would
seem reasonable ;  but we must  determine first what is irritation.
That is called irritation which excites  inflammation, and a patient
is said to be irritable when a part of the whole constitution is easily
affected by any slight  cause.  But  everything relative  to  locked
jaw does not arise from irritation of the wound itself, neither from
inflammation or symptomatic fever ; for in such states the constitu-
tion  is not disposed  to  it.   It arises  from  an irritable  habit,
which may be  increased or  produced by irritation, but  not  such
as is   capable  of  producing  inflammation.  When there is  in-
flammation, the locked jaw  arises only when that is  subdued.
When from causes incapable  of exciting inflammation, the irrita-
tion may be considered the immediate, but not the remote cause ;
for there must be a disposition for the  disease,  such  a cause being
insufficient for producing such effects : thus also madness is produced 
OF SPECIFIC  DISEASES, ETC.
347
 from the slightest causes when the mind is predisposed; so it is in
 agues and fevers, the constitution being particularly predisposed at
 the time to  such diseases.   If  it were  from inflammation, the
 locked jaw would come  on  at  first, or when  the  inflammation is
 most violent;  but then the constitution is strong, which is a state
 unfavourable to the disease.   It is perhaps impossible to say what
 are all the remote causes which produce this effect; probably many
 combined ;  and it would be  impossible to give all the immediate,
 but I shall give as many of both as I have observed.
   Constitutions most susceptible  of the Disease.—First, there is a
 disposition of the nerves, and that principally of the nerves of the
 voluntary muscles and sensation,  rendering sensibility  more  acute
 in such, so that they can scarcely bear to be touched.  This appears
 to be from irritability of the nerves, and not from irritability of the
 living principle.  To produce the disease  only a slight immediate
 cause is necessary, which is the case also in most irregular actions
 of  the  nervous system, as we see in tickling, which will produce
 convulsions, though these would not be produced by a bruise in the
 same part.  Those most susceptible  of the disease are of  weakly
 delicate frames and  of suspicious  minds, and not of strong and
 robust  ones.  It is common  to  have involuntary  actions of  the
 muscles in weakly constitutions, as we see in pregnant women, who
 are  subject to  cramps, fits,  &c, although the living principle is
 acting  at the  same time vigorously; this was also the case with
 myself, at a time when weak.   I threw a stone at a deer, and  over-
 exercised the muscles of the arm, which produced cramp and extra-
 vasation in my arm, and loss of the use of the muscles: this pro-
 duced sickness and paleness,  and after a little time cramp came on
 in my leg; but at last this and the other symptoms went gradually
 off: if the irritation had continued, a locked jaw might have come
 on.  Now here, from the irritation, a spasmodic affection was pro-
 duced in a person in health.   This species of irritation is very dif-
 ferent from irritation of the living principle causing inflammation.
  Climate seems the first of the predisposing causes, and that which
 can probably produce it without other causes: the second is the
 consequence of considerable local inflammation : the third is irrita-
 tion.  The immediate cause is often a small wound of  a part pos-
 sessing  but little  living powers.  In warm climates it is most fre-
 quent, and consequently it is seldom found in cold weather.  In the
 West Indies and in the Mediterranean, besides tetanus, we also find
 the diseases with which I have classed it very  frequent.  Sweden,
 Denmark, and other cold climates are not subject to it.  The cramp
 is  most  frequent in warm climates, and also in bed: fits also are
 most frequent in bed, for warmth seems to have a peculiar effect in
producing a particular disposition in the nerves ; and when  there is
an  immediate slight cause, such diseases readily take place: nay,
some are disposed to such actions without any immediate cause,
which probably arises  from climate, joined with a  strong  natural
predisposition.   The cases which I have  seen from wounds were 
 348          HUNTER'S PRINCIPLES OF SURGERY.

 those  of the  tendons, for these  parts heal less readily, and the
 constitution is much  weakened  by wounds of such parts, so that
 sometimes a  limb  will waste from such a cause,—wounds being
 much  more irritable here than in other parts, and particularly when
 attended with loss of blood.  Nothing produces irritability more than
 a great  loss of blood, especially when accompanied with a wound,
 and with this  disposition of constitution.   The wounds producing it
 are either considerable or slight: the first is  a predisponent, the
 second an immediate cause.  When I have seen it  from the first, it
 was after the  inflammatory stage, and when good suppuration was
 come on;  in some  where it had nearly healed, and the patient was
 considered healthy, under the disease as well as before.  Some have
 had locked jaw  after the healing  was completed.  In such I have
 supposed the  inflammation was the predisponent cause, rendering
 the nervous system irritable  as soon as it was removed.  When it
 comes on in horses, as after docking, it is after the  wound has sup-
 purated, and begun to heal.  A young man burned  his face with
 gun-powder:  in a fortnight after he was  nearly well; but a short
 time after a locked jaw came  on, and continued for two months,
 and then recovered ; but  before  that time his wounds were per-
 fectly healed.   It arises from slight wounds, before either inflamma-
 tion or suppuration comes on.   A man had a locked jaw about a
 fortnight after a nail entered the sole of his foot, which he did not at
 the time regard as  of any consequence, the wound not being larger
 than that from bleeding, and not attended with any  pain, inflamma-
 tion, or  hardness:  he died;  and  after death I  found  a black line
 continued to  a hard body under the skin, which could be dissected
 out  almost like a  lymphatic gland,  and was  found to be a bit  of
 leather, surrounded by coagulable lymph: the  black  line wTas the
 mark of the nail.  Here was  no pain which could be the cause, and
 little, if  any,  inflammation,  and the suppuration had not begun:
hence  it appears that the  spasm arose from  the slight irritation.
 Would  producing a greater irritation have prevented or cured  in
 this case? or would dissecting out the extraneous body have done
this?*   These two  kinds of wounds appear very dissimilar:  I con-
 sider that the  inflammation is the predisponent cause in the large
ones, and that in the case of slight wounds there must already exist
a predisposition, which only requires an immediate cause to bring it
into action.   The  disease oftener arises from slight wounds than
large ones, which may partly, but not entirely, arise from such being
most frequent.  Locked jaw arises from  other weakening causes;
it  sometimes arises  at the  termination of a fever, and  also at the
termination of a flux, which is one of the  most weakening diseases
we have.  It  is singular that it should begin in the  muscles  of the
lower jaw, and extend from these as a centre; but this is not a
  * [We should  probably answer this question in the negative, considering that
the progress of the symptoms is not in any degree checked by the entire removal
of the irritation by amputation of the injured part.  The fatal result, on the con-
trary, is generally precipitated by this means.] 
                  OF SPECIFIC DISEASES, ETC.              349

general rule, as it has been known to  begin in the muscles  of the
neck.  When it is confined to the muscles first attacked it may then
be considered as mild.
  Tetanus appears to have a dangerous period, in which it is most
liable to attack vital parts, which period seems to be before the con-
stitution  has become much accustomed to   it;  when of  longer
continuance, not having attacked vital parts, its liability to  attack
them seems lessened, which is generally in a fortnight, as the consti-
tution has then  become  accustomed to the spasms, and  can  better
bear them:  I have never seen one die where  it had  existed three
weeks, and after this it often continues, sometimes for several months.
Sometimes they may recover in three days, which is  generally the
most fatal  period ; but sometimes they may go on three weeks, and
afterwards recover.  If violent, it kills about the third or fourth day
from the attack.
  As it appears to attack parts not necessary to life, it seems strange
how it kills; and, seemingly, the patient is in good  health at the
time without inflammation, and with  a good  appetite; and,  yet,
though not starved to death, from the difficulty of deglutition, it kills:
however, it is sometimes combined with other, diseases, and then it
is difficult to say which  disease kills ; but when it is alone, the fol-
lowing seems to be the case: the disposition increases, and the effect,
spreading to vital parts,  affects the muscles of respiration, as the
diaphragm and intercostal and abdominal muscles, as we see in gout
when it attacks a vital part.
  The first symptom is  a stiffness in the muscles of the lower jaw,
or neck; but before the  patient  is sensible of it, its progress  is ge-
nerally gone some length, not having had occasion to open the mouth
wide, for when it is perceived  it is probably only by accident: this
stiffness makes the articulation  imperfect.  When the spasm is per-
ceived, a hardness may be felt in the temporal and masseter muscles,
and most of the muscles  of the face become contracted: if it extends,
the muscles posteriorly on the  neck become stiff, consequently the
head is erect, and generally drawn backwards;  the spasm extending
to the muscles of the back, it becomes one concave arch, preventing
the patient from lying on his back, and  a  heavy pain is felt at the
lower part of the sternum, from  the spasm probably of the dia-
phragm:  from this and  the abdominal muscles being contracted,
respiration is almost suspended, and the pain is similar to that  of the
cramp.  By this pain, and the dyspnoea, we judge of the muscles of
respiration and the diaphragm  being  affected.   General spasms
next come on, as subsultus tendinum, cold sweats, and death; and
it is  remarkable that the patient generally, if  not always, retains
his reasoning faculties during the whole progress.
  Of the Treatment.—All the antispasmodics have been given, but
without apparent  success; opium has kept its ground the longest,
but  with  little reason, as it only quiets;  but from some patients
having got well under its use, its name has been raised: I have tried
it, both in large and small doses, though always unsuccessfully. I
                             30 
350
HUNTER'S PRINCIPLES OF SURGERY.
think medicines have no power without they produce some visible
effect: opium never removes the cause, though it will prevent the
effects; it cures spasms, and removes pain, but it does not remove
the cause.   It often does good, by not allowing the symptoms to do
harm to the  constitution.  The  first  appearance of a  cure  is a
recovery of strength, as weakness is a predisposing cause; and the
first indication should be to strengthen the system.  I should recom-
mend everything to produce  extreme  external cold, as cold appli-
cations, consisting of snow with salt, to the part, and that  the
patient should be put into an ice-house or sent to a cold climate as
soon as possible.*   I know of no internal medicine.  The pain is
somewhat relieved by counteracting the  violent contraction of the
muscles: opening the mouth by force has eased it;  but this has also
killed, by causing a translation of the disease: keeping the back
bent has also given ease ; but these have relieved only in the incipient
state.  Electricity has  a temporary effect, in relaxing the muscles,
and in partial  affections has cured, by rendering the contractions
gradually less violent.
  A man fractured his arm, and about a fortnight after had symp-
toms of a locked jaw.   I found several pieces of bone in the wound,
which I  supposed produced irritation ;  these I extracted, and gave
two grains of opium every two hours, dressed the wound with tinc-
tura thebaica,  and over all applied a poultice; he continued as bad
as before.   The next day I directed bark and opium : on the fourth
day he was better; on the fifth much more so, and  his pulse good:
he was bled, which was  repeated  on the sixth, immediately after
which he fell into a fit, and died in half an hour. This sudden change
could not be from the loss of blood, though assisted by it, and by
his natural aversion to bleeding: he was of a nervous  constitution,
and his  spirits  were  easily affected.   It was probable that  this
affection of the nerves was transferred to the heart and brain, and
probably the mind had something to do in this business. In another
case of locked jaw  I gave three grains of opium  every quarter of
an  hour, but the patient died ;  the opium had no effect, and the mus-
cles were not relaxed by death.  On opening him no preternatural
appearances were found.  In one case I tried saccharum Saturni,
because lead produces paralysis, and as I conceived the locked jaw
a disease directly opposite to paralysis; I gave it in pills, and it
produced costiveness, and a peculiar sensation: a glyster relieved
him, and he  was better, and they omitted the pills because he sup-
posed they made him costive, and would not be persuaded to  take
any more.  He was at last seized in the night  with a difficulty of

  * [A remarkable case of tetanus, which was cured by an accidental exposure
to cold and inclement weather for upwards of sixteen hours,  is related by Sir
James Macgrioor in the 6th vol. of the Medico-Chirurgical Transactions, p. 450.
Dr. Elliotson has also alluded to a case of tetanus in a horse, which  recovered
under nearly similar circumstances.  Med. Gaz., Vol. XL, p. 474. It is needless,
however, to say that not any remedy has yet been discovered which is uniformly]
or even generally, successful in controlling the symptoms of this disease.] 
OF SCROFULA.
351
breathing, and spasms on the abdominal muscles, which killed him.
In this case I lamented that the lead  could not be continued.  The
ol. animale has been tried, unsuccessfully.
  I attended  another  patient  in  England, with Sir N.  Thomas.
Asafcetida  and opium were  given without effect;  these were left
off, and bark given in large quantities.  Dr. Warren being  called
in, advised, among other things, a bath prepared of milk and water.
After this he seemed better, but died  soon after.
  I discovered, to my  amazement, the different modes of different
physicians.   Sir  N. Thomas  had read  much, and knew all the
antispasmodics from  the days of Hippocrates  downwards.  Dr.
Warren having just cured his son of locked jaw, implicitly followed
the same practice in this case, being  unable to  alter his rules of
practice in the smallest degree, as occasion might require.
                       CHAPTER  XXI.

                          OF SCROFULA.

Symptoms well  marked, and usually easily distinguished ',—tl specific disease,
  but without a  morbid poison;—appears to have a sedative quality ;—not con-
  fined  to man;—certain  constitutions most susceptible of it;—certain parts
  most  liable to its attacks;—certain ages also ;—not proved to be hereditary ;
  __climate a predisposing cause;—and season ;—immediate causes numerous.
  —Inflammation of scrofula;—suppuration;—pus;—ulceration;—cicatrization;
  __difference according to the nature of parts.—Disease of the hip.—Lumbar
  abscess.—White swelling.—Consumption.—Scrofulous testicle ;—scrofulous
  breast;—distinguished from cancerous testicle and breast.—Cure of scrofula;
  —warm climate;—medicine;—sea-bathing;—regimen;—local applications ;
  —surgical treatment

Scrofula is so well marked, and has so many characteristics, that
few can mistake it; yet I  suspect there  are three diseases which
have a great affinity to it, viz. spina ventosa, exostosis, and rickets.
The first seems to be  a  pure  case  of scrofulous suppuration in
bones ; the two last to be only varieties of scrofula.   Scrofula is to
be classed as  a specific disease, but  not as  a poisonous one. It
has, in a degree, the power of making neighbouring parts  sympa-
thise, by continued sympathy.   It seems  to  have resident  in it a
sedative quality, as the disease goes on without  any increased ac-
tion, and from there being  no  adhesive inflammation.  The pus
which is formed passes along the interstices of the muscles, and is
there even incapable of irritating.
   Other animals, besides the  human subject, are  liable to it, and
probably from the same causes; thus, we find a disease very simi-
lar to  it in young turkeys, and also in monkeys, and I had  once a
young  boar which died of a similar disease ;  that is, it had  swelled 
352           HUNTER'S PRINCIPLES OF SURGERY.
lymphatic glands almost everywhere, and thickenings of the joints,
like white swellings : but every constitution is not equally susceptible
of it, although probably every constitution is more or less suscepti-
ble of it.  In some there is peculiar susceptibility, so as to have it
produced by a slight immediate cause ;  but this susceptibility is lost
by age.  So, likewise, some parts are more susceptible  of it  than
others.   Those most susceptible of scrofula are the delicate, who
cannot bear much fatigue or cold without being affected, who are
very irritable, and cannot bear strong impressions,  as of mercury,
who are of irritable minds, light-haired, and of fair  complexions.
In fair  people  there is a more languid circulation than in  dark,
and they would appear to have less  red blood.  When  it attacks
after the age of puberty it seems not so  much  confined  to colour.
When it attacks dark people I think they have  a thin skin.  Every
part has in some degree its specific disease, and this disease has its
parts.   Some parts are even disposed to it without the above causes,
even by the slightest  accident.   1st. The lymphatic  glands, par-
ticularly the superficial, and those most exposed, as those of the
neck  and lungs,  which last may be reckoned external.  As the
office of these glands seems to be for giving passage to the  absor-
bents, with their contents, it might be supposed it was only depen-
dent on absorption ; but as this is a  specific  disease, and not  con-
fined to these parts, we must look for another cause, and then too
the lymphatic vessels might be supposed subject to  it; which  they
are not; hence these glands must have  some specific  properties
rendering them liable to it.   Joints also are particularly liable to it,
and especially those of the feet and hands, from their  having so
many joints, with ligaments  and  tendons.  The elbow and  knee
come in next, and sometimes the hip and  shoulder, and frequently
the vertebrae.   In short, every part is subject to it, but no part more
than another, except the above mentioned.  The skin has less dis-
position to it than any other part, for the skin will resist the neigh-
bouring disease for a long time.
  Although all ages under the  above  circumstances  are in some
degree subject to it, yet youth is more  particularly so, for beyond
the age of fifteen the disease is less frequent, although  it will occur
from that period up  to forty; few  cases, however,  occur above
forty-six.  In youth it principally attacks the lymphatic glands ; at
a later period, the testicle; and the same things happens in other
animals.
  I do not think that scrofula can be proved to be hereditary, for
if we compare the number of scrofulous  subjects  who  have, and
who have not scrofulous parents, we shall  find them pretty nearly
equal.   I have  known many families where  it  has arisen sponta-
neously, the parents or predecessors having  never  been subject to
it;  and on  the other hand,  I have known parents who  have had it,
and their children have perfectly escaped.   It certainly  often runs
in families, but only when the natural predisposition  and immediate
causes are present; fair delicate children will probably have  it by 
OF SCROFULA.
353
 the influence of climate.  An hereditary disease should act univer-
 sally ; it should pass to all the descendants of a diseased parent;
 to the dark as well the fair complexioned; to the old and young,
 and in all  countries and climates alike.  The children may have
 the  predisposition,  but  this does not come up to  the  meaning of
 hereditary disease.   It is only the predisposing cause which can be
 hereditary.  It is hereditary for people to be born  with lymphatic
 glands, but it is not necessary for  people  to be born with them
 diseased.   Probably a susceptibility of peculiar irritations  may be
 hereditary, as we  see in families with  regard to small-pox, &c.;
 but this is  an infectious disease.   The weak and delicate are inca-
 pable  of supporting the changes of temperate climates: the most
 delicate go into this disease, and the  parts most subject to it are
 those which are the most delicate.   Climate may be  considered
 both as an immediate and a predisponent cause: the different kinds
 of weather, as damp and cold, seem to be the great disposers to the
 disease; however, in cold  climates, where there is most constant
 dryness, it  is less frequent.  That irregularity of cold and moisture
 is one  of the  greatest disposers  to it, is  evident, from its never
 happening  in warm climates; but the inhabitants of warm climates
 coming into cold ones often become  affected with it.   Some parts
 of the same country are more subject to it than others, which is
 also the case in other diseases, as agues, consumption, &c.   The
 animals of warm climates  often die of indurated  lymphatic  glands
 when brought to cold ones, as turkeys, the joints of their toes being
 first affected, in a similar manner to white swellings.  The disease
 which is called the pip in fowls is also the scrofula.
  The seasons likewise have considerable effect; for, indeed, they
 may be said to form temporary climates  in some parts  of  the
 earth.   Thus, in summer the disease is less frequent than in winter,
 and often that which is produced in winter is carried off by summer.
 But the regular cold of winter does not affect these people so much
 as spring,  for the spring disturbs  the constitution, and rouses parts
disposed to scrofulous action similarly to a slight fever.  The autumn
 has the same effect as the spring, but not so powerful.  Every
 unnatural  affection of the constitution has the  power, in some
degree, of  calling forth scrofula;  but the disease is never an act of
the  constitution.   Though there is  constantly  a constitutional
 susceptibility, its effects are always  local.  It is a constitutional
 local susceptibility.
  Scrofula appears spontaneously to arise up every day, the suscep-
 tibility in some  being so strong  that by the simple  continuance of
the immediate predisposing circumstance (climate) they fall into it,
without any other  immediate  cause.  The  immediate causes are
many.   Everything capable of producing unnatural actions in a
part is  capable of exciting scrofulous  action where the suscepti-
bility exists; thus,  the fevers of small-pox, measles, and chicken-
pox often  produce it.  The lues produces scrofulous buboes;  the
irritation of mercury in curing the lues  produces  nodes; cold  also 
354           HUNTER'S PRINCIPLES OF SURGERY.

produces  it, principally in  the glands  of the  lungs or neck; and
strains, gout, and rheumatism often leave the affected parts in a
scrofulous state.   These causes are  more  violent  than that  of
climate, and produce the disease usually from a pretty considerable
irritation, attended with inflammation arising from  the  accident,
combined with that of the  specific  kind; but the swelling soon
becomes indolent, so that it does not soon get well, and if opened,
the sore is still not healable.  We should  therefore avoid opening
it as long as possible.   The true scrofula seems attended with little
or no inflammation; or if it is so, its sedative quality prevents it
from producing pain ; but when there is less of the true scrofula, it
may give pain; however, it is attended with  many of the effects of
inflammation, as extravasation of coagulable lymph,  producing
swelling and  also adhesion of the cellular  membrane, or of the
sides of circumscribed cavities.   I have seen the whole of the intes-
tines adhering to the  peritoneum, seemingly from a scrofulous
cause,  and having scrofulous  tumours and  suppurations  in them
also: the symptoms were  tightness in the belly, without pain and
costiveness;  at other times  purging.  The adhesions in the lungs
of consumptive people  are probably of this kind.   Their indolence
and want of pain  led  me to  suspect that  scrofula has  sedative
qualities which it gives to the  matter, which does not irritate the
parts unconnected with the disease.   Where the inflammation is
visible  its colour  is of a purplish  red, which is a proof of a languid
circulation.
   The progress  of scrofula is  commonly very  slow,  but  some-
times the lymphatic glands swell  considerably in one night;  but
then there is a quick and  immediate exciting cause, such as cold
or fever,  in which case there is common inflammation joined with
the specific, which soon leads to  suppuration, although after the
phlegmonous inflammation is gone off it becomes truly scrofulous.
The swelling  at first is interstitial, but after some time there appears
to be a change of structure, as in the lymphatic  glands, the testis,
and more particularly the bones, the whole bony structure of which
is absorbed, so as to leave  nothing but a true scrofulous deposit,
similar in appearance  to a scrofulous gland.   When in the extre-
mities of the  joints, the part in view is thickened, with little pain;
this is principally seated in the ligaments; the joint loses its motion,
and the whole limb becomes weak and wastes away.
   Scrofulous suppuration is very imperfect  if it is truly of this
kind, and there is often none at  all.   The extreme parts may lose
their life  entirely;  yet they do  not  mortify, but form a curdly
matter, similar to that  in encysted tumours.   This want or loss of
life, if  there was no specific action, would cause  inflammation, as
other dead parts would; but scrofulous parts are incapable of this
stimulus.   Many scrofulous tumours suppurate and ulcerate, espe-
cially when near the skin ;  but this is not entirely the  suppuration
of the original disease,  but from the inflammation of the neighbour-
ing parts.  The matter, like common matter, is often  a mixture 
OF SCROFULA.
355
of pus with coagulable lymph, which last is often most in quantity,
it is a kind of glairy and often a  curdly matter, being a mixture
of  the  solid  parts which  are dead with the vitiated secretion.
The ulceration is  generally very slow, and when near the  skin is
often stationary, even after the appearance of redness ; sometimes
it will remain in this state for several months, with a broad surface,
not coming to a point, the skin assuming a shining purplish hue;
but there is no absorption of  the matter, as is generally supposed,
from the scrofulous indolence. It seldom happens that granulations
form, the sore remaining months, and  sometimes years, without
any.  When  formed, they look transparent, as if loaded with water,
and have little power of contraction.   The cicatrization is as slow
as the other processes, from  the essential  and  leading steps to it
being backward.  The skin around loses its natural elasticity, and
so does not give to the contiguous granulations a skinning disposi-
tion.
  To describe the appearance of scrofulous tumours  and sores is
impossible, but we can easily distinguish them by sight. A scrofu-
lous swelling generally begins  in one  of  three ways: first, by a
circumscribed tumour ; secondly by a more  diffused tumefaction ;
thirdly, by suppuration, without any tumefaction.   These all fre-
quently appear in the same person at once.  The first is seated in
the lymphatic glands, and assumes  this form from the part being
circumscribed, and also because the parts  do not give the stimulus
by contiguous sympathy to the adjoining dissimilar parts ; but there
are some  which seem scrofulous, and yet are not in the lymphatic
glands.  These  I have called tumours; as, for  example, those  in
the uterus, the  breasts, &c.   Of the second kind  are scrofulous
joints,  and the diffused swellings on the skin, toes, fingers,  hands,
and also  on the  testicle;  although, when  the whole testicle is
affected, it is generally circumscribed.   Of the third kind are cer-
tain loose bags of matter, without  any tumefaction  to distinguish
them, although  near  the  skin ;  these  are often pretty deep, and
therefore  are adapted to the parts they are  in.  There is no true
adhesive  inflammation in  these cases, when they occur in  true
scrofulous habits.  In the breast it begins like a scirrhus, and is
sometimes taken for one; but it has no  pain, and  is so gradual in
its growth that it produces no tumour in the axilla, so that it may
be safely removed.  In the  testicles it often goes off  and returns
again.  The  second kind, when near the skin, often ulcerates, and
hollows the skin by the cellular membrane, giving way more readily
than the skin;  so that when suppuration  comes on, the  swelling
does not subside, as in other cases.   When in a bone, it is generally
very slow, and the matter consists of a curdly substance.   If the
bone is dead, exfoliation is  very slow, and in such cases the bone
is eaten away by the exfoliations, as we  mentioned when  on the
subject of exfoliations; that  is, the absorbents  of the surrounding
granulations  take it up.
  The  different  appearances in scrofula will  vary according to the 
356          HUNTER'S PRINCIPLES OF SURGERY.

nature of the part, and to  these we have given different names;
scrofula in the joints we have called white swelling; in the loins,
lumbar abscess; in the lungs, consumption;  in the hip, hip-case.
Some of these are not suspected to be scrofulous.  When it attacks
particular parts, it produces symptoms peculiar to the part; but in
some parts which are not very necessary to health, it is not  easily
discovered.   If the extremities are  attacked, we find a lameness;
and if a joint, a wasting of the limb. When it attacks visible joints,
it is in general easily known; when it attacks the knee,  it has com-
monly true inflammation conjoined with it, probably from its being
frequently excited by accidents.
  Disease of the Hip.—In  most cases of lameness, or  wasting of
the lower extremities,  the  affected limb appears longer than the
other, in consequence of the patient  pressing most  on the  sound
limb, and putting the diseased one further out from the pelvis, so
as to raise the ilium.   This is particularly the case in  diseases of
the hip, although the leg is  not found to  be longer than the other, if
the patient is laid on the back.  It arises from the centre of motion
in the pelvis being rather altered by habit, which is removed if laid
on the back.   But sometimes, when the muscles are much wasted,
the limb is shorter, which I cannot account  for, nor why the  limb
is sometimes drawn up more, and sometimes  put  out further than
the other.   Mr. Cline says the limb is actually longer and  shorter
in different stages of the disease,  and accounts for it thus: in the
first  instance, inflammation takes place in  the  ligaments  of the
joints, occasioning the parts to swell, and a large quantity of syno-
via to be accumulated in the joint, which displaces and pushes out
the head of the femur, thus occasioning a lengthening of the limb;
but as the disease advances, absorption  takes place, not only of the
accumulated synovia, but also of the bone itself, with the surround-
ing ligaments;  and the head of the bone being drawn into the new-
enlarged cavity, by the action  of the gluteus and  other muscles,
occasions a shortening of the limb; and  this lengthening and short-
ening of the limb is peculiarly evident on laying the patient on the
belly.   The glands in the groin of the affected limb becomes en-
larged, from absorption of the matter.   The first appearance of
scrofula in the hip is announced by a weakness in the limb, followed
by a wasting; but sometimes there is a  thickening of the surround-
ing parts before suppuration comes. It is  sometimes  difficult to
distinguish it from lumbar abscess, which I  shall  next proceed to
speak of.
   Lumbar Abscesses.—The mode of their  coming on evidently
proves them to be scrofulous: lumbar  abscess  comes on almost
insensibly, but sometimes the patient can remember a  pain  in  the
part, a pain on the knee, or a pain on the outside of the thigh, lead-
ing to the foot. These  are often called growing pains, which shows
that the disease is affecting other  parts; which symptoms, arising
from sympathy, are often more severe  than  the  original disease.
The progress is often so slow, that  the weakness is frequently  not 
OF SCROFULA.
357
 apparent even when  matter  is  approaching the  surface, as on
 the thigh or loins. It often arises or is caused by injuries, as strains;
 in which case it  is attended with more than  usual sensibility and
 weakness.  Its occasional removal by sea-bathing proves it to be
 scrofulous.  It seldom occurs after thirty years of age, except from
 accident, so that  it is most frequently met with in young  subjects,
 who have other symptoms of scrofula.
   White Swelling, in its beginning and progress, is generally similar
 to other scrofulous cases; stealing, as it were, upon the part, and
 occasioning stiffness.   There is sometimes a fluctuation with pain,
 but then it is not  truly  scrofulous; the pain  is sometimes  scarcely
 perceivable, but at other times it is considerable.  These cases are
 of two kinds,  one of which is truly  scrofulous, the other is only
 common inflammation, mixed with more or less of scrofula; the latter
 terminates in adhesion or suppuration.  In scrofulous  sores on the
 fingers of children, the pieces of bone are often  destroyed, and
 come  away insensibly, the finger becoming shorter and  alarming
 the friends,  to whom it is necessary that we  should explain the cir-
 cumstance.
  Of Consumption.—Most consumptions are of a scrofulous nature,
 which is evident from the attending circumstances and cure. They
 are very frequent, in this and other scrofulous climates, in the fair
 and delicate, and in the young and middle-aged. They come on gene-
 rally in a true scrofulous way by catching cold.  By this the glands in
 the neck are enlarged, at the same time that tubercles form in the
 lungs, which afford a scrofulous secretion, or  are converted into a
 curdly substance, which in  the end ulcerates and  opens  into the
 bronchi.  Sometimes  thay occasion pain, and generally a cough,
 difficult respiration, and expectoration.  The pain is considerable if
 the immediate cause is violent, as great  cold;  and the  dyspnoea
 and cough will be according to the degree of inflammation.  The
 spitting varies according to the inflammation, being at first mucous,
 but after ulceration  is formed purulent.  The patients generally
 die ; but as  all consumptions are not  scrofulous, we should distin-
 guish  them.  The  diagnosis may be formed by the violence or mild-
 ness of the attack; by the slow or rapid progress of  the  disease;
 by the degree of  pain in some one part, and by the hardness and
 quickness of the pulse, &c.  Spitting of blood, which is sometimes
 violent, at other times trifling, is not always followed by a consump-
 tion.  Does  this bleeding arise from a disease in the lungs, or from
 a small vessel giving way ?   I cannot answer this question ; but
 this I  know, that such symptoms often precede a consumption.  If
 the  lungs are affected, the symptoms will arise from the functions
 of the,part being  impeded, as difficult respiration.   When we ex-
 amine consumptive people after  death, we  generally find a true
 scrofulous appearance; and as it is  clearly scrofulous, it admits
only of one mode of cure, which strengthens the  opinion of  its
being  scrofulous.  The physicians here keep their patients as long as
they can, and then send them away to Bristol  and other places to 
358
HUNTER'S PRINCIPLES OF SURGERY,
die.   But, if we see the symptoms pretty early, and consider it as
scrofula fallen on parts which are essential to life, we should not
trifle with it as with a finger; we should send them to a warm cli-
mate  at once, or near to the sea-side; for bathing and short voyages
tend much to cure scrofula, and consequently to cure consumption.
Bleeding, however, is often necessary, to proportionate the quantity
of blood to the quantity the lungs are able to  circulate; otherwise
bleeding is very injurious, as tending to produce greater weakness,
when already great delicacy exists.
   Of the Scrofulous Testicle.—The testicle is the next part in order
of susceptibility  for the disease, and when so affected has  been
often supposed to be cancerous.  Scrofulous testicles begin with out
any visible cause, are slow in progress, and are often cured  by sea-
bathing : when  they suppurate,  the  suppuration  is scrofulous.   I
have  seen  them in  lads of sixteen years of age, but never sooner;
from  whence we might think that they are not scrofulous.   They
are seldom seen in old people: for as the action of the testicle before
and after  puberty differs,  its diseases probably differ also.
   Of the  Scrofulous Breast.—I have  only seen one truly scrofulous
breast, which came on at the age of twenty-six, and increased gra-
dually to thirty-eight.  It  was sixteen or eighteen pounds in weight.
In this case there was no disease leading to the axilla, as in cancer;
so that I dissected  it out,  and it healed kindly, although the patient
had other scrofulous  appearances at the time.   It  was perfectly
circumscribed, which  is never the case with  cancer, when of any
size.   Cancer may be  so at first, when small and loose in the cellu-
lar membrane :  but when as large as a large egg, it affects the sur-
rounding parts, and is more diffused.   True  scrofula, however, if
attended  with inflammation, will also adhere, and diffuse and lose
itself in the surrounding parts, so as to put on a cancerous  appear-
ance.
   Diagnosis  between  Scrofula and  Cancer in the  Testicles and
Breasts.—A cancerous testicle affects the absorbents going from the
testicle and the spermatic cord;  but I do not think that this is uni-
versal, since we sometimes find the cord unaffected, but in scrofula
it is never enlarged or affected at  all.   The  distinction, however,
in some cases, is very difficult.  As we operate in cancerous cases
because the cord  is  sound, so we  must often do so in scrofulous
cases which have no cancerous disposition. In the scrofulous breast
we have no thickening leading to the axilla, or in the axillary glands,
but in cancer  they are  thickened from continued sympathy; and
this is, perhaps, the best  criterion.
   From the circumstance of the cancerous disposition spreading by
what  I call continued sympathy, the surrounding parts being con-
taminated and  taken  in  with the  original disease, the skin  in  all
these parts takes on the same disease with the cancer; but in scro-
fula it does not do so strongly: therefore when a cancer breaks it
spreads, but in scrofula the skin seems rather to have a disposition
 to heal. 
OF SCROFULA.                      359
  Of the Cure of Scrofula.—The remedies must be directed both to
the constitution and to the part affected; but if we had a specific
medicine, then attacking the constitution alone  would be sufficient,
as it is in the venereal disease.   As to external  parts, the only cer-
tain cure is extirpation, and  this is very confined and is often impro-
per, because the parts frequently get well of themselves ; still we are
often obliged to have recourse to this means.   Internal medicines
have very little power;  they cannot alter the constitution of fair
people, or prevent the effects of climate, or change the disposition
of parts; neither can they make young people old.   They can only
lessen the susceptibility  of  the constitution, but do not reach the
cause; hence  there  will soon be a relapse, if they are disconti-
nued,  climate being often  of itself an  immediate  cause of the
 disease.
   We'can sometimes affect the constitution by changing the climate;
 but changing  the  climate will not always effect a cure, for when
 vital parts  are affected it is seldom  done till too late.  Change of
 climate is equally necessary in other cases as  in  tubercles of the
 lungs, these all depending on the same constitutional disease.  Scro-
 fulous patients should go towards the South, or near the  sea-side,
 or take short voyages.  Sea-bathing  in consumption appears tre-
 mendous, but it should be adopted in a warm climate.  When these
 means cannot be complied  with, strengthening remedies are useful,
 as bark and cicuta,  with cold bathing ; but  these  have no specific
 effects.  Mezereon seems to have great power in the  cure of this
 disease : a man with a very large swelled elbow, which appeared to
 be scrofulous, (although he had more pain than is usual in scrofula,)
 had been under a course of mercury for a venereal affection when
 the swelling came on; he rubbed it with a liniment composed  of
 acetum scillae, but with no advantage:  he  was then  directed the
 mezereon  decoction, and  soon  recovered the motion and natural
 figure of the arm.  The cure was completed in twelve days without
 any sensible effects  from the medicine  or the liniment,  which  he
 continued to use.  A woman with enlarged lymphatic glands of the
 neck, which did not subside as  usual with warm weather, I cured
 by mezereon.  I gave it in the  following manner: mezereon root,
 one ounce; water, six  quarts; liquorice root,  half an ounce.  Boil
 down to four quarts.  Half a pint to be taken twice a day, or  as
 much as the stomach will bear.
    Sea-bathing seems to have the greatest specific power. In general
  it is used in summer; but the disease requires it most in winter.   It
  is to be considered  in two lights; first, as a simple bath;  secondly,
  as to its specific quality.   Baths are of three kinds: cold, warm,
  and tepid; the specific effect being the same,  whatever may be the
  temperature.  When other diseases attend scrofula, for which baths
  of certain temperatures would do  harm, the sea-bath should  be
  regulated accordingly.  In some constitutions a different  degree of
  warmth is suitable  from what is suitable in others.  In some cases
  two  good purposes may be answered, for in some the  cold and 
360
HUNTER'S PRINCIPLES OF SURGERY.
 specific are both wanted, and in others the tepid and specific.  The
 directions for sea-bathing are in general insufficient, but they should
 be particularly attended to, as with some the cold bath will disagree
 independently of all  disease; some will be rendered cold  all day
 by it, though they will recover  by its specific effect, which is always
 the same in  all  constitutions.  I do not  think that the sea-bath
 lessens permanently the susceptibility to the disease, but that it is
 a temporary cure for the present diseased action, and prevents the
 effect of immediate  exciting causes; but  after leaving it off, the
 susceptibility returns, and the disease often returns in winter after a
 summer course of bathing.  Next  to sea-bathing  and mezereon,
 hemlock seems to have the greatest specific power.  Burnt sponge
 has been recommended, but I am in  doubt of its specific powers
 Mineral alkali is serviceable, but its specific powers are very weak.
   Warm clothing, and that next the  skin, is most proper, because
 it keeps the warmth constantly the same.   This is Nature's method
 in the cure of animals, and it should be particularly attended to in
 children : the outward clothing may be according to people's fancy.
 Children of this disposition should never expose their naked feet to
 cold and wet, as  is frequently the case.  The  exercise should be
 gentle, and the diet principally of a vegetable kind: but I consider
 this of little service, as  the disease is frequent in those countries
 where little else but vegetable diet is eaten.
   From  the indolence  of scrofula  we  might a priori  think that
 many local applications would be serviceable,  especially those of
 a stimulating kind; but these all prove injurious, as mercury, cop-
 peras, balsams, &c.; indeed, few applications are of any service.
 I have myself only found benefit from cicuta and sea-water.  The
 juice of hemlock made into a  poultice  is serviceable after suppu-
 ration has come on;  and poultices made with sea-water have  done
 good, when the  cicuta  has failed,  especially in  white swellings,
 before suppuration has taken place; and I may also mention that
 this water,  as a lotion, applied  to sores, often gives them a healing
 disposition.
   The best surgical treatment for those cases which will not admit
 of removal, is  to  do nothing.   Where  suppuration is superficial,
 openings into the abscess should not  be made, as they are often
 absorbed spontaneously, and when they break of themselves  they
 heal the soonest: but exceptions may arise, as when an opening is
 required to extract an  exfoliated bone; otherwise openings  only
 add to the causes which produce such diseases.   Those parts which
 cannot be removed, as lumbar  abscesses, are  generally incurable;
 and the question i?. are they to be opened or not ?  The only answer I
 can give is, that before opening them patients are generally pretty
 well,  but immediately after  opening  them they become  unhealthy
 and  hectic, which  continues  till  death.   Hence  the practice of
opening  them shortens  life; but  sometimes thev get well  bv this
practice, that is, perhaps, about one in a hundred: and  it mav be
thought right to treat all as if they were  curable, as we cannot 
OF MORTIFICATION AND CARBUNCLE.         361
distinguish; this must be left to  the  surgeon and the  particular
circumstances of the case.
  The common effects of surgical treatment will  not be found to
arise in cases of scrofula; cutting always does harm.  In common
indolent  abscesses, free openings  is  the best remedy, and the pro-
duction of as much violence  as we can; but  this will  not  do in
scrofula and cancer.  In scrofula, irritable inflammation  frequently
supervenes, or erysipelas  extending to the cellular membrane, and
produce  sloughing:  for we  find that no violence can increase the
restorative action without also increasing the original disease. We
find few actually die from the disease, although the vital parts are
attacked.   When the lungs are  affected, it is the difficulty of the
respiration which kills;  when  the  mesenteric glands are affected,
death happens from the want of nourishment; when there is lumbar
abscess, the constitution is worn  out  by long-continued  discharge
and teazing complaints; but when  superficial parts only are affected
they generally get well.  Accident produces many visible  causes
of cure,  as fevers, &c.:  and probably many invisible ones too.
Climate is often a cure as well as  a cause of the disease.  Children
are most favourably situated for a cure, from  the daily variation
of their constitutions.  Puberty often produces a cure, wdiich may
be called the natural, and is most manifest in women.   When the
disease begins at a later period  it has not these  resources, but is
more tedious.
                      CHAPTER XXII.

               of mortification and carbuncle.

Mortification ;—death of parts;—accompanied by pain :—with or without inflam-
  mation ;—treatment.—Caustics  and  cauteries.—Carbuncle ;—peculiarity of
  situation;—often numerous;—attacks free livers;—appearance, progress;—
  constitutional and local treatment.

The effects of life are preservation and  action : death is the loss of
both.   Life may  exist in the whole, or  only in a part; but it must
always be in a vital part.  Other parts  may be dead,  without
affecting materially the machine.  The immediate cause of death
in a part would appear to be a loss of circulation: this may arise
in various ways, but it must be the effect of some cause.   Mortifi-
cation is very different from universal  death: the loss of natural
life arises from some universal action having taken place, the same
structure still remaining; but it is altered in mortified parts, all is
blended in one  mass of animal matter, and  cannot possibly be
injected.
  Partial Death, or Mortification, arises from various causes,  yet
                             31 
362
HUNTER'S PRINCIPLES OF SURGERY.
there is probably in all of them some cause which may be called
specific.   There are many others which  may be  considered  as
immediate and remote causes, as happens in gout, which may  be
produced  by many causes, yet the specific  cause has a peculiar
mode of action in this as it has in other diseases.   Mortification is
commonly attended with great pain, characterised by burning, and,
if it is in view, the stagnation of blood in the vessels always pro-
duces a livid colour.   The same burning sensation takes place from
pressure, if carried sufficiently far to produce mortification, and is
familiar in people's heels after lying long in bed.  There are two
kinds of mortification, one without the other with inflammation.
The first  arises from causes less visible than the  other; that  is.
there is no increased action, or sensible heat, although the burning
pain is considerable.  What  the predisponent cause is I cannot
tell :* I have suspected something like a spasm of the small vessels,
but I cannot be certain: we know spasms  will sometimes threaten
mortification,  as we see in priapism, by which  I have seen mortifi-
cation produced in  a dog.  When the  disposition  is present, the
action goes on ;  as we see in  sores, some parts being of a purplish
hue, and going on  in this way, while health is in the other parts.
In some of these cases, a part withers and dies, and does not stimu-
late  the living parts, so as to produce separation, for a long time;
but I have seen too few of these cases to judge of them accurately.
The second kind seems to  arise from  a change taking place before
death.   Inflammation seems  to be the immediate cause; but this
inflammation  has two remote causes, of which  one is weakness.
which is the  commonest  cause of mortification ; but the other,  or
that which produces carbuncle, is not well known.
  Inflammation  sometimes depends upon an increased action with
increased power of the vessels ; but in mortification it must depend
on an  increased action with diminished power; in all cases where
this  kind  of  mortification takes  place, we have evidently a defi-
ciency of the  animal  powers.   In young  people,  mortification is
generally  preceded by fever ;  in  old by debility ; and the weakest
parts generally give way first, as  the toes.  But debility alone does
not produce mortification, if there happens  to be  strength in the
part sufficient for the action which is induced : debility, therefore,
is only a predisposing cause.  We see this in  scarifying" anasarcous
legs, in weakness from accident  in weakened parts, in bruises, in
frost-bitten parts, or wherever action  is produced beyond what the
powers of the  part or system are able to sustain.  But the increased
action is  not  necessarily  inflammation ^ it may be a salutary en-
deavour of the part to restore itself;  which  salutary action the
powers of the part  canmot support,  and hence  it gives way and
dies.   When  frost-bitten  parts are exposed to heat, the debility is

  * [Later observations  have  rendered it highly probable that dry gangrene
always  depends  on a more or less complete  obliteration of the great vessels:
either the arteries or veins, but particularly the latter.] 
OF MORTIFICATION AND CARBUNCLE.          363
 increased by the necessary action, which action the strength of the
 part cannot bear.   Heat is congenial to life ; but it should be pro-
 portioned to the degree of life, otherwise it will increase the debility.
 On this principle it is that cold air is so serviceable to people weak-
 ened by disease.  In frost-bitten parts, for example, the living prin-
 ciple  is much  diminished by the previous cold, and heat must be
 gradually  applied,  in  proportion to the quantity of life  which
 remains ;  but as  the manifestations of  life increase, so should the
 heat be increased also, otherwise  by applying a degree of heat, at
 once, too great in proportion to the life, the part will mortify, which
 is invariably the case in  man  and all other animals;  for warmth
 induces a more than ordinary exertion of the living powers, which
 may even be so considerable as to destroy the  powers themselves.
 This proportion of power and action  should be attended to in many
 common diseases:  as  appears  from  a  case which I have already
 described.
   Parts which have been weakened seem much disposed to take on
 the continued sympathy; and the parts, finding  this disposition,
 become irritable, and are easily inflamed, which inflammation pro-
 duces death oftener  than any specific inflammation.  Mortification,
 however, is neither peculiar to weakened habits nor to accidents;
 but is often consequent on common inflammation,  as in compound
 fractures.   In a state of health the powers are much greater than
 the action ; but when this state does not exist, either the powers or
 the action must be predominant.  Thus  in mortification the powers
 are too weak for the action ; but  this weakened power is produced
 by various causes, such as old age, accidents, or erysipelas.   The
 skin of such as take on this irritable action is generally opake, and
 looks withered even in the young subject.
   Of the  Cure.—If our principles are  just, it will be easy to lay
down a rational practice.  Practitioners have been conscious of the
 predisposing cause, which is debility, but not of the immediate  one,
 which  is increased action.  Hence bark, cordials,  wine, &c, have
 been given, by which  an artificial or temporary action has been
 excited; but this  practice produces  an increased action, without
 producing increased powers, and afterwards the debility is greater.
 Antiseptic substances have also been employed, such,  for instance,
 as preserve dead flesh; but this is very absurd.  The  local treat-
ment has  been equally so:  consisting in the application of warm
dressings in the wounds  made by scarifications; thus stimulating
parts, the actions of  which were already too violent.  This practice
might be suitable  enough in the first kind of mortification, where
death comes on without any increased  action or effort.  Will  any
thing lessen action, and increase also the power ?  Wine will not;
bark is the only remedy of this  kind we have:  other medicines
may be given on this principle, but none  of them are so efficacious;
opium  for instance is useful, from  lessening the action, but it does
not increase  the strength:  it is, as I have ascertained by experi- 
364           HUNTER'S PRINCIPLES OF SURGERY.
 ment, more especially  useful when applied to the part than when
 given internally.
   Of Caustics and Cauteries.—The death of a part  may be  pro-
 duced by a deficiency or privation  of the  living  principle,  and is
 then called mortification;  but it may also be produced  by mecha-
 nical and chemical causes, as bruises, the actual cautery, or caus-
 tics.   Too much action will also arise from a violent  stimulus, as
 arsenic, and kill a part, and in proportion to  the deficiency  of the
 living principle, the sooner will death be induced:  as happens in
 bruises, in which the cellular membrane sloughs  before the skin,
 though the skin is the part which is most injured.   The  more  vas-
 cular a part is  the greater is the power of life;  hence  muscles,
 glands, skin, &c, difficultly part with their life; whilst  bones  and
 tendons soon die by exposure, from want of living power to support
 the  necessary inflammation.   The  actual  cautery  coagulates the
 juices, in consequence of which the living principle cannot exist.
 When caustic alkali is combined with animal or vegetable substance,
 the compound forms  a  kind of soap which is soluble in water.   The
 operation of a caustic is not  immediately on the living principle,
 but chemical; but its effects are retarded in some measure by the
 living principle, so that  it acts more rapidly on some parts than it
 does on others.   As no substance acts  chemically till  in  solution,
 the caustic must first be dissolved, which is slowly effected by the
 perspiration on  the skin.  By the application of a caustic,  a  blister
 is raised, and serum accumulated, which dissolves  a greater quan-
 tity of the caustic ; and this effusion is the consequence  of all  irri-
 tations, and is intended to get rid of the cause of irritation.  Alkalies
 are  in  many cases to  be  preferred, although from their  ready
 solubility they are disused in some cases.  Their action  is  so very
 expeditious that the  presence of the surgeon  is  required:  they
 ought, therefore, only to be used in superficial  abscesses,  as they
 give much pain and spread, and would take  up too much  of the
 surgeon's time when the parts to be destroyed are deeply seated.
   The caustic alkali, or lapis  infernalis, should have  its end wetted
 with water previously to its being  applied to the living part; as
 soon as it  is  through the  cuticle, the cutis effuses serum, which
 should not be allowed to extend beyond  the  intended  slough, but
 should be wiped off writh an armed probe.  It is impossible to  say
 what time will be necessary for this effect, as it will depend on the
thickness or depth of the part; but when a very long time is neces-
 sary, we may scarify the upper part so  as to quicken  its  effects;
 and this I may observe  is a very ready way of opening  superficial
abscesses, when near the skin.  When we make an issue in  this
way, we should go as low as the cellular membrane.  The common
caustic consists  of caustic alkali and quick  lime, which  should be
mixed with soft soap, or with  liquid caustic  alkali, if its  powers
require to be increased ; the concentrated acids are likewise  em-
ployed, as for  example  the  vitriolic and nitric, which should  be
applied, like the caustic  alkali, by means of a piece of glass, or 
OF MORTIFICATION AND CARBUNCLE.          365
 some other substance which will not be acted upon.   The metallic
 salts are chiefly employed to destroy luxuriant granulations, as blue
 vitriol, lunar caustic, &c.; but if they are used to produce a deep
 slough, they must be used in  powder, mixed with some soft  sub-
 stance.  These last  substances  only coagulate the  parts, but  do
 not chemically combine with  them,  as the alkalies do.  Arsenic
 seems to have  both  a chemical  and a  poisonous effect upon  the
 living textures.
   Now as most parts are capable of communicating their sensations
 to the brain, the gradual destruction which  caustic occasions pro-
 duces considerable pain.   This may be alleviated by mixing opium,
 or  extractum thebaicae  with the caustic, or by the application of an
 opiate plaster an hour or two before  the caustic, which will have
 a very good effect, especially in women and  children who cannot
 well bear the caustic long enough  to  produce  its proper effects
 without these alleviations.* A long while generally elapses before
 we can bring a cut issue to a proper degree of suppuration, as the
 means which are employed for keeping it open prevent a good
 suppuration, by keeping up inflammation;  but caustic seems  to
 answer better,  by destroying a certain quantity of substance, which
 separates in the form of an eschar, and  leaves  an open sore that
 will generally  suppurate freely.  In some the  eschar  is slow  in
 separating; in  others it will be thrown  off in  about ten  days; but
 in others it will require  three weeks, the separation being  always
 more rapid when the caustic goes fairly into the cellular membrane,
 which has less life than the cutis.
  The separation of a dead part from a living is performed by the
 absorbents, which take into the circulation the edges of the sound
 parts which adjoin to the dead, and thus the dead part being set  at
 hberty drops off.   But in order to effect this, inflammation is first
 produced, and then ulceration or absorption follows.   The separa-
 tion takes place sooner  or  later, in proportion  to the life of the part;
 hence  the  skin, muscles, and  parts which  are  nearest  the heart,
slough  readily: tendons and bones slowly; and cellular membrane
less readily than  the skin.  Life in a part is in proportion to the
number of vessels it has for its simple support, the vessels for other
purposes not adding to its powers of life, considered in  itself.   In
new-formed parts, however, the separation is  not so slow as  in
original parts, although they are disposed to slough more readily;
 but this depends on a different principle, viz. on weakness, which is
 consistent  with what has  been already observed.  How far the
brain is  capable of sloughing I cannot determine, but I  should
imagine that people would  never live long enough for  this  process
 to take place.  In vegetables  we find dead parts rot; but they are

  * [Nothing is so effectual for alleviating the pain occasioned by potassa fu3a»
 as the application of common  vinegar, which immediately combines with  the
 alkali to form a neutral salt.  It possesses also another advantage, in restraining
the  operation of the  caustic, which in some  instances is very apt to, spread
beyond the assigned limits.]
                              31* 
366
HUNTER'S PRINCIPLES OF SURGERY.
not separated as the dead parts  of animals, because they have no
absorbents;  but if they separate, they do so by a process of putre-
faction.
  Soft parts, when about to slough, first become darker coloured,
and if exposed to the air become dry and  hard.  The separation
always begins at the external edge, forming a groove  between the
living and dead parts ; this groove becomes gradually deeper, till
at last it is quite through, and the slough drops off.   Why the sepa-
ration  should begin at the surface I do not know, except that the
external parts are  more ready to take  the  alarm, or that the skin
goes through  its operations and separates more rapidly than the
cellular membrane;  but as  we find in bones that the exfoliation
always begins at the external edges, I cannot offer the above as an
explanation.   Its beginning from the edge makes the separation at
first only from the circumference, but sometimes  it  is from  the
centre, as when matter is formed underneath.
  The separation of which I have been treating is of two kinds;
first, where the cause is constitutional, as in mortifications; secondly.
where it is  local, as by caustic.  To the first  kind of separation
much attention is to be paid, as the mortifying disposition must cease
before the part already mortified can be removed. When the sepa-
ration is begun, if the parts are small, they may be allowed to go on
their own way; but where it is a whole limb, it is necessary to remove
it, as  the length of time required for the separation would often wear
out the patient's constitution.   The  when and  the where this  is to
be done  is a  matter of great importance.   We should  certainly
remove the bulk of the mortified limb ; but as  there  is danger of
inflammation and fresh mortification being brought on, from cutting
the living parts, even though the mortification  should be stopped,
from  the constitution  being mended, we must wait till we see  a
healthy line of separation, and, by the appearance of the granulations,
judge of the propriety of amputation.  I would recommend removing
the part  in mortifications of the leg, by cutting  into the dead parts
near to  the living; and after a  time, if it be necessary (which can
only happen in the legs,) the irregularities can  be  removed.   In
sloughs from caustic, practitioners  used to cut out the eschar ; but
as a part remains which requires the same length of time to separate
as the whole, nothing is gained by this proceeding.
   Carbuncle, or Anthrax, is an inflammation of a  specific  kind,
which is shown by its regular termination.  It may in some measure
be reckoned a cutaneous disease, commonly beginning in the  skin.
The  mortification which takes place  in the parts succeeds inflam-
mation ; yet it does  not always arise from inflammation, attended
with general debility ; nor does it always take place in the weakest
parts, as the foot, but commonly near  the source  of circulation.
That there is some peculiarity in the constitution, is perfectly evi-
dent, from the patient being apparently otherwise well, with a orood
pulse.  It seems to be a specific effect of this inflammation to pro-
duce death in the part.  It most frequently appears on the back  or 
OF MORTIFICATION AND CARBUNCLE.          367
the neck, and seldom in the fore part of the  body, which is very
singular.  Carbuncles seldom come alone; but seldom more than
one begins at the  same time, but in succession: I have seen them
extend over the whole back.   Another peculiarity is, that they sel-
dom attack any but those who have lived above par, especially  in
eating ; in which respect they resemble gout,  as well as in the cir-
cumstance that they are generally  inclined to occur in fat people.
I suspect that any irritation, applied to those in whom there  is this
peculiarity of constitution, brings them on; therefore to an elderly
man of this disposition  I am cautious of applying blisters.   The
inflammation is in the cellular membrane, and though very similar
to the erysipelatous, is yet very different.  It does not produce adhe-
sive inflammation, but runs into mortification, as  the erysipelatous
does; neither does it produce true  suppuration.   At first it appears
like a pimple or small-pox pustule,  in the cutis, the matter of which
would seem to penetrate to the cellular membrane, and affect  it; but
perhaps the  disease itself extends to the cellular membrane  in the
first place, although the  first idea is most probable, as  there is  no
adhesive inflammation to prevent that being the case.  The tume-
faction is considerable, but flat:  the cells being filled with pus, mixed
with coagulable lymph.  The matter approaches to the  skin  by
ulceration ; or if very tight, it mortifies.  The matter  oozes from
several openings, like water out of a sponge.   At last, in most cases,
the cellular membrane dies, and the ulceration in  the skin  extends.
Sometimes the whole  sloughs off together, leaving a wide chasm,
with inflamed lips.  When suppuration takes place, there is con-
tinued sympathy in  the  surrounding contiguous parts, and then the
inflammation becomes more of  the adhesive kind.  The local pecu-
liarities are  as follow:  1st, it begins like a pimple ;  2dly, the inflam-
mation  spreads a little, giving  it  the  appearance of a boil; 3dly,
the inflammation spreads under the skin, and a  doughiness takes
place, the skin  itself not being much affected, the tumour having a
defined  edge, and being six or  seven inches  perhaps in diameter.
The skin now becomes  affected, beginning  at the first point of the
disease, and spreading throughout; little  pimples  are frequently
formed upon it, which often communicate with  the cellular  mem-
brane beneath.   Bounds are at last set to it by the surrounding
adhesive inflammation.   The practice  should be to open it as soon
as it begins to form a base, to prevent its spreading further.   When
it has gone through all its stages the process  of cure begins, and it
heals as soon as other sores, and one is often healing while  others
are forming.
   Boils, I suspect, are all of the  carbuncular species, but less  in
size, with more of the adhesive inflammation, which prevents their
spreading.    Boils  have another distinction,  which is, that they
seldom produce suppuration equal to their inflammation ; and, as  in
carbuncle, there is produced  a visible slough, so there is a core in
boils which  answers to the slough.  When boils are very large the
constitution  is in  fault, but not  so  when  few and small;  they are 
368          HUNTERS PRINCIPLES OF SURGERY.
then supposed to be salutary.   Boils arc most  frequent in youth,
carbuncles in age ; yet we find  boils in old people; but carbuncles
are seldom in people below the middle age.
  Treatment of Carbuncle.—As carbuncles begin with a species of
inflammation, which terminates in mortification, the patient  being
generally of a full habit and in  apparent health, it  might be  asked
if the constitution should not be treated by evacuants.  I would
treat it always according to circumstances;  but in the latter stage
I have  always found evacuations improper.  Evacuations  never
answer in constitutional specific inflammations, as they do in com-
mon inflammations.  Bleeding in gout and erysipelas is often very
injurious, yet it is occasionally  necessary ; neither  in inflammation
from poisons has it a good  effect, unless where the constitution is
ready to run into violent common inflammation, in  addition to that
produced by the specific power  of the poison; hence, in small-pox,
gonorrhoea, &c, bleeding is sometimes  useful: but evacuations and
bleeding never agree so well with those who have lived above par
as in the temperate; hence they are more useful in acute rheuma-
tism than  in acute gout.    Cordials and bark,  and warm  medi-
cines, are  commonly  given, and  made more stimulating by the
addition of tinctures; and  these are given for two reasons; first,
because the part is dead ;  and secondly, because the patient often
becomes much debilitated.   But such medicines can  only keep up
the strength  and the action depending upon strength, but cannot
overcome the specific  nature of the disease: therefore we  should
give others, that we may at last find out a specific; yet, if we had
a specific,  these  remedies would be often also necessary,  as they
are in lues.   I have, however, tried  other means, but with little
success.
  A gentleman,  aetat.  70, who had lived  well,  and  had had a
universal dropsy, which he appeared to be cured of, was attacked
with inflammation on  the left shoulder,  which turned out to be true
carbuncle, which, as soon as it was opened, was followed by several
more near the spot.   The person  under whose care he was gave
him one drachm of powder of bark with ten drops of tinct. thebaica
every hour,  which rather  purged him; he also took calomel and
opium, the former of which was increased, to see if mercury would
do  good;  but it had no effect;  neither did  it prevent  more from
forming.   One was very large, and there were several smaller ones
in different parts of the  back; one was opened pretty early, which
seemed to  stop its increase, and I opened another at its orifice, with
caustic, which discharged the matter, and seemed to stop its progress.
The first during this time was healing.  When the first appeared he
seemed to be in good  health, but afterwards he gradually lost it,
his appetite became bad, his pulse  quick and small, and his ankles
a little swelled.   As neither bark nor calomel and  opium had been
of any use, I said to Dr. David Pitcairn, " Now do not let us permit
this patient to be lost, whilst we are only using such means as expe-
rience shows to be of little or no effect; let us try something new ; 
OF MORTIFICATION AND CARBUNCLE.
369
for David, this is a case more belonging to my province than yours,
and I, being an older man, have seen more of them than you have,
and can tell you what perhaps you did not know, that we have no
powers in this case that are known."  Now David is a  truly sensi-
ble man, and not governed by form ; he therefore agreed, but wanted
to know  where we were to begin.   " Why, with the first letter of
the alphabet, and go through the catalogue of the materia medica,
so as we  do not stop too long on the letter B (Bark), as is gene-
rally done."   As cicuta was a medicine  of considerable powers,
and then not thoroughly known, we began with that, of which the
patient took half a drachm in the day, but without effect. I  then
tried sarsaparilla, both in powder and decoction;  the powder was
made into bread and pudding, to eat through the day, but with no
good effect.  Dr. Pitcairn now  proposed decoction of elm bark,
from having seen it  of use  in erysipelatous inflammation,  there
appearing an affinity between  this disease and erysipelas ; this I
assented  to, but from a thought which had struck me, I  wished to
try the fossil caustic  alkali (soda); so  they were given together,
and we thought they were of service, as it was during  this course
that the patient recovered, though it must be confessed it was  very
slowly; but  some fresh  ones which had  shown themselves disap-
peared again.  I have given fossil alkali to several since with good
effect.   I was myself always troubled with boils, until I took forty
drops of this lixivium night and morning in milk for two months,
when all my boils disappeared, and I have since  had no return of
them.  Another gentleman asked my advice on whom two or three
carbuncles had  begun to appear, and he was perfectly cured by this
treatment.
  The topical treatment  consists in the free dilatation  of the skin
which covers the sloughing cellular membrane ; but as this comes
after all the mischief  is done, I think it a bad practice at the latter
stage, although  applications to the part are useless until the slough
is  separated.   Small openings at the  beginning, to  prevent the
increase, is all we  should do,  and not make any openings  after-
wards.*

  * [The practice of modern surgeons is to make free openings in all stages of
the disease,  for which the  best reasons may be given.   An escape is thus
afforded to the diseased  sloughs and  secretions, and an opportunity given to
apply appropriate  dressings  to the sore;  but the propriety of  this treatment
chiefly arises from the indisposition of the skin to  ulcerate sufficiently extensive
to allow the sloughs to come out. See note, p. 196.] 
370            HUNTER'S PRINCIPLES OF SURGERY.
                      CHAPTER XXIII.

                           OF POISONS.

General considerations respecting poisons;—definition of a poison.—Mineral
  poisons.—Animal poisons, natural and morbid.—Morbid poisons ;—their ori-
  gin ;—effects local, constitutional, or mixed.—Of local diseases.—Itch ;—
  nature;—cure.—Cancer, definition of;—origin and progress;—effects only
  local;—does not affect the constitution ;—reasons for this opinion ;—exten-
  sion of the disease by three modes;—absorption of the poison;—does not pro-
  duce specific fever;—no proof of poisonous  disease  of the constitution.—
  Local effects of cancer ;—predisposing causes.—First appearance and symp-
  toms of cancer ;—progress towards suppuration ;—treatment;—destruction of
  cancer;—extirpation;—mode of effecting it, and cautions  to be observed.—
  Cancerous testicle.—Fungated sores.—So-called cancer of the penis.

No unexceptionable  definition  of a poison can be absolutely given,
for almost everything capable of injuring in a healthy or unhealthy
state may be considered as  a  poison.  They are such  as destroy
either the structure or the functions of an animal.   The last  may
be similar to the weather, which often affects the mind, and  may
be called  a poison of the  mind.  But  there  are many  substances
which, when applied  to a healthy state of the body, may injure, as
poisons; yet when applied to an unhealthy state they  will coun-
teract that state, and keep up health as long as they have the power
of irritation.   The healthy action, then, being a  tertium quid of the
unhealthy and poisonous, these are to  be considered  as medicines
which have different  effects  at different times, and  under different
circumstances, as food; sometimes they  are capable of curing one
diseased state and not another, even of the same specific disease;
indeed, each disease has its own peculiar  specific. Many  substances
act as poisons in some constitutions and not in others; as muscles,
&c, thrown into  some  stomachs poison them ; also strawberries
and cider in some persons cause flushing and erysipelatous inflam-
mation.   Whatever our idea of a poison may be, we  must gene-
rally exclude the idea of quantity, for even the most innocent sub-
stances may become poisonous by quantity, as common food.  Some
cannot eat meat of any kind without  being affected, but can eat
fish or fowl without harm.  If we  do  not pay regard to quantity
we cannot distinguish poisons from  medicines, as many of our me-
dicines may even be  given so as to poison or to  produce no effect
at all.   So vague are our ideas of poison that we do not give the
name of poison to all the actions of the  same substance when it is
formed to act in two different ways,  though it may kill in both
ways.   A man killed by swallowing a piece  of glass could not be
said to be killed  by  a  poison, because we  know its effects; but
powdered glass  swallowed would irritate the coats  of the stomach, 
OF POISONS.
371
and kill, and would hence be called  a poison.  Many other things
might be called poisons, as cold water drunk when a person is hot,
producing fever, erysipelatous  inflammation, the eruption called  a
surfeit, &c.
  Poison is not only what is taken in by the stomach, but also by
the lungs, as mephitic air, which kills  immediately, and has no
cure;  so likewise many applications administered externally  are
called  poison.  Our present idea is that they act in three ways, viz.
mechanically, chemically, or on the living principle.  The two first
always act locally, but the third either on the whole or on a part.
We do not call everything  a poison which acts mechanically, as
swallowing a knife ; but we suspect  a different mode of action from
powdered glass or hair, and therefore call them mechanical poisons,
imputing the effects to some hidden power, which is in some mea-
sure right, it being their irritating effects on the living principle of
the coats of the stomach, not simply cutting and lacerating mecha-
nically as the knife does.   These ought not therefore  properly to
be called  mechanical poisons.  Melted  lead or boiling water will
kill chemically, yet cannot properly be said to be poisons.  Some
only irritate the part, the  substance being too weak to have  any
chemical effect.   Nor is everything which acts on the  living prin-
ciple to be called a poison;  but we should distinguish between poi-
sons of this kind and medicines;  yet we find " a slow poison" is a
common saying, as brandy.  Arsenic kills by inflaming the sto-
mach, and not by a peculiar action, therefore it is not a poison; nor
is anything else which kills  by common  inflammation or  common
effects.  I would define poison to be a substance which has a pecu-
liar mode of irritating, a peculiar mode of affecting the living prin-
ciple,  and which produces its effects more or less in any quantity,
however small.  Of this kind are most of the  morbid poisons ; but
 small-pox falls short of the definition, in not keeping up its  effects
 after having once affected the same person.
   Of the different ways in which Animals may be affected by Poi-
 sons,—There  are three ways of their acting, and also a mixed way.
 The first is where the poison affects only the part  in contact with
 it, and no part of the general system, except from the  local injury.
 This includes the three kinds of poison, viz. mechanical, chemical,
 and those acting on the living principle.  Examples of these are
 glass  acting mechanically, sublimate of mercury acting chemically,
 and the matter of cancer, which acts only on the living  principle.
 The second is when the poison affects the  constitution,  which con-
 stitutes it a morbid poison entirely,  as, for instance, the jail distem-
 per; but how it gets to the constitution is unknown. The third  is
 when the whole nervous system is affected, as by poisoned arrows,
 honey, muscles, nux vomica, and probably also the bite of a mad
 dog, which produces  no visible  effects  on the injured part.  The
 mixed, or compound, is of two  kinds:  first, when  it produces  in-
 flammation of the part, as was observed of cancer and itch, and at
 the same time affects the whole constitution, as  the venereal dis- 
372           HUNTER'S PRINCIPLES OF SURGERY.
ease, which the cancer and itch do not.  The second is that which
has three different modes of contaminating a part, like the third class,
viz. 1st, locally, as in the itch; 2d,  like the jail fever, which  acts
first on  the  constitution; and  3d, like the first of the compound,
producing local inflammation; of this kind  is  the  small-pox,  &c.
We might make a fourth out of those in which the poison might
be taken into the constitution without producing local effects in the
first place, as in jail fever, natural  small-pox,  &c.; but  these  are
then received by contact, and  not by insertion.   In some the con-
stitution is unaffected till ulceration has taken place, from knowing
which we can often  prevent their general effects.  How a  poison
lies inactive so long  is with difficulty explained, but it is a principle
belonging to each, each having also its own specific  latent  period
before it affects the constitution.
   Mineral Poisons.—The mineral  poisons  are mostly metals,  the
poisonous qualities of which depend on their solution in our juices ;
their  virulence is often  increased by their combination with acids,
as, for  instance, mercury with the muriatic acid; but they can
poison either by affecting the living power, or by acting chemically;
chemically when strong, and by irritating when diluted.   Minerals
are capable of acting in the three different  ways;  when mechani-
cally, it might be supposed to be  by altering the composition or
arrangement of the animal fibre, so as to injure without destroying
the living principle:  but  such cannot  properly be called poisons.
They may act chemically by combining with  animal substances,
as the vitriolic and  other acids, and  caustics.  When they act on
the living principle without seeming to alter the part to which they
are applied, they are probably absorbed, and excite universal irri-
tation, as for instance, lead  and  mercury, which, when  given too
largely, seem to have this property;  but each  of these will kill by
their action on  the  stomach.  I know of no  mineral poison that
produces universal  sympathy when  locally applied,  except  it is
applied to the stomach.   Most of them produce peculiar complaints
as we see from lead, mercury, arsenic, opium,  &c.
   The  Vegetable Poisons appear  to  be  of three  kinds; first, the
natural juice of plants without having undergone any  secretion;
 secondly, the secretions of plants, as honey and  the essential oils;
 thirdly, those which have undergone  a change by a chemical pro-
 cess, as the oil of tobacco.  These  produce  their effects  in  two
 different ways,  similar  to the mineral, viz.  chemically, and on the
 living principle.  Their power on the living principle is much more
 extensive than that  of  the mineral, and their  effects  are peculiar
 and  different from  those of any other  disease, so  that they are
 generally well characterized.
    The Animal Poisons  act  principally on the  living principle.
 Nothing shows the variety of animal  matter more than the poisons.
 The  blood may be considered as the  fluid  animal, because it con-
 tains all the parts which  compose the  animal, and the whole body
 is composed out of  it.  The solids which exist already  must have 
OF POISONS.
373
the power of decomposing this fluid according  to  the stimulus of
each part, and on that the natural and  morbid  secretions  depend.
I  shall consider these  under the  heads of  natural  and morbid
poisons.
   1st, Natural Poisons.—Many of these first affect  the stomach, as
some kinds of fish;  others consist of animal secretions, which are
produced by particularly formed organs, provided  with an appro-
priate apparatus and  ducts, for the  especial purpose of secreting
and inserting the poison in the bodies of  other animals.  These
secretions do not affect the parts which contain  them,  although
they would probably poison  the animal itself if inserted into any
other parts than those which naturally contain them, as, for instance,
in scorpions, which  poison each  other, although the Abb6 Fontana
denies this as to the  viper.   The second species produce their effects
in two ways, by contact or by insertion.   Those which affect the
skin by simple touch are various, as sea insects, the ant, &c.; but
before the others can  possibly operate they must be conveyed into
 a wound, which brings  them to the living principle, on which they
will always act under  these circumstances, but not when the cuticle
is entire;  hence all  these  animals make a wound before  they can
act.  This second  species are all of them very active, producing
immediate effects, both  locally and constitutionally, otherwise they
would not answer  their intended purpose, which is the defence of
the animal.   According to  the  quantity, they would  appear to be
more or less violent in their effects, as in small  animals  the  effect
is the same in kind, but  not in degree, as in a large one; thus a
large one kills, while  a  small one does not; the rattlesnake  being
longer and larger than the common viper, kills  much sooner.
   Those which poison by the touch, first produce  a soreness, and
some swelling and  inflammation, which latter is  of the adhesive
kind, although the swelling  is generally oedematous.  Those which
act externally and locally do not occasion swelling at any distance,
so that the continued  sympathy is not great, as that  from the ant.
These all appear to have their peculiar  distance, unless the effects
are increased by rubbing, itching being generally their consequence.
Those  which become  constitutional have also local effects, which,
however, are not so fixed as those from the other sort; for in these
a kind of continued sympathy exists, and a dissolution of the parts
comes on, which produces extravasation of blood, and consequently
a dark colour.  The first  symptom is pain, and  if the  poison  is
absorbed there  is also a sore red streak, extending to the lymphatic
glands, situated  between the injured parts  and the thoracic duct.
The glands also, which are principally in the bend of the great joints,
 swell,  and become  painful, showing either absorption of the  poison
or that the lymphatic  system sympathizes.  A cold fit often follows,
and  sometimes  convulsions and death in a short time.  The injured
parts likewise swell, and become dark  and  livid, from vessels car-
rying red blood which did not originally do so ;  but the continuance
of the  local effects  does not arise from the constitution, otherwise
                              32 
 374          HUNTER'S PRINCIPLES OF SURGERY.

 similar effects would manifest themselves in other parts of the body.
 Suppuration of the part to which the poison is applied rarely hap-
 pens :  but by absorption this may sometimes happen, as in common
 buboes.  Effects such as we have been describing are seen in the
 viper,  scorpion, &c.  Some  insects poison in the act of sucking
 their food, as the gnat and bug, and these seem to produce specific
 diseases;  that is, they appear not to suck  the  common  red blood
 from the vessels, but to produce  an inflammation, and afterwards
 suck the extravasated blood from the inflammation which they have
 occasioned.
   2d,  Of Morbid Poisons.—These probably arise from a diseased
 state of the body or part, which  originated  either spontaneously, or
 from the application of similar matter from another animal.  This
 is proved by the late origin of all of them.  We have many daily
 arising spontaneously, and  which continue their excitement.  The
 cancer is a proof of this, and I once thought  the same of hydro-
 phobia ; but Mr. Meynell tells me he never had a hound mad  but
 what had been bitten.   Some of the morbid poisons are lost, and
 others  are losing ground every day for want  of frequent commu-
 nications : some of these act in a fluid state, and others in a state of
 vapour.  The venereal poison requires contact, and possesses itself
 of those parts which are most frequently in  contact; some affect
 the secretions so as to  make  them  poisonous,  as the saliva in  the
 mad dog.   It may perhaps in time happen that  the human race shall
 be extirpated by poisons alone; but it is more  probable that  many
 poisons are extirpated,  and that new ones arise in their stead every
 day.   Morbid poisons differ from the natural in requiring a morbid
 action  in the body to produce them, as cancer, which is either the
 produce of a similar disease, or  arises spontaneously.  These pro-
 duce greater variety of effects than the natural, some of which are
 local, and others both local and constitutional.
   Some affect the whole system rapidly, as the variolous matter;
 but not so the venereal.   Many of them are not content with simply
 poisoning those people wfio come within their  influence, but com-
 municate it  to others, who in  their turn are capable  of affecting
 others.  Every part of the body is more or  less susceptible of being
 poisoned.   The effects of some poisons seem  confined to peculiar
 animals;  as  cancer, which occurs only  in  the human  species.
 Others affect various animals; as hydrophobia, which attacks horses,
 cows, dogs, cats, geese, fowls, &c, when they are bit.  Others only
 affect animals of the same species, as the variola.  Some appear to
 choose peculiar ages; as the cancer, which never occurs in young
 people. Many choose  a peculiar sex, or peculiar parts  only  are
 affected by them, some parts being more susceptible of some actions
 than others: as, for instance, the breast, of cancer;  the skin, of
 small-pox; and the salivary glands, of hydrophobia.  Both the great
 and small  effects of morbid poisons depend less on quantity than
those of the natural do.  Some poisons perform their own cure, as
 in those cases where the constitution is only capable of being affected 
OF POISONS.
375
by them once; which, as we have no artificial cure, is a happy cir-
cumstance.   But others seldom or never affect the system in such
a manner as to oblige it to discharge  the poison.  Some perform
their own cure, when the mode of their action is on a peculiar part,
as gonorrhoea.
   Of the Modes of receiving Morbid Poisons.—If morbid poisons are
applied in a solid state, they must become fluid, by the moisture of
the part, before they can act.   The manner of receiving them and
being affected by them is in three  ways : 1st, when the effects are
always local and never  reach the constitution, as in cancer; 2d,
when the constitution only is affected, as in jail distemper;  the 3d,
or compound, is when the  poison can affect one only or both at the
same time, as the lues  and small-pox.   The  first is of two kinds:
 first, when  the patient contracts  a poisonous disease, either from
 known causes, or from  violence  committed on parts which are
 capable  of running  into diseased  action, and  of communicating
 the same to others, as cancer and  lues ; the second is where the dis-
 order  is  external and local, so  as to affect only the  cutis, as the
 itch.  The manner of receiving the second, or entirely constitutional,
 may be either by effluvia or contact.   The first, or that by effluvia,
 is  owing to the air being  impregnated  with poisonous  vapours
 arising from the animal body; but how the poison is received into the
 constitution is unknown, there being no traces of it before it shows
 itself by the fever, as in the jail distemper and  hooping-cough. The
 second of this division of constitutional poisons is the plague, which
 is caught by contact; but whether it could or could not be produced
 by inoculation is unascertained.   The mode of receiving the  third,
 or  compound kind, is twofold: first, it differs from merely local
 poisons, because it seldom acts locally at first, as the variola; tor
 we receive this disease naturally without  knowing it until the con-
 stitution is affected.  Secondly, it can affect both the constitution
 and the part, as the  above; but generally there is local inflam-
 mation,  and sometimes  ulceration,  previously to the constitution
 being affected, as in lues.                                .  .
    Of the Itch.—This is one of our first class ot  the first division ot
 morbid  poisons, which affect by simple  contact and are always
 confined to the parts to which  they are applied.  Scabies  never
 affect the constitution ;  from  which  I conclude that it  is  never
  absorbed.   However it originated,  it is  now become a  common
  noison   It produces small ulcerations, which are  generally much
  confined;  but  when  the  disease is of long standing they are  as
  large as a sixpence, and covered with a  scab.  First there is a
  smaU vesicle, which discharges a kind of matter, which gradually
  thickens until genuine suppuration  takes  place; *e matter  wbch
  is thus formed produces ulcers of the  same specific kind  although
  its powers of contaminating  are evidently weak, as c eanhness pre-
  vents contamination.   The irritation of it  ^scarcely sufficient to
  produce inflammation, and continued sympathy hardly evei takes
  place in it.  It gives no pain, but occasions a sense of itching,  it 
376
HUNTER'S PRINCIPLES OF SURGERY.
is generally caught by  shaking hands, or from lying  together, as
the lower orders of people commonly do, who are most subject to
this disease.  Uncleanliness aids this effect; therefore washing the
hands, even after the matter is on them, prevents the disease from
taking place.   When it arises from  lying  in an  infected bed, or
from  a nurse, it is generally  communicated to every part of the
body; a fact  which gave rise to an opinion  that its origin was
derived from nastiness.  The  disease has been said to arise from
animalculas ; but these, if present, are, I am sure, unnecessary for
the existence of the disease, as I have often examined the matter
and found no  animals  in it;  yet they may sometimes be in the
matter.  I forget who was telling  me  lately that Dr. Teigh had
shown them to be, not in the pustule, but in the skin near it, as little
black specks.   It is capable of affecting the  cutis when covered by
cuticle, but not where the cuticle is thick.   It  affects parts thinly
covered with cuticle most, as between the fingers, but often no part
escapes, making the  cure very troublesome ;  for as the cure is
effected by local applications,  it then  becomes  necessary that they
should be extended over every part of the body.
   Although a specific disease and a poison, yet it has several cures,
which act in various ways ; but all must have powers to remove
the irritation of the disease.   Mercury  often cures and often fails;
yet a girdle often will cure when the unguent  will not.   Solution
of sublimate of mercury sometimes  cures, as does a decoction of
hellebore.  A  sulphureous unguent is most efficacious;  but it is
volatilized by the heat of the body, and is disagreeable.  If mixed
with water, the smell is somewhat prevented; but it  is then less
efficacious. Sulphur  given internally reaches the skin, and pro-
duces a smell  thereupon, and will then  cure ; but  to produce this
effect it must be given so largely that it is apt to prove purgative:
opium therefore should be conjoined with  it.  Sulphur, however,
is the only certain remedy ; and when properly  used, it  may be
depended on.
   Of Cancer.—The  diseases  commonly classed under this name
are in appearance very different, and probably are very different
in their nature; they should not, therefore,  be  called by the same
name.   I would call  that  cancer which produces  the  following
effects; viz., a circumscribed tumefaction with much hardness, and
a drawing in of the skin covering it, as if the cellular membrane
underneath  was destroyed:  then a species of suppuration  takes
place  in the centre, and  ulceration of the external surface.   This is
its most frequent appearance.   It most commonly attacks  the con-
glomerate glands, and first the  female breast; also the uterus,  the
lips, the external nose, the pancreas, and the pylorus;  besides which
the testicle is very subject to  it, though that is not  to be classed
among the conglomerate glands.  So  that when I speak of cancer,
I mean a peculiar  disease in some of the above parts.   There is
another disease  which is also  called  cancer, which I have called
fungated ulcer.  The frequency of a disease in any one part is apt 
OF POISONS.
377
to lead us to suspect that this one disease is peculiar to that parti-
cular part; but scrofula  attacks these parts also, in the form of a
tumour, and a distinction between them would  be a great  advan-
tage, although this probably can only be made in the breast, which
is subject  to both diseases.   When small, they probably cannot be
distinguished ; but as they increase, the distinction  is more easy.
If cancer, it will  vary its  appearance by  becoming less circum-
scribed, not having so determined an  outline, from the  cellular
membrane around becoming diseased ; the  skin will be less move-
able, the nipple more or less retracted, and the lymphatic  glands
going to the axilla will swell.  But in scrofula there will be  no sur-
rounding disease, no affection of the nipple or  axillary glands, no
adhesion, even though the tumour be large; I have seen one loose,
when it weighed eighteen pounds;  the veins become also enlarged.
When scrofulous  tumours are large, and become slightly inflamed,
they get more diffused, and put on a greater resemblance to cancer ;
but  in cancer the  inflammation comes on earlier, and goes on with
the  disease.   In cancer, the surrounding parts that are affected by
continued sympathy also become cancerous near the skin, that  is,
all the parts become blended in one mass ;  but in scrofula, although
the  surrounding parts are in action, yet that action is not so  scrofu-
lous as the part itself; so that  the  skin will sometimes heal over
the  scrofulous tumour, as I have seen in the testicle when suppura-
tion had taken place, by which I determined the disease was  no
cancerous.  The  tumefaction  is from interstitial extravasation of
coagulable lymph, and the tumour is more ready to inflame than
in the scrofula.   Cancer is one of the first  class  of our first division
of poisons, viz. that which  only produces  local effects, though  it
has been supposed to contaminate the constitution; which would
be terrible indeed, as we have no specific  nor even a palliative
for  it.
  The reasons for this opinion are the following.  When a cancer-
ous tumour has  been removed  often, the  sore does not  heal, or
breaks out again.   Sometimes it breaks out again in another part
of the body ;  which has been thought a proof  of its arising from
the  constitution.  This  last circumstance  as often  arises  where
there has been no operation as where there has  been one ;  it does
not therefore depend on that circumstance as a  cause.   However,
the  operation having or not having been performed does  not affect
their argument, unless they could prove  that cancer is an  act of
the  constitution, and acts as a drain or concentration of the cancer-
ous poison, and that by stopping this  it  must go somewhere else.
But the proportion of those who have it break out in two different
parts of the body, compared with those who have it only in one, is
about half what'the latter bear to those who have not the  disease
at all, or about five  hundred to one.  I never saw it in two different
parts of the same person; but I have seen it in more than two dis-
tinct points of the same part.  It often arises in distinct points of
the  same breast, but seldom at the same period; and some of these
                               32* 
378
HUNTER'S PRINCIPLES OF SURGERY.
may be so much in their infancy when the operation is performed
as not to be observable, but afterwards increase and require  a  se-
cond operation.
  The surrounding substance of the breast has often little tumours,
sometimes containing a blackish fluid;  these may be called cancer-
ous hydatids.  It is therefore best to extirpate the breast completely
at once, to remove the whole complaint.  It must further be proved
that the continuance of the disease, or contamination of other parts,
is not owing to the healing or not healing of the sores.  The above
reasons for believing it constitutional would satisfy any one not of
the profession; but for surgeons to be influenced by them shows
an ignorance of the first principles of the animal economy.  They
should recollect that though it affects  the neighbouring parts, and
the parts through which the poison passes, by sympathy, producing
a similar disease, it does not affect distant parts, like those which
really  affect the constitution.  A scirrhus or cancer appears to
have three modes  of contaminating:  1st, by continued  sympathy,
which is common to other diseases; 2dly,  by remote sympathy,
which is peculiar to  itself; 3dly, by contact  or communication of   p
its matter to other parts  by contamination.  I have called  these
consequent cancers, in opposition to the original.  Absorption would
appear to arise during both stages of the disease : first, by the ab-
sorption of the tumor in a scirrhous  state, that is, the  coagulable
lymph, which possesses the cancerous property; secondly, by the
absorption of matter produced by suppuration.  Both appear  capa-
ble of contaminating  the absorbents through which  they pass, and
so far agree with local morbid poisons ; but it may  be a compound
poison, so as to affect other parts,  as small-pox does.  Whether it
is a compound poison I will leave  you to judge from the following
remarks on the effects of poisons on the constitution.
   Whether a poison be a compound one or enti ely constitutional,
it first produces a fever that is universal, a specific general irrita-
tion ; and, if compound, local irritation also,  which local irritation
produces a discharge, as  in small-pox  and measles, the  discharge
being similar to the original in these, but not so in the venereal
disease.
   Let us now see how far cancer agrees with  these:  if it does
agree, it must be  a compound; if it does not, it  must be  entirely
local.   A cancer  in the breast or  testicle is  similar to the inflam-
mation and ulceration after inoculation, or to a chancre, only  differ-
ing in specific properties.  The matter of lues and  variola may be
absorbed and cause  inflammation of the absorbents, and the can-
cerous matter is also capable of absorption and of contaminating the
parts as it goes along, so as to form buboes,  or what I call conse-
quent  cancers; so far therefore  these diseases are similar.   But
the above diseases are very quick in their effects, while the cancer
is very slow : and so far  their cases are dissimilar.   The variolous
poison occasions fever and an eruption similar to the original one;
but the venereal poison does not  do  this, its effects being merely 
OF POISONS.
379
local, consisting of blotches on the skin, &c.; neither does the can-
cerous poison when in the constitution produce fever, nor is there
any local effect which arises  strictly from the constitution.  Does
cancer then produce any effect on the constitution ?
  When it has existed a long time we find slight fever and hectic ;
but this is no more than the effect of  all long continued irritations,
or sores which are not disposed to heal, but no peculiar effect is
produced from this affection on the constitution.  The effect which
has been mentioned is produced even by the venereal poison when
of long standing, but it is different from the  specific.  I have seen
locked jaw and difficult respiration produced from a cancer in the
breast; but these were occasioned by the irritation of a non-healing
sore; small-pox does not produce this hectic.  It has been said that
cancers are produced by ill health, as rheumatisms  are; but this
arises from  the age of cancer being  the age  of such complaints,
and being thus the predisposing cause of both, but  not particularly
of the cancerous disposition.  Let us compare the cure of cancer
with that of the venereal disease, when the latter can be extirpated
externally.  If we remove entirely a chancre, the sore heals readily
and does not  return, and if this is done  before  any absorption
has  taken place, then  there will no  future disease;  but  if after
absorption has taken place, and after a bubo  has formed, then,
although  the  sore will heal, the bubo will go on, and the con-
stitution will be affected.  So likewise, if we remove a cancer, and
no  absorption has taken  place, the sore will heal and the constitu-
tion will not suffer;  but then the whole must be removed, as in  the
local venereal disease, otherwise it will return.   If removed, and
there has been absorption, the  parts  heal,  though the consequent
cancer goes on; but if the whole cancerous parts are removed, the
constitution is free; here it  differs from Ihe venereal; for there,
when absorption has taken  place, sores break out in other parts,
but this is not the case  in cancer.  The general opinion has been
the reverse of this.   This shows that a cure is the consequence of
a total removal of the parts, notwithstanding  absorption has taken
place, if all the diseased  parts are removed.
   The only powers of contamination of this poison are; 1st, when
it spreads  from the centre, thus  producing  a  disposition to  the
disease in the surrounding parts, and an extravasation of interstitial
 matter; 2d, when the disease  extends to  distant parts, as  when
 little tumours form under the skin at some distance, not in the  line
 of absorbents; and 3d, when it produces the  same disease in  the
 absorbents  and  glands.  This  last is easily conceived, from  its
 being a poison;  but the affection of a part that seems to have  no
 connexion whatever with the diseased part is not so easily accounted
 for.
   When scirrhus  is entirely let alone, it is commonly very slow.
 A  small  lump  in the breast may sometimes continue for  many
 years : but whenever inflammation  takes place, its  progress  is
 accelerated, in as  much as inflammation is an  increased action of 
380
HUNTER'S PRINCIPLES OF SURGERY.
the part itself, as well as of the surrounding parts;  so  that  if we
remove the tumour in  this condition the glands in the breast will
probably inflame  and sometimes suppurate, although often these
effects are not cancerous.   When inflamed, the tumour increases
very fast, but the sympathy is very slow, which is common in many
diseases.  When distant parts, not in the  line of the absorbents,
are affected, it would appear that such parts are very slow in taking
on the diseased action, although  the  disposition has been formed,
for we frequently see that they do not take on an active form for
some years after.   In  those  cases where there is absorption  of
coagulable lymph, it becomes a question whether the lymph is can-
cerous, or whether the affection is only sympathetic; most probably
it is the last.   The last two forms of the disease are generally very
slow, which circumstance makes them  dangerous, as it  cannot  be
ascertained when parts are really  affected with the disease, which
often necessitates a  second operation, it being necessary to remove
all  the parts which have undergone  the disposition, although  the
inflammation or tumour itself is circumscribed.
   The predisposing Causes  of Cancer are three  in number, viz.
age, parts, and hereditary disposition; perhaps climate  also has
considerable effect,  though not itself a predisposing cause.   The
cancerous age is from forty to sixty in both sexes, though it may-
occur sooner or  later in  certain cases.  The testicle for instance,
often becomes cancerous at twenty or thirty; but then not from the
disposition of the parts alone, but from accident.*  Cancer has
been  supposed  to be in young  people's eyes;  therefore  it is most
probable that the breast is less subject to it at  this  age,  and other
parts  are  not  so much  confined to  age  in  this  disease.   We
often see  tumours in the  breast  at  thirty, and probably some of
them are cancerous, although scrofula is more to be  suspected.
When cancer occurs in the breast of women under forty, it is more
rapid in its progress than when the patient is older, and  also more
extensive; remote sympathy likewise  takes place more readily in
them than in the old, so that the operation  succeeds better in the
latter  on  this account.  However, we seldom  find it in the young
or very old; although of the two  it is most frequent in the latter.
When it occurs  in  the young, does  it not show a very strong dis-
position for the disease, and therefore more danger, from  a greater
likelihood of its returning?
   The parts most disposed to Cancer are those peculiar to the sexes,
as the breasts and uterus in women and the testicles in men. Can-

  * [The distinction between the various forms of medullary disease and cancer
was not well understood in the time of Hunter, and consequently he has classed
together several diseases which  modern  pathologists have very properly sepa-
rated.   It is unquestionably true that cancer may exhibit itself before the age of
forty, and fungus  haematodes after that period ; still, as a general rule this does
not happen, nor is there any individual fact more characteristic of the difference
of these diseases than the different periods of life at which they respectively
occur.] 
OF POISONS.
381
cers are more frequent in women than in men, in the proportion of
three to two ;  owing, perhaps, to the more frequent changes taking
place in these  parts in the former.  It is that change which renders
them unfit for  conception and changes the whole system, which is
particularly obnoxious.   Thus, the three disposing causes are : 1st,
a peculiar part; 2d, the age of the patient; and 3d, the peculiarities
of the part  at this age.  The parts  next in  order and frequency,
and which  are common to both sexes, are the conglomerate glands
about the lips,  nose,  throat, tongue, pancreas, stomach, especially
the pylorus; intestines, especially the rectum.   Besides these,  we
have it in the eyes and glans penis.   The disease  also appears in
other parts of  the body; but, as most other parts are similar in
structure, it does not attack one more than another.  It sometimes
falls on  the bones from contamination, but on no one in particular.
  Whether  Hereditary—Some suppose cancers  to be  hereditary;
but  this  I can only admit according to my principles of hereditary
right; that is,  supposing a person to possess a strong disposition or
susceptibility for a particular disease,  the children  may also;  but I
have not yet ascertained the generality of this fact.  In many per-
sons it would appear that some of the predisposing causes are suffi-
cient to become the immediate ones ;  as when the diseased action
takes place at  a certain stated time, without any immediate cause.
Are  they more frequent in  one country than  another?   I  have
heard they are  very rare in the  West Indies; and  they do not
seem to be frequent in the Friendly  Islands, where the  women fight
for  prizes, and  aim chiefly at the  breast;  so, most probably,
climate has some power, both in disposing  to the  disease and in
preventing  it.
  Symptoms.—On the first appearance of a cancer it is  a  hard
tumour, and being specific it is  circumscribed, having its  specific
distance, when it is called scirrhus, which is a cancer not yet ulce-
rated.   Sometimes the first symptoms of a cancer in the breast is a
bleeding from  the nipple, which must  come from the  ducts of  the
lactiferous  tubes;  and this I have seen in  men.   In the testicle it
sometimes  begins by forming  a hard knot, but is generally  more
universal.  When in the lip, there is a thickening of some  part of
it, and this  increases till ulceration takes place:  it comes  on  simi-
larly in  the nose.  -There is  one peculiarity in  cancers, which is,
that  when the  skin is  affected there  is a wrinkling or tucking  in of
it, which appearance  always leads to  suspicion of cancer.   It often
begins in the  antrum, and  distends  the whole face; but  I rather
suspect  this to be of the fungated kind.  In the bones it begins by a
soft swelling, which I also suspect to  be fungated, from its  forming
such luxuriant fungoid granulations when ulcerated. In the testicle
sometimes a softness and even an obscure fluctuation  may be felt,
although I  suspect this not to be cancerous.  The pain  at first is so
trifling as scarcely to be  noticed; but when there is a disposition
to suppuration and ulceration, a shooting lancinating pain is felt,
and also a dead heavy one, which pain  increases more in  propor- 
382           HUNTER'S PRINCIPLES OF SURGERY.
lion than the disease appears to do. It is more violent in some parts
than in others, depending in some degree on the sensibility of the
part; thus, it is more  violent  in the breast and testicle than in less
sensible parts.  Cancer, however, produces no symptoms peculiar
to itself; they are only such as would arise from any injury to  the
part capable of producing the above effects, independently of any
specific quality. Cancer of the lip, of the nose, or of any other part,
will produce no peculiar symptoms; but in the  testicle, symptoms
peculiar to that part will be occasioned, as, for example, pain in the
loins and sickness, with suppression of  the secretion of semen; in
the bladder, the symptoms will be like those of stone; in the rectum,
purging and  tenesmus ; in the stomach,  sickness and vomiting;
within the skull, headache and coma.   Cancer appears to give rise
to no constitutional symptoms, except such as would arise in other
diseases from  the long-continued wearing  pain  and perpetual dis-
charge.
   The progress towards suppuration is of two kinds: one  by exter-
nal ulceration, the other by the scirrhus becoming encysted.   The
first happens when the tumour reaches  the skin and affects that part
with disease, when the skin first becomes shining and then ulcerates
and forms a sore  which is called a  cancer.  While this  is taking
place, inflammation is beginning from  internal exposure, and  the
exposure increases the inflammation.   The other mode depends on
a change in the substance of  the tumour itself akin to suppuration,
but which  is  very different from any  other kind  of  suppuration.
The cavity contains a fluid, which fluid appears of various  kinds,
and in some cases begins very early. In some breasts, where such
an encysted tumour has been  removed, many small knots are found
during the operation,  by either cutting through or  against them :
they often  suppurate without  any inflammation, therefore there is
seldom any inflammation until there has first been exposure, When
the matter has been evacuated, common  inflammation and suppu-
ration take place, and the disease then  proceeds rapidly.
   Cancerous matter may be reckoned  of two  kinds: first, that in
the tumour, which is various; in some  serum, in some blood,  and
in others  coagulable  lymph,  or else a yellow curdly matter.  The
second is of a bad quality, and proceeds  from the  internal cavity,
which is similar in all respects to that formed externally by ulcera-
tion.   The fluid from a  cancerous ulcer is most  commonly of a
purplish red, which makes the skin of that colour; the absorption
here seems to be of the intermediate substance between the skin
and cyst.   When near to the skin, it inflames  and  ulcerates as in
other ulcerations.
   Of the  Treatment.—No cure has yet been found ; for what I  call
a cure is an alteration of the  disposition and the effect of that  dis-
position, and not the destruction of the cancerous parts.  But as
we have no such medicine, we are often obliged to remove cancer-
ous parts; which extirpation, however, will often cure as well as
we could do  by  changing the disposition and action.  Arsenic 
OF POISONS,
383
seems to have some power  of  this kind, and its effects might be
increased, by being used internally and externally; but its use is
very dangerous, and I am afraid insufficient for the disease.   This
is  a remedy which enters  into the  empirical nostrums  which
are in vogne for curing cancer ; and among which Plunkett's holds
the highest rank.  But this is no new discovery, for Sennertus, who
lived the Lord knows  how long ago, mentions a Roderigues and
Flusius, who obtained considerable  fame and fortune  by such a
composition.   I was desired to  meet  Mr. Plunkett,  to  decide on
the propriety of using his medicine in a particular case :  I have no
objection to  meet anybody : it was the young one; the  old one is
dead, and might have died himself of a cancer for aught I know.
I asked him what he intended to do with his medicine.   He said,
" To cure the patient."  " Let  we know what you mean by that :
do you mean to alter the diseased state of  the parts ? or do you
mean by your medicine to remove the parts  diseased 1"  " I mean
to destroy them,"  he  replied.   " Well  then, that is nothing more
than I  or any other surgeon can do with less pain to the patient."
Poor Woollett the engraver died under one of these cancer-curers;
he was under my care when this person took him in hand.  He had
been a life-guardsman, I  think, and had got a never-failing receipt.
I  continued  to call on  Woollett  as  a  friend, and received great
accounts  of  the good  effects; upon  hearing which, I said,  if the
man would give me leave to watch regularly the appearance of the
cancer, and see myself the good effects, and should  be satisfied of
its curing only that cancer,  (mind, not by destroying it,) I would
exert all  my power to make  him the richest man in the kingdom.
But he would have nothing to do with  me, and tortured poor Wool-
lett for some time;  till at last I heard the sound testicle was gone,
and at length he died.
   Arsenic may be  given internally with safety.  If applied exter-
nally to a large surface,  it will  often affect the constitution, though
to a small one  it may be safe and efficacious; as, for example,  a
grain of arsenic to  four ounces  of water, applied in a poultice twice
a day;  this  will often destroy the cancerous disposition and render
the sore more healthv.   Sometimes the quantity of arsenic must be
increased, and when'it gets better, less must be used.   When the
cancerous disposition  is too strong to  be removed by this means,
we must destroy  the parts; and for this there are two modes: 1st,
by destroying the life of it; 2dly, by an operation.   The  destruction
of all   the cancerous  parts is  the intention  in both: in destroying
locally any  specific disease which has the power of its own increase,
the whole must be destroyed.   That first method I divide into two:
 1st, the power which  life has of destroying  itself, by producing an
action  it cannot support; 2dly, by chemical effects.  The second
method is by an operation ; but the first method is not so extensive
 as the second, for with the knife we can go where the other cannot
 reach  ; so that the first  can only be employed where tne disease is
 exposed and circumscribed.  When lying on a nerve or artery, the
 deadening method has the recommendation of safety. 
384           HUNTER'S PRINCIPLES OF SURGERY.
   The first mode produces too much action, as would appear from
 the effect of arsenic, which does not act chemically, but produces
 inflammation, and probably weakness also; so that  the  diseased
 parts will  be destroyed  by it, while the sound parts will remain
 alive ; and this makes it preferable to caustic, which is not only too
 violent,  but  deadens  the  sound parts  as well  as the unsound.
 Plunkett's  medicine is made as follows :  crowsfoot, 3  drachms and
 2 scruples  ; dogfennel dried, 1 drachm ; crude sulphur, 2 drachms
 and a half; white arsenic, 5 drachms: beat in a mortar, and form
 into a powder; one or two drachms of which are to be mixed with
 the yolk of an egg, and being spread on a piece  of bladder to be
 applied so  as to cover the sore.*  Arsenic alone would produce too
 violent an  inflammation, and destroy the sound parts by mortifica-
 tion.   The second, or chemical mode,  is by caustics, by which life
 is destroyed by  the combination of the caustic with the  parts it
 comes in contact with, making but little distinction between those
 which are  sound and those which are unsound ; but these cannot be
 used very  extensively, for obvious reasons.
   The Second mode, on' Extirpation.—In considering the propriety of
 this we must often be more careful than in the above modes; and as
 the knife  may be extended further, so the diseases may be more
 complicated  than in the other modes.  We should first consider if
 the whole  disease can be safely extirpated, and  if so, the operation
 is proper.  Some cannot be extirpated  safely, as when in the extre-
 mities ; but in such cases the whole  limb may be safely removed,
 which should in doubtful cases  always be done.  But sometimes in
 the breast  it  is so fixed to the ribs as not to be entirely removeable.
 Now to know if a cancer is proper for operation, two things should
 be considered, viz. the cancer itself, and  its consequences.  Great
 attention should be paid to the tumour, whether it  is moveable or
 not; for as the disease is further extended, so  the parts are more
 united to the tumour.   If it reaches a part which cannot be removed
 as the hips, or parts  which cannot wholly be removed by amputa-
 tion, then  nothing can be done; but  if the tumour  is not  only
 moveable,  but the part naturally  so, then there is no impropriety
 in removing it, with  regard to the tumour itself; but before remov-
 ing it,  or a limb, we must consider if there are  any consequences.
 We should examine  for example, the  glands in the groin or axilla
 to ascertain if they are thickened or swoln, and also the course of
 the absorbents; for if these are sound and moveable, then the disease
 may be safely removed.   But if any are so deep or fixed as not to
 admit of removal, then we must consider whether the whole  limb
 can be removed,  above  the consequent tumours;  and if  not, we
 ought to do nothing.   All the  above circumstances being consid-
 ered, and no objections existing, the  breast may be safely removed;
 and if any consequent cancers easy of extirpation are found, they

  * [Any preparation containing so much  arsenic must be exceedingly unsafe
and dangerous.] 
OF POISONS.
385
may be safely removed also.  But it requires very great caution to
know if any of these consequent tumours are within proper reach,
for we are apt to be deceived in regard to the lymphatic glands,
which often appear moveable, when, on extirpation, a chain of them
is  found  to run  far  beyond out of our reach, which renders the
operation unsuccessful.   As this  is not easily known, I would, in
most cases, where the lymphatic glands are considerably enlarged,
advise that the case should be let alone.   We cannot be too nice in
our examination, nor often too rough-handed  in the  operation.  In
cases where the original and consequent tumours are  circumscribed,
and  sufficiently moveable, the operation has  generally been suc-
cessful, being nothing more than a common wound.   But the parts
may have acquired the diseased action, and thus render the opera-
tion  unsuccessful, although that action was invisible.  Whenever
there are such appearances the parts should beremoved as soon as
possible : on the contrary, when the disease-has not beem entirely
removed by the knife, from its not having been carried into the
sound  parts, the operation is unsuccessful; and  these^arethe cir-
cumstances which gave the idea of the disease being constitutional:
but let us observe what part of the sore does- not  heal, and what
part breaks out again after the  operation.  This is  either  in the
cicatrix, or, in the lymphatic glands.  Now, if the whole disease is
not removed,.,the sore either does not heal, or if it does, the cicatrix
breaks out again ; so likewise, if  the  surrounding contaminated
parts are not removed, although the whole original disease is, then,
some  months after, there will be a new ulceration  there; and so
with regard to the glands also, if any of these are  so far diseased
as to  require extirpation, but too high up for the  knife.   I have
sometimes  seen, after the operation, the glands  under the clavicle
swell,  and  push out  the clavicle on the lower part  of the neck; it
has also happened, that after removing the glands in the axilla the
absorbents  between  them and the original disease have become
contaminated, in which case they should be removed as soon as possi-
ble.   The  contamination extends in other instances  on the inside of
the sternum, in the course of the internal mammary  artery.   Some-
times  these consequent cancers  appear long after  the operation,
even years, when they should be  immediately removed.  After the
visible disease is removed, we should minutely examine the sore, so
as to feel and press every part, and if any thing is hard or irregular,
remove it.  After operation in the  axilla, we should introduce the
finger into it, in order to discover if any of the other glands are
affected;  and before-the part is dressed the tumour  itself should be
inspected, to see if there are any corresponding appearances, so as
to lead to the supposition of a part  being left; but this can only be
done  in  those from  the  breast,  those  only  being-  circumscribed.
Having once had the. misfortune to leave a part,  I let it go on for a
few days, when the sore granulated  healthily all over, except  at that
part, which had a blueish appearance,  and discharged a dark co-
loured matter.  I then  dissected  that bit only, and the  patient
                              33 
386           HUNTERS PRINCIPLES OF SURGERY.
recovered.   If a contaminated part is left, it comes into action in a
few months  after the operation; and if two or more are left, they
all appear about the same time, and should be removed if they can
as soon  as  possible, before they have  contaminated other parts,
when, in general, it will succeed, as far as I have seen.   If these
are not removed, other parts will be contaminated, and kill in the
end ; but if  parts contaminated do not come into action at the same
time, after the original is removed, we shall not succeed.  It is sur-
prising to see how a young man, if  he  catches an idea which has
any novelty, will write away on it  and tell you wonders.  Thus,
Mr. Fearen  has lately recommended healing by the first intention
in this  disease, which is the last thing to be  thought of, as we have
here only in view the total  removal of the  disease, and  not the
healing of the wounds.  But no man should write a book without
taking every circumstance  of the  disease into consideration; he
should not  write  from a single idea,  which  many circumstances
may render futile.  I have used this plan  in small circumscribed
cases  in the breast, where  there was  very much skin, although I
have been very  liberal of my removal  at the  same time.
   Of the effects of Cancer in ihe Breast when incurable.—When
the glands become indurated the fluids are not absorbed, in conse-
quence of which there is  a stagnation  and extravasation of serum,
causing oedema of the parts around.  The arm, and the integu-
 ments of the  chest below, swell, and the  fingers  are  sometimes
 rendered immoveable, and very painful.  The inflammation about
 the diseased parts spreads, and causes a tightness around, which
 occasions dyspnoea,  and  in this  stage sympathetic cancerous  tu-
 mours often arise at a distance, and hectb  fever comes on. We
 must now give large doses of opium, which yet do not often relieve
 the pain.   I have seen the oedema of the arm before there was any
 tumefaction of the  lymphatic glands ; but when oedema occurs,
 which is not the consequence of absorption, there may nevertheless
 be afterwards  hardness of the glands  from  this cause: however,
 the oedema above mentioned puzzled me, having never before seen
 it without the glands being enlarged, and I have never seen another
 case.
    Of the  Cancerous Testicle.—The same observations  are here
  applicable  as in the breast, with respect to the propriety or impro-
  priety of an operation.  If the cord  is thickened the operation is
  doubtful, the consequence going often  further than at  first  appears.
  If it has not extended so high as the ring, I would advise extirpa-
  tion, it  being the  only resource left.  When the testicle has affected
  the scrotum there may be absorption to the glands of the groin, as
  in lues; of this I have seen one case, where, half a year after the
  operation for the removal of the testicle and scrotum, the glands in
  the groin ulcerated, and  killed the patient.   In this case the testicle
  had  become adherent to the scrotum.  I cannot say how far it
  would have been proper to have removed  these  glands at first, but
  from the adhesion the scrotum was necessarily removed.   I was at 
OF POISONS.]
387
first puzzled to account for the appearance of cancer in the groin,
as we know the testicle receives its vessels, &c, from the loins, and
therefore the glands in the loins become affected by the disease
extending along the course of the cord; but when I recollected that
the scrotum was affected, I knew it to be owing to the  lymphatics
of the scrotum, which pass through the  groin.   In cancerous dis-
eases the surrounding parts become contaminated, and these  again
contaminate others ;  but in scrofulous suppuration the surrounding
parts, although affected, are not scrofulous, because this is  not a
poisonous disease.  Before  suppuration breaks  out we can  form
little idea of the state of the part as to its malignancy: but after it
breaks out we can, for if healthy it will recover itself, and granulate
healthily; but if the contrary, it will not; hence, in the suppuration
of the testicle, we cannot say whether it is scrofulous or cancerous
till it  is ulcerated, when  the mode of healing  informs us of the
disease.
  Of Cancer of the Lip.—If small,  the operation for the hare  lip
should be preferred, and it is right in this case to have the cure in
view as soon as the operation is done, although we should be sure
to remove the whole disease.  These principles attended to will be
sufficient to guide us in the management of cancers  in other parts
of the body.
  Of Fungated Sores.—These are  commonly called cancers, and
are similar to them in being incurable, although they differ in other
respects.  The cancer eats, as  it  were, away parts, though there
is still an increase of growth or tumefaction; but in fungated sores
there is a spongy fungus which cannot be kept down.  It is, in fact,
a specific well-marked disease, which appears  common to  every
part, which I believe the cancer is not.  I have seen it in the antrum,
the tibia, the eye, the testicle, and the  rectum.  Its beginning, I
believe, is in the form  of a tumour, both of the encysted and solid
kind; for I have seen  an encysted tumour opened which threw out
this fungus, which is  very soft, spongy, and pulpy, of a dirty black
colour, very easily torn, and very apt to bleed : the matter does not
seem to be poisonous, for the glands and absorbents never appear to
be diseased by it.  Here [exhibiting it] is a preparation to show the
disease on the sole of the foot, and  here another, of the tunica vagi-
nalis  in which the fungus was very extensive, as  was also  this
fungus  on the penis.   A woman had a large one on the upper part
of the  foot, for  which  I  amputated the  leg,  and in this case the
glands  in the groin were  not affected, and she recovered, which
fhows there was no poison to contaminate by absorption.  A man
had a swelled testicle, which was not very painful, and the cord was
not  affected, which led me to  think  that  it was scrofulous; the
scrotum became affected by local sympathy, and adhered to  the
testicle.  I removed the testicle, but not entirely the adhering skin,
and after some time a fungus arose from the  skin, and his  health
became impaired by the repeated hemorrhage.  I tried arsenic made
intoTocSs with flour, which were stuck into the fungus  but  stall
  hese did not destroy it sufficiently, and the man  afterwards died. 
388
HUNTER'S PRINCIPLES OF SURGERY.
If this had been cancerous the progress would have been  different,
for  the  skin would have become cancerous from contamination,
and the cord would probably have been affected in the same way.
On  dissection of this fungus from the cicatrix of the  old skin the
glands above were found sound.  This species of fungus  is pretty
regular in structure; it is striated, and radiated, and its external
surface is larger than that of the surface of contact.  Nothing is left
for  it but to remove it,  no natural cure being known ; but we should
be careful to remove the whole of the diseased parts that have the
disposition, as they will otherwise soon take on the action.  It kills
without appearing to have done much mischief, whereas cancer does
much local mischief, and so do the consequent ones, before death.
The first case of fungated ulcer from  accident which I ever saw
was one from a blow on the arm, which was afterwards obliged to
be amputated.
  Cancerous Diseases  of the Penis are somewhat similar to the
former, consisting of a fungus, which begins  on the glans,  and
increases till the whole becomes an excrescence, which resembles
the  fungated sore when cut  or torn, except that it is much slower in
its progress:  sometimes it attains a large  size, and appears like a
cauliflower; and sometimes it is in the form of a tumour, covered
with skin, and ulcerated at  some parts only.  These tumours may,
I think, be classed with the true tumours, which consist of a new-
formed  substance; but I do  not  think they ever arise from the
venereal disease, as has been supposed. Extirpation,  in my judg-
ment, is the only  surgical resource;  and if so, it should be done
as early and as effectually as possible.
  The Hcematocele Specifica Testis takes its name from the nature
of the contents, which  are blood, serum, or often a firm coagulated
blood,  the extravasation arising  from a diseased action,  or a
peculiar mode of secretion, and not immediately from accident, as
is the case with one species, which  leads me to call this haemato-
cele specifica testis.  It is often taken for a eancerous  testicle, and
removed for such,  and  the fluid blood is then mistaken for cancer-
ous extravasation,  though it is common extravasated  blood in the
tunica vaginalis; although I will not deny that  there may be new
cysts occasionally found that may contain blood, as  other  new
cysts do matter.  Those which I have seen have felt like an obscure
hydrocele, or something between hydrocele and scirrhus testicle.
(See note, p.  232.) As it is so uncertain what  is the true case, I
have always  advised tapping in the  first place.  In some there is
much serum, and this in the centre of the coagulum, which adheres
to the  sides of the sac, the whole feeling like a thickened  sac;
and often  the sac is really much thickened.  In  some the testicle
has  been  so pressed  as to  burst,  and to fill  the  cavity of the
tunica  vaginalis; but  whether  this is  a  specific disease  or  not,
or a cancer similar to that in the breast, I do not  know.  I rather
think it is specific, but if not specific, the treatment of hydro-
cele would be proper; but  it must  be distinguished  from sarco-
eele, as in that  a different treatment is necessary.  But we  find 
OF POISONS.                     389
it will  not admit of the same  cure  as  hydrocele.   The coagu-
lum adhering to  the sac keeps off the  stimulus of imperfection,
and prevents  a  cure, so that in many cases it would be perhaps
best  to dissect  out  the whole tunica  vaginalis.  Perhaps in some
the blood may become part of the solids, by becoming vascular, as
was shown in a  preparation.  A gentleman in China had, he thought,
a  swelled testicle,  for which he used  mercurial  ointment.  On
coming to England, I could not  determine  the case, but  rather
thought it a hydrocele.   I tapped him; but no fluid was discharged,
although the lancet was pushed  in an inch  deep.   Mr. Pott was
called in, who thought.it a scirrhus testicle, and the operation was
performed.   On examining it, a bloody serum was found in it, and
the coats of the sac  (which was the tunica vaginalis,)  were
extremely thick, and the testicle was  much  squeezed by  it.   I
should  think it  was a mixed case, and  might have been cured as
hydrocele;  but  am not certain.
   In a case of true haematocele there was first an uneasy sensa-
tion, and the testicle  was  painful to the touch afterwards;  the
swelling increased, and was mistaken by a surgeon for hydrocele;
then the hardness increased, and the  pain become  acute; several
punctures were  now made, which brought on much inflammation,
which  required that an opening should be made, in order to examine
the parts, which were found to consist of grumous blood  and a
thickened coat.   It was  advised that  all  should be removed,
together with some of the skin: but I think not enough, for although
the parts healed readily, yet some months afterwards a swelling in
the abdomen reappeared, and destroyed  him.  On dissection, there
was found a set of tumours extending  to the diaphragm, on the
epiploon, together with some others in the liver, respecting  which
it  was  a question whether they were scrofulous or cancerous ; they
went along the  loins, in the course of the absorbents, showing them
to be cancerous; but  the tumours in  the epiploon, which is  a part
not in  the course of the absorbents, staggered me in that opinion,
and  other circumstances  puzzled me still further.  At present I
know not where to class this  disease,  but I find  it has  not the
powers of recovery when put in the way of it by exposure.
33* 
 
ANALYTICAL  TABLE  OF  CONTENTS
SURGICAL  LECTURES.
                    CHAP. I.—Introduction.

Introductory remarks  ......    7
Fundamental  principles of physiology the only guides to  a just
    practice     .......    8
Mr. Hunter's opinion of operations      .       ...    9
Preliminary observations on matter, attraction, repulsion, &c.    .   11
Of animal and vegetable matter   .       .       .       .       .13
Distinguished from common  matter by its peculiar properties, as
    growth, propagation of the species, &c.     .       .       .14
Errors of the mechanical and chemical physiologists    .       .16
The living principle is the main thing to be taken into account in
    this investigation     .       .       .       .       .       .17
The  subject  will be elucidated by  a reference to comparative
    anatomy, disease, and monstrosities  .       .       .       .18

                      CHAP. II___Of  Life.

Difficulty of conceiving of this principle .       .       .       .19
Complex in its effects, although simple in its essence    .       .   20
May possibly arise  from a peculiar arrangement of the ultimate
    particles    .       .       .       .       .       .       .   ib.
Erroneous comparison of life to mechanical powers     .       .21
Action not an essential property of life   ....   ib.
Vitality of  an egg        .       .       .       .       .       .22
This illustrated by experiments   .       .       .       .       .   ib.
Yet action, when once established, continues life at the same time
    that it exhausts it           .       .       .       •       .23
Peculiar form of putrefaction in certain bodies   .       .       .   24

                   CHAP.  III.—Of the Blood.

Erroneous views on this subject  .       .       ..       .       .   26
Animalization and vivification two distinct steps in  the conversion
    of foreign matter into part of a living body  .       .           27
The blood not merely fluid animal matter        .       .       .   ib.
But has also become vivified     .       .       .       .       .   28
Coagulation, and its importance in determining the nature of this
    fluid        .......   30
Of the varieties  of this phenomenon    .       .       •       .31 
392
HUNTER'S PRINCIPLES OF SURGERY.
                                                               Page
Case proving the life of the blood      .       •       •        .33
The death of blood prevents coagulation  .       .       •        .34
The analogy between muscular action and coagulation    .        .   35

    CHAP.  IV.—General Views of Organization  and Action.

The compounding of an animal body is according to certain esta-
     blished laws        .       .      .       •       •        .37
Of the sense in  which the term organization is used      .        .   ib.
Organization and life are distinct from each other       .        .   38
An animal differs from a machine inasmuch as every part  of the
     former  is endued with  independent action and vitality       .   ib.
Of the different kinds of action and  their mutual dependence    .   ib.
Of elasticity     .       .        .       .       .       .        .41
Conclusion       .       .       ..       .       .       .        .   ib.

   CHAP.  V.—Of the  Functions  of Nutrition  and Absorption.

The Stomach
   Is the peculiar and essential part of all animals        .       .42
   Is intimately connected with the other vital and internal organs    43
   In which respect it may be compared with the sympathy of^the
       brain with externnl parts .      .       .       .           ib.
   Sympathy of this  organ  with tendinous parts and with the mind   ib.
 Vascular System.
   Its action necessary to be understood  .       .       .       .   ib.
  ^Of the arteries,  veins, and absorbents   .       .       .       44, 45
   Relative offices of these  three  systems of vessels      .       .   45
   Of absorption, and its different kinds   .       .       .        .46
   Modelling absorption illustrated by the growth of  bones        .   47
   Absorption of entire parts     .      .       .       .        .48
   Of the various uses of absorption     .       .       .        .49
   Of the attempts to explain this process        .       .        .51
   Absorption induces an alteration in the matters  absorbed        .   52
   Table of  absorption   .        .      ,.       .       .       .   ib.

     CHAP. VI.—Of the Brain and Nerves, and  of  Sleep.

Passive and active states of the brain, giving rise to sensations and
     mind        .       .        .       .       .       .        .53
Too much influence  attributed to the brain in the bodily actions  .   54
Of the action of the nerves, and of the senses   .       .        .55
Sensation, and the laws by which it1 is regulated  .       .        .57
Connexion between the different functions of  the brain  ..        .   58
Of sleep, and its importance in the animal economy     .        .   '59

CHAP.  VII.—Of  Susceptieility  of  Impressions; of  Stimuli; of
         Dispositions of the  Body ; of Habit  and Custom.

Difference between impressions on animate and inanimate bodies  .   61
Of stimuli, and  the laws by which they are governed    .        .   62
Of dispositions  of the body     .      .       .       .        .63
Of dispositions  of the mind compared with  those of the body     .   65 
ANALYTICAL CONTENTS.
393
And of both with the action of machines
Those parts which are most distant from the sources of power are
     the weakest  ......
Of habit  and custom, and the laws to which they are subject
Particularly of the diminution of passive impressions by repetition,
     in proportion as the active power is increased
Page
  65

  66
  67

  69
             CHAP.  VIII.—Of the Heat of Animals.

Heat is one of the first principles of action  in nature
Of the sensation of heat .....
The  order in which the different functions cease when heat is
    withdrawn   .       .       .      .       .
Of the causes of animal heat    ....
Cases in  which this function was remarkably deranged
Experiments      ......
Diminution of heat during sleep  ....
Experiments  on hedgehogs      ....
Heat of the lower animals varies with the external temperature
Standard  heat of the higher animals not uniform  .
Resistance to external heat, and experiments
Difference in  the capability of different animals to generate heat
On climate      ......
           CHAP. IX.—^General Principles of  Disease.

Disease the consequence of some unnatural impression
Diseased actions often established on the same principles as healthy
     actions      ......
Obscurity of the  physiology of disease   .
Difference of susceptibility in  different individuals
Susceptibility of  constitution and of parts  for different actions
Universal susceptibility producing local diseases  .
Temperament    ......
Of the disposition for restoration, of necessity, and of disease
Disease consists in a disposition for wrong action, but not in the
     aetion itself  ......
First symptoms of disease       ....
Disease from too  great and from too little action
Diseased actions always simple, so that two diseases cannot exist
     in the same part at the same time
Of wrong actions, as spasms, locked jaw, &c.
Of irritability    ......

                    CHAP. X.—Of  Sympathy.

Sympathy may be regarded as  a secondary principle, introduced
     into the economy of the higher order of animals
Connexion of principles of action in the living body
Sympathy between different bodies      .
Of natural or diseased sympathy, and division of the subject
105
106
108
 ib. 
394
HUNTER'S PRINCIPLES  OF SURGERY.
Inflammatory and hectic fever are examples of constitutional sym-
    pathy       .....
Certain parts sympathize more strongly than others
Of similar and dissimilar sympathies
Sympathy between the body and mind
And of the mind with the living principle
Uses of sympathy in the animal economy
Of delusion, and the manner in  which it may be explainer.
Delirium ......
Dreams  ......
Animal magnetism       ....

       CHAP. XI.—Of Local and Constitutional Diseases.

Difficulty of distinguishing local from constitutional diseases
Diseases are constitutional, local, or mixed
Of  common and specific diseases
Of  the effects of age, climate, seasons, temperature, and  the
    moon, on disease    .....
The humoral doctrines examined
Experiments of injecting medicines into the blood
Which produced  no specific diseases
Of hereditary diseases, and in what sense they are to be considered
     so
Scrofula and gout, with reference to this principle
Of  the effects of the mind on disease
Of  symptoms, local and universal
But to judge of  symptoms, the  general character of the  patient
     should be previously ascertained

        CHAP.  XII.—General Principles of Inflammation.

Frequency and nature of inflammation
In a healthy constitution it has  three terminations, viz.
Adhesion        ......
Suppuration, and ......
Ulceration       ......
Causes of inflammation  .....
Comparative susceptibility of parts to inflammation
Strength and weakness of the constitution and of the part affected
     modify the  inflammatory process
Effects of inflammation on the  constitution
And on the vascular system in particular .
Inflammation of vital and of non-vital parts
Effects on  the constitution different according to the stage  of the
     inflammation       .....
Rigors and exacerbations .....
Of the state of the blood in inflammation .
Colour, heat, swelling, and pain ....
Of the resolution of inflammation
Of the restoration of injured parts
Of ecchymosis   ......
Puge 
ANALYTICAL CONTENTS.
395
Of external wounds, and the method of Nature in healing them
Further observations on adhesive inflammation

            CHAP. XIII.—Of Adhesive Inflammation.

Inflammation a restorative action .       .       .       •
Of adhesive inflammation, and the causes which limit its extension
Of the utility or final intention of inflammation   .
The extravasated lymph is always of the same nature as the parts
     which produce it
Local symptoms, viz. redness, swelling, and pain
Of the uses of adhesive inflammation     .       .      .       •
 Adhesive inflammation sometimes imperfect
 Of the resolution of inflammation        .       .      •       ■
First, by constitutional means, as low diet, medicines and bleed-
     ing, and    .......
 Secondly, by external applications       .
 Of revulsion and counter-irritation       .       •       •
 Treatment of adhesive inflammation when  suppuration must take
      place       .....••
Page
 171
 172
173
174
175

176
 ib.
177
179
180

181
185
186

  ib.
CHAP. XIV.—Of Suppurative  and Ulcerative Inflammation ;
    Granulation, Skinning, Hectic Fever, and Dissolution.
Of suppuration, and the circumstances under which it occurs
Does not arise from the access of air, nor from the violence of the
    inflammation simply considered
But most frequently on the surfaces of mucous canals
Symptoms of suppuration
Treatment of suppuration
Of suppuration without inflammation
Of granulation and cicatrization
Theories respecting the formation of pus
Of the globular natuie of this fluid, and  the modes by which  it
     may be distinguished from mucus
The quality of pus varies under different circumstances
The final intention of this secretion
 Of interstitial and progressive absorption, together with the
     and immediate causes of these actions
 Of the relaxation of the skin over abscesses
 Progressive absorption always attacks those parts which are near-
     est the  skin .
 Absorption may take place without ulceration
 Of ulceration    .       •       •             •
 Newly-formed parts are most subject to ulceration
 Granulations may be produced without any breach of the
 Of the nature of granulations    .       •
 Of the union of granulations by inosculation
 Granulations have less powers, and arc shorter-lived than
      parts        •       •       •       •
 Contraction of granulations, followed by cicatrization
remote
solids
original
187

188
189
 ib.
190
 ib.
192
 ib.

194
195
196

 197
 199

 200
  ib.
 201
 202
  ib.
 204
  ib.

 205
  ib. 
396
HUNTER'S PRINCIPLES OF  SURGERY.
Of tho formation of new skin, and the economy of Nature in this
     process     .......
Of the nature of the new-formed cutis, cuticle, and rete mucosum
Constitutional.effects of suppuration     ....
Hectic fever     .......
Arises from a disease which the constitution cannot overcome
But is sometimes an idiopathic disease   ....
Symptoms of hectic fever       .....
Erroneous-opinions respecting the cause of hectic fever
Hectic fever is not produced by large abscesses until they are opened
Treatment of hectic fever       ......
Of dissolution, or death, arising from excessive suppuration, inde-
     pendently of hectic fever    .....
206
207
 ib.
 ib.
208
 ib.
 ib.
209
210
 ib.

 ib.
CHAP. XV.—Practical Illustrations  of the preceding Subjects.
Of ruptured tendons, and particularly of the tendo-Achillis
Principles of treatment   .....
Muscular exertion impossible until the injury is repaired  .
Of simple fractures      .....
Of compound fractures, and  of the  manner in which compound
     fractures may become  simple, and e converso
Inflammation, suppuration,  and ulceration of circumscribed cavities
Pleuritis .....
Empyema and hydrothorax
Of the treatment of these cases  .
Pericarditis       ....
Emphysema from fractured ribs, and treatment
Peritonitis, common and puerperal
Peritonitis after paracentesis
Hernia   .....
Caesarian operation
Wounds into the  cavities of joints
Ganglions        .....
Inflammation of the eye  .
Inflammation of the brain
Inflammation of veins
Inflammation of arteries  .
211
212
214
 ib.

216
 ib.
 ib.
217
218
219
 ib.
220
221
222
 ib.
223
224
 ib.
225
 ib.
227
CHAP. XVI.—Of Hydrocele, and the Actions  of Medicines.
Theory of the cure simple, but the operation often fails
Description of the disease, and its  different varieties
Disappears in children, but rarely in adults
Diagnosis        ....
Situation of the testicle varies in different cases
And also of the vessels   .
Of  the palliative cure
The proper feeling of the organ will often enable the surgeon to
     distinguish a hydrocele from a pulpy testicle
227
228
230
 ib.
232
233
234

235 
ANALYTICAL CONTENTS.
397
                                                               Page
The sac sometimes  suppurates  after the simple evacuation of its
    contents     .......  236
Of  the radical cure       .       .      .       .       .       .   ib.
A distinction to be made between operations of convenience and
    operations of necessity     .....  237
Observations on the different modes of radical cure      .       .  238
Which failed from ignorance of the true principles of cure      .  239
The causes of failure common to the following methods, viz.    .  241
Seton, tent,  and caustic  ......  242
Of  the mode of performing these operations     .      .       •  243
Of  the method recommended, viz. by incision    .      .       •  244
Of the action of medicines      .....  247
Medicines destroy the action, but canuot destroy the disposition to
    disease      .       ...       .       .      .       .  249
In the restoration of action, as  after drowning, the strength and
    action should be well proportioned to each other    .        .  250
Of  the effects of external applications     ....  251
Of  pressure, friction, heat, cold, and electricity  .      .       .  252
Of  diseased dispositions and actions     ....  253
 nstances in which the action  destroys the  disposition    .       .   ib.
Some parts have a greater disposition to heal than others .       .  254
Of  the effects  of  age in this respect      ....  255
One disease often cures another   .       .       .      .       .   ib.
Of  the uniformity of Nature's operations  in the recovery from
    disease      .......  256

               CHAP. XVII.—Injuries of the  Head.

Of  the different kinds of injuries of the head  from external vio-
    lence, viz. concussion, compression, wounds of the  brain,
    want of due compression, and  inflammation .      .       •  256
Concussion      .......  258
General observations on fractures of the skull     .      .       •  259
Compression     ....•••  260
Wounds of the brain     ......  262
The external  table may be  fractured without the internal,  and
    e converso  ..•••••   *63
Of  the propriety  of trepanning in the above mentioned cases     .   ib.
The operation described  .        .       .              •       •  264
Of  wounds  of the dura mater, and their consequences   .       .  264
Hernia cerebri   ...••••   *"•
Of  the principles of treatment in injuries of the head    .        .  265

  CHAP.  XVIII.—Of the  Diseases of the Bones and Joints ;
                 of Fractures, Dislocations,  &c.

Bones liable to all the diseases of soft parts       .      .       •  267
Death of bone, and caries        .....  268
Diseased actions of bone ...-••  269
Ulceration and induration of bone       .       .              j
Of  simple  fractures, and the mode in which union is accomplished   270
Treatment of simple  fractures    .       .       •       •       .271
                                 34 
398
HUNTER'S PRINCIPLES OF SURGERY.
False joints      ......
Bones subject to the adhesive, suppurative, and ulcerative inflam-
     tion .....
Compound fractures, and their treatment  .
Compound fractures communicating with joints
Question of amputation considered
Fracture of the patella, olecranon, and outer ankle
Periostitis        ....
Spina ventosa    ....
Necrosis .....
Of the contraction of diseased joints
Sprains  .       .       .      .       .
Dislocations      ....
New joints produced in consequence of dislocations
Inflammation of joints, and the reason of their great danger
Of lose substances in the joints  .
Of the different kinds of anchylosis
Wasting of the muscles in consequence of diseases of the joints
Exfoliation of bone      .      .       .       .
Necrosis ......
Of the extraction of exfoliated bone
Rickets  .
Mollities ossium  .....
Of the effects of mechanical pressure on riekety bones
Exostosis        ......
Of the exfoliation of cartilage
Page
273
         CHAP.  XIX.—Of  Hemorrhages  and Aneurism.

Hemorrhage     ......
  May arise from 1 st, natural eauses ;  2d, disease;  3d, violence
  Of the effects of loss of blood on the system  .
  Of the efforts of Nature to suppress hemorrhage
  Of lateral wounds of arteries  .
  Of the artificial means of stopping hemorrhage
  Of secondary hemorrhage
Aneurism        .....
  Classification of aneurisms and definition of the term
  Causes of aneurism    ......
  Experiments to illustrate this part of the subject
  Action of the heart not the only cause of aneurism
  Although arteries are apt to yield most on that side where the
      force of the heart is greatest,  ami where they are least
      supported         .....
  Opinions of Pott and Bromfield on the operation for aneurism
  The operation should be performed as early as possible
  Of those arteries which admit the operation
  General observations on the operation .
  Cases         .       .       .       . •     .
  Notice of the first case in which the author operated by taking
  up the artery in  the middle of the thigh
310
312
313
814
 ib.
315

316 
ANALYTICAL CONTENTS.
399
   CHAP.  XX.—Of Specific  Diseases,  Tumors,  Hydatids, and
                             Tetanus.
                                                               P
Of ulcers, and the causes which retard their cure
Of abscesses, and particularly of those which are deep-seated
Of Specific  Diseases, or rather of those dispositions and actions
    which are not productive of restorative actions
These may be divided into the irritable
Producing irritable inflammation
And indolent
Producing hypertrophy of parts
Varicose veins
Corns
Chilbains
Preternatural accumulations of fat
Elephantiasis    ......
Of the enlargement of particular organs
Observations on the cure of indolent dispositions in diseases
Of the suppuration of indolent parts.
Of Tumors
Wens
Tubercles
Warts
Polypi
Tumors in the cellular membrane
Of the removal of tumors        ....
Tumors in bones         .....
Encysted tumors,  the cysts of  which are, 1st, natural;  2d,  ac-
    quired       ......
Of Hydatids of the uterus, kidneys, liver, lungs, brain, &c.
Encysted tumors of the  cutis    ....
Of inflammation, suppuration, and ulceration of new-formed parts
Of fistula? in general     .....
Fistula laehrymalis      .....
Fistula of the parotid duct      ....
Fistula in ano   ......
Fistula in perineo        .....
Of the cure  of fistula?
Of the attention necessary in diseased joints respecting motion
Tetanus ..•••*•
Of the classification of this disease
Causes   ...«•••
Constitutions most susceptible of tetanus .
Of the climate and kind of wound which have the greatest influ-
    ence in producing this disease
Of the mode of attack    .
Treatment generally unsuccessful

                   CHAP.  XXL—Of Scrofula.

Scrofula a specific disease without a morbid poison       .       •   351
Other animals besides the human subject liable to it       •       •    »>.
Some parts, constitutions, and ages more subject to it than others .    ib. 
400            HUNTER'S PRINCIPLES OF SURGERY.
                                                               Page
Scrofula not hereditary   .....
Of climate and seasons in reference to this disease
Susceptibility to scrofula may be acquired
Progress of scrofula slow, and suppuration imperfect
The different appearances of scrofulous tumours and sores
Diseases of the hip      ....
Lumbar abscess  ......
White swelling  ......
Phthisis pulmonalis      .....
Scrofula of the testicle    .....
Scrofula of the breast     .....
Of the medical treatment of scrofula
Of the surgical treatment of scrofula

        CHAP. XXII.—Of  Mortification and  Carbuncle.
Mortification of two kinds, one with, and the other without, in-
     flammation  .......  361
In the former case it  arises from the  action being too great for
     the power   .......  362
Of the principles of treatment     .....  363
Of death from caustics and cauteries     ....  364
Of the separation of the dead from the living parts       .       .365
Carbuncle       .......  366
Depends on some peculiarity of constitution distinct from mere
     weakness   .......  367
The appearance and progress of carbuncle described     .       .   ib.
Boils    .       .       .       .       .       .       .           ib.
Treatment of carbuncle   ......  368
CHAP. XXIII.—Of  Poisons.
General considerations respecting poisons				. 370
Of the different ways in which animals may be affected by poisons 371				
Mineral poisons ....... 372				
Vegetable poisons				ib.
.... C first, natural . Animal poisons: \second% morbid				373
				374
Of the mode in which morbid poisons are	receivec	I		375
Scabies ....				ib
Cancer ....				. 376
Does not affect the constitution				377
Extension of the disease by three modes				. 379
Predisposing causes				380
Of the parts most susceptible of cancer				ib.
Whether hereditary, and in what sense				. 381
Symptoms				. ib.
Progress towards suppuration				. 382
Treatment				ib.
Extirpation				. 384
Cancer of the testicle				386
Fungated sores .				387
Cancer of the penis				. 388
Haematocele ....				ib.
the  end. 
               PLATES





                     TO






         HUNTER'S LECTURES





                     01*






THE  PRINCIPLES  OF  SURGERY. 
 
PLATES TO HUNTER'S PRINCIPLES OF SURGERY.      ii
PLATE I.
Fig. 1.
Fig. 2.
Fig.i 3.
mm
 
 
PLATES TO HUNTER'S PRINCIPLES OF SURGERY.
ill
Fig.  1.
PLATE  II.
Fig.  2.
-  ' •  ; 
 
PLATES TO HUNTER'S PRINCIPLES OF SURGERY.
IV
Fig. 1.
D       A
PLATE  III.
Fig.  3.      Fig. 4.
 
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   DISEASES OF  THE  LIVER  AND  BILIARY   PASSAGES.

       By Wm. THOMPSON, one of the Physicians of the Royal Lnfirmary  of Edinburgh.

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                          Clinical Remarks on some Cases of

         LIVER ABSCESS   PRESENTING   INTERNALLY.
                             By JOHN G.  MALCOLMSON, M.D.,

             Surgeon Hon. E. L C. Service, Fellow  of the Royal Asiatic Society, Ac. 
6
BARRINGTON
AND   HASWELL'S
              MEDICAL  NOTES  AND  REFLECTIONS.

                            By  HENRY  HOLLAND, M.D.,  F.R.S.
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                               COMMENTARIES OX THE

         HISTORY   AND   CURE   OF    DISEASES.

                              By  WILLIAM HFT.ERDEN,  M.D.,

                           New and Handsome  Edition,  1 vol. 8vo.
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                                  ESSAYS  OX  THE

      SOURCES  AND   MODE  OF  ACTION   OF   FEVER.

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time and labor devoted to its examination."— WcsUrn Ljuicct.


                                  ON    DENGUE.

       ITS  HISTORY,   PATHOLOGY,   AND   TREATMENT.

                              By HENRY  S.  DICKSON, M.D.,

  Professor of the Institutes and Practice of Medicine in the Medical College of South Carolina.

                                  1 small volume.  Svo. muslin.


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        DERANGEMENTS,  PRIMARY  AND REFLEX, OF  THE  ORGANS OF DIGESTION,

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that we  have encountered.  While it embraces  all that is important or interesting to  be found in the writings
of other authors, it contains much original information, which the physician will find of great practical useful-
ness."— Westtrnand Southern Medical Recorder.
  •• We recommend this volnme most warmly to the attention of our readers."—London Lancet.
  '• This volume may, in fact, be denominated with no small degree of  propriety an encyclopedia of dyspeptic
disorders."—X. Y. Lancet.
  "It is decidedly the best compilation in the English language on the extensive class of disorders and diseases
comprehended under the term dyspepsia, united with a very large proportion of original matter, derived from the
author's own experience."—Med. Chir. Reo.


                EPIDEMICS   OF  THE  MIDDLE   AGES.

                         From the German of I. F. C. HECKER, M.D.,

           NO. I.—THE  BLACK DEATH IX  TUP. FOURTEENTH  CENTURY.

  " Hecker's account of the " Black Death," which ravaged so bir^e a portion of the globe in the fourteenth cen-
tury, may be mentioned a- a work worthy of our notice, both as containing many interesting details of this tre-
mendous pestilence,  and  as exhibiting  a curious specimen of medical  hypothesis."—Cyclopaedia of Practical
Medicine,
                             NO. II.--THE DANCING  MANIA.

  "Medical History has long been in need of the chapter which this book supplies; and the deficiency could not
have been remedied :it a better season. On the whole, the volume ought to be popular; to the profession it must
prove highly iiee,vt:i!'e. as conveyinj: so  much  information, touching  an important subject which had almost
been suffered to 1* lmried in oblivion, and we think tbvt to Dr. Babington especial thanks are duo for having
naturalized so in.,-re'tin,' a production.  Tbe style of the translation, we may add, Is free from  foreign idioms:
it reads like an English original."—Lond. Med. Gaz. 
MEDICAL  PUBLICATIONS.
7
                       A  TREATISE   ON   TETANUS.

By THOS. BLIZARD CURLING, Assist. Surg, to the London Hospital, etc. 1 vol. 8vo. half sheep.
Y "This book should be in the library of every surgeon and physician.  It is a valuable work of reference.  It
does not pretend to originality, for originality on such a subject was not wanted.  But a compendium 01 iacis
was wanted, and such a compendium is this volume.   We cannot part from Mr. Curling without thanking nun
for the information we have received."—Med. Chir. Rev.


                                    APHORISMS  ON  THE

 TREATMENT  AND   MANAGEMENT  OF  THE  INSANE.

                                By I. G. MILLINGEN, M.D.,
 Late Medical Superintendent of Lunatic Asylum, Hanwell, Middlesex, etc.—1 vol. Svo. half sheep.
   " Dr. Millingen, in one small pocket volume, has compressed more real solid matter than could be gleaned out
 of any dozen of octavos on the  same subject. We recommend his vade macum as the best tning oi xne una we
 ever perused."—Dr. Johnson's Review.


           A  PRACTICAL TREATISE ON THE  PRINCIPAL DISEASES OF THE LUNGS,

 CONSIDERED  ESPECIALLY IN RELATION  TO THE PARTICULAR TISSUES AFFECTED, ILLUSTRATING THE

                                  DIFFERENT  KINDS OF COUGH.
                            By G. HUME WEATHERHEAD,  M.D.,
 Member of the Royal College  of Physicians, Lecturer on the Principles and Practice  of Medicine,
            and on 'Materia Medica and Therapeutics, etc., etc.—1 vol. Svo. half sheep.


      A TREATISE  ON  THE  DIAGNOSIS AND  TREATMENT  OF  DISEASES OF  THE  CHEST,

                            By WM.  STOKES, M.D.,  M.R.I.A., Etc.

 2d Edition, with an Introduction and Numerous Notes, by the American Editor.—1 vol. 8vo. sheep.
   "It is delightful, indeed, to contemplate the sound pathology and rational therapeutics which it inculcates;—
 so different from the swelling egotism, the groundless assertions, the illogical conclusions,  and often empirical
 treatment) recommended  in some of the modern works on these and other important medical subjects."-i/ed.

 &« ^inconsiderable part of the book is made up  of Dr. Bell's  notes, and it  now constitutes one of our most
 useful^treatises on the diseases of the chest, characterized by sound pathology and rational therapeutics."-.^

  ^lo^weU knoCn^retoe writings of Dr. Stokes, that no effort of the medical press in this country is necessary
 to increase  their circulation.  Young practitioners would find  this volume a pathological guide, which they
 would be unwUlin^ to part with when made familiar with its intrinsic yalue »-ift»to» Med. and Surg. Journ.


  THE  DIAGNOSIS,  PATHOLOGY, AND   TREATMENT  OF



                                 By W. W".  GERHARD, M.D.,
  Lecturer on  Clinical Medicine in the  University of Pennsylvania, etc.-l vol. Svo.  sheep.   Third
                                      Edition, much improved.

    "We would sav bv all means study this volume."—Buff. Med. Jour.                     T„-.^
    « mvf-   .ou',r r?;",y'TiUZ, nf rir Gerhard's well known work on thoracic diseases."—London Lancet.
     This  is the third edition of ^' ^™^L whidTare constantly made against physical exploration in medi-
  cineTby ZlelT.S^StSS can  never advance beyond the point atwhich they ceased to

  16 « Ind^iS .Sfto be Invidious, we may not inaptly designate Dr. Gerhard as the Louis of America."

  "HwortmhSoTtts Diseases of the Chest will be accredited as the highest authority on that subject."

  - West. Journ. Med. o-^djurg.           , D  Gerhar(i for the excellent work with which he has presented

  them a ^^O^^^^^^S^^ * «* »*" Sale°f *»» *"»* -**•"-****
  Med. Exam.                  recommend the book of Dr. Gerhard as the fullest and most judicious manual,
  motionS^ff^Ti* «^-^ W canprocure,'-^e^ and Southern Recorder.


                              A   PRACTICAL   MANUAL

   ON   DISEASES  OF  THE  HEART   AND  GREAT  VESSELS.

                Translated from the French, by WILLIAM A. HARRIS, M.D., U.S.N.    _
    "This is an excellent epitome  of a large and important class of diseases-especially as  to diagnosis. -Med.

   Chir. Rev. 
,8
BARRINGTON  AND  HASWELL'S
^This work, though issued under the modest title of a manual, is yet so comprehensive as to afford minute In-
struction on every point of which it treats."—Phil. Med. Ex.
  " We do not know of any production in which so much positive knowledge has been compressed within mode-
^*!f^i?IB*tS, and.yet clearness of description presented, as in this manual."—Bulletin of Med. Science.
  " We hope this manual, comprising, as it does, a  summary of what has been published in more elaborate works,
wul be extensively read, and that the study of it  may lead to  a more correct  appreciation of the character of
these diseases."— West. Jour, of Med. and  Surg.
  "The present treatise will prove of great value, as it reallv contains all that is well known on this most diffi-
cult yet important branch of pathology and therapeutics.'— West. Lancet.
  LECTURES ON  SUBJECTS  CONNECTED  WITH  CLINICAL MEDICINE.

                 AUSCULTATION   AND   SEMEIOLOGY.

                                   By P.  M.  LATHAM, M.D.,

     Physician extraordinary to the Queen,  and late Physician to St. Bartholomew's Hospital.

                                        1 vol.  8vo. sheep.
  " It is classical in style, replete with facts, rich in  illustration, sound in doctrine, and a legitimate product of
the Hippocratic school of observation."—X. Y. Journ. Med.
  " Containing valuable matter presented in a highly agreeable manner."—Buffalo Med, Journ.
  " They contain clear, concise, practical views of semeiology, and of  the  value of symptoms, in the diagnosis
and treatment of disease, which are not to be found  in any other single work."—South. Journ. Med. and Phar.
  " The chapter on the Doctrine of Symptoms, embrace auscultation and the various  physical signs of disease,
and ought to be studied by all who aspire to a knowledge of these subjects."—Medical Examiner.
  "We consider this  publication well deserving of  that patronage which men of enlarged professional views
should bestow upon works of the first character on practical medicine."—Boston Med. and Surg. Journal.
                            LECTURES   ON   SUBJECTS

  CONNECTED   WITH    C L I N  I  C A  L    M E D  I C  I  N E,

             COMPRISING   DISEASES   OF  THE  HEART.

                                   By P.  M.  LATHAM, M.D.,

    Physician extraordinary to the  Queen, and late Physician  to St, Bartholomew's Hospital.

                                     1 volume 8vo. sheep.
  " It is a deeply reflective volume, replete with results indicative of close observation, and abounding with
hints and directions which cannot fail to give a strong and beneficial impulse to the study of cardiac disease."—
Brit, and For. Med. Rev.
  "We know of no work where the reader will find so clear and easily intelligible a view of a difficult practical
subject—the Diagnosis of Diseases of the Heart—as in Dr. Latham's two volumes."—Mcdico-Chirur. Review.
  " He will find in them much that no  other work upon the subject  contains, and what is even better, much
that will move him to observe more closely, and ponder more earnestly,  what is going on within his own expe-
rience."—Amer. Journ. Med. Science.
  " One of the most remarkable works which has, for a long time, been  presented to the profession; a work full
of original remark, abounding in correct analysis, just reasoning, clear and lucid expositions of doctrine, and
judicious practical teachings."—South. Journ. Med. Pharmacy.
  " We commend the book most heartily to our readers, as one of high  value, and not less pleasing than valua-
ble."—Western Journal.
  " These have all been illustrated by the able and  experienced author  in a most interesting and lucid manner,
so that hereafter no work will be regarded as more essential in studying diseases of the heart  than this of Dr.
Latham."—N. Y. Journ. of Med.
  " Throughout the whole work, we meet with the evidences of the deepest reflection, and of the most philo-
sophical caution and acumen in weighing and analysing facts."—Land.  Med. Gaz.



                               A   TREATISE   ON   THE

NATURE, CAUSES,  AND  TREATMENT  OF  ERYSIPELAS.
                                   By THOMAS  NUXNELEY,

Lecturer on Anatomy, Physiology, and  Pathology in the Leeds  School of Medicine, Surgeon to the
                    General Eye and Ear Infirmary, <fec, Ac.—1 vol. 8vo.  sheep.
  " Nothing short of a perusal of the entire book will do justice to the author or reader."— Western Lancet.
  " The work in its entireness is one which will  be accounted necessary  to every physician's library."__Western
Journ. of Medicine and Surgery.
  " Did  our space allow, It would be both interesting and  profitable to enter into a full analysis of this work •
but we  would advise our readers,  one and all, to purchase it, and thus  judge  of its value from a personal
examination of its pages."—X. Y. Jour. Med.  and CoUat. Sciences.
  " Mr. Nunnelev contends, and we think with success, that puerperal fever and erysipelas are one and the same
disease, modified by the seat of the inflammation."—N. Orleans Med. Jour. 
MEDICAL  PUBLICATIONS.
9
                      PRACTICAL   OBSERVATIONS
ON  DISEASES  OF  THEHEART,  LUNGS,  STOMACH,  LIVER,  ETC.
                      OCCASIONED  BY  SPINAL  IRRITATION,
   And on tlie Nervous System in general, as a Source of Organic Disease.
        Illustrated by Cases.  By JOHN MARSHALL, M.D.-l vol. Svo. half sheep.


                     CLINICAL   LECTURES.
                       By  ROBERT J. GRAVES, M.D., M.R.I.A.,
    Professor of the Institutes of Medicine in the School of Physic,  Trinity College, Dublin.
         Third American, from the Dublin Edition, with additional Lectures and Notes.
                             By W. W. GERHARD, M.D.,
 Lecturer on Clinical Medicine to the University of Pennsylvania, Physician to the Philadelphia
                        Hospital, Blockley, Ac — 1 vol. 8vo. sheep.
  « The possessor of this treatise will actually have an embodiment of all that is modern in the science to which

 "SS^relo^^                                                 matt8r; ft ^ b

 ^d'aStob^

 |S5=^^SnS
 library of practical Medicine.;'—XY./?"«*■       .   ..    . scarcely a disease to which the human frame
 • r^^rtoes ^t'^^ln^mlSStto.^orlntid^TLrf as a guide to practice, especially
 gdlmcu^^                                               md **«* RWUW-

      ANDRAL'S  CLINIC  ON   DISEASES  OF   THE  ENCEPHALON,
                         it                 «          "       ABDOMEN.
                         tt                   "          "       CHEST,
                   Either of the Works can he had Separately.
                                 Three volumes 8vo. sheep.
   «TheW«e^i^
                               SURGERY.

      THE  COURSE  OF  LECTURES  ON   SURGERY,
                   Delivered in the Royal College of Surgeons in Ireland,
v,  ♦!,„ l. te ABRAHAM  COLLES, M.D., for thirty-four years Professor of Surgery in the College. ■
By the late A^**1.1   ,ml,rPB80f Mr Colles's name, any practical man looking over these pages would
  « Even without the precious impress°f Mr. ^oiieisii^j a u art »_£„■<. and For. Med. Rev.

^FeT^^^^^
^Ch^hesltation^m^
volume which has Deen ouerw                                                              ,
Surg.            , .      „„,, nf tt,p«.e lectures with a very high opinion of the judgment and surgical ,
TuTen of^Tto P^rr ^
und^ra'ctical facts."-io«d  Xf-f™.         amanof accurate observation and extended experience: not ■
 h" ?0^f P "dueton o7 a^mpiler who C Laired his knowledge of diseases only from the recorded observa- [
tions of ^ere."-^K Jbum. oj^      o{ ,ta technical verbiage, must read these lectures as they fell from j 
10                BARRINGTON   AND   HASWELL'S
PRINCIPLES  AND   PRACTICE  OF  SURGERY,

                      By FREDERICK TYRRELL, Esq.
       Fifth American, from the last London edition.—1 vol. 8vo. sheep.
     LECTURES   ON  THE   PRINCIPLES  OF   SURGERY.

                                  By JOHN HUNTER, F.R.S.,
With Notes, by James F. Palmer, Senior Surgeon to the St. George's and St. James's Dispensaries,
                              etc., etc.  With plates, 1 vol. 8vo. sheep.



                LISTON'S  ELEMENTS   OF  SURGERY.

                             Edited by' SAMUEL  D. GROSS, M.D.,

Professor of Surgery in the Louisville Medical Institute.  Author of Elements of Pathological
                                        Anatomy, etc., etc.,

Fourth American, from the last London edition, with upwards of one hundred and sixty illustra-
                                tive Engravings.  1 vol. 8vo.  sheep.


  " We must not forget to mention that the volume is rendered still more attractive by the addition of numerous
wood engravings (some of them introduced by Dr. Gross), all finely executed. These will be found of very con-
siderable advantage to the student, materially assisting him in comprehending the explanation of morbid struc-
ture.''—Western Jour, of Med. and Surg.
  " We are here presented with a republication of Mr. Listen's admirable and much praised work on Surgery,
which has been subject to the alembic of a critical and learned friend, Dr. Gross.  He has  added ' copious notes
and additions,' such as the progress of surgery in the United States demands in order to meet the wants of the
surgeon; and has  bestowed  unwearied  pains to adapt it to the present condition of things.  It is modern in
every respect, since it contains tlie latest improvements, and the very last discoveries, in the domain of operative
surgery, both here and in Europe."—Boston Med. and Surg. Jour.
  " In another essential feature this edition is greatly improved.   With the principles is taught also with it the
practice of surgery; and both morbid structure and operations are doubly described; first by the  author  and
editor, and next by the graver of the artist."—Z?uH. Med. Scien.
  " Mr. Listen has seen much, thinks accurately, and speaks independently.  From a volume written by such a
man, more really valuable practical instruction is to be derived than from all the books that were ever compiled."
— Western and Southern Med. Recorder.
  " It embraces all the principles of surgery, which the work on the operations does not."—& Journ. of Med. and
Pharm.                                      «
  " Few living authors are better qualified for expounding the principles of surgical science, and the evidence of
these attainments are abundant in the work before us."—Philad. Examiner.
  " This  is a work of established reputation. It has gone through two editions in Great Britain, and the same
number in this country.   The additions of the American edition are copious, and add materially to the value of
the work."—Amer.Jour. Med. Sciences.
  " The notes and additions by Prof. Gross, are well arranged and judicious,  supplying some evident deficiencies
in the original work.  It is no mean praise, that this treatise has so readily found its way into the hands of the
profession."—Western Lancet.


                               LECTURES   ON  THE

      NATURE   AND  TREATMENT  OF   DEFORMITIES.

                                By R. W. TAMPLIN, F.R.C.S.E.,

  Surgeon  to the Royal Orthopaedic Hospital.—lvol. royal 12mo., with numerous Hlustrations.
  " They  constitute a work both original and useful.  Mr. Tamplin, if we are not greatly mistaken, will be gener-
ally admitted to have performed a useful task well, and to have made substantial additions to the treatment of
deformities without any parade or self-laudation."—Bulletin of Med. Science.
  " To those numerous members of the profession  desirous of making themselves acquainted with the most
recent and approved principles of treating a class of diseases which have hitherto been considered to fall within
the special domain of quackery, we cordially recommend Mr. Tamplin's valuable lectures."—Lond. Med. Gaz.
  " We strongly recommend our professional friends generally, and especially such as reside in the country, to
have a copy of it beside them."—Med. Chir. Rev.
  " This work is practical in the strictest sense of the word, being confined to facts and  illustrations of princi-
ples, furnished in a plain, brief, and systematic style."—S. Med. and Surg. Journ.
  " Their collection into a separate volume is a just tribute to their intrinsic  merit, as well as to the high char-
acter of their author."—St. Louis Med. and Surg. Journ.
  "The author is a sound, practical man, and in these lectures he gives us the result of a large experience in one
of the best conducted and  most valuable charities of London; a charity devoted exclusively to the treatment of
deformities."—Buffalo Med. Journ.
  " This work may be consulted with much profit  by the surgical reader; and we therefore strongly recommend
our professional friends generally, and especially such as reside in the country, to have a copy of it beside them."
—Med. Chir. Rev. 
MEDICAL   PUBLICATIONS.
11
            HUNTER  ON  THE   VENEREAL  DISEASE.
                 With Notes, by Dr. BABINGTON.  With Plates.—1 vol. 8vo.

  "Under the hands of Mr. Babington, who has performed his task as editor in a very exemplary manner, the
work has assumed quite a new value, and may now be as advantageously placed in the library ot tlie stuaeni as
in that of the experienced surgeon."—Brit, and For. Med. Rev.                                  .  .  ,.
  "The notes, in illustration of the text, contain a siunmary of our present knowledge on the ™oject, tne
manner in which these notes are constructed  is  at once  clever and perspicuous; and the modes ot treatment
prescribed, spring from a right apprehension of the disease.  We would recommend to the reader the note on ine
primary veneroal sore; the note itself is an essay in every word of which we fully concur. —Mea. (xaz.
  LECTURES  ON   VENEREAL  AND   OTHER  DISEASES
                  ARISING  FROM  SEXUAL INTERCOURSE.
                                      By M.  RICORD.
  "Twentyeight lectures are given, which fully and minutely embody the ^^^.%^L^ ^as
day, in the treatment of those maladies having an origin in the source adverted to in^tho title-sheet,  ltnas
an advantage over more costly books upon the same topic, because it is muUum in parvo, and may be purchased
for a trifle."—Boston Med. and Surg: Journ.                                     .         .  fill th^ hi
  "The present lectures, clinical in their character, and appearing » » "ndnl?i*,*™w?Sn will cjnniend
tus which the profession at large have for some years felt.  We regard the work as one which wdl «m»a
itself to the profession as the most concise and able exposition of the doctrines of syphdis^ -^^£<*
  "We cannot close this notice of M.  Ricord's Lectures without expressing an approbation^of the mam  n
which the reporter and translator has executed his task; nor without again  repeating the high estimation
^&1^^^iltfS£^£^^^ snould 1- in the library of every medical man."
—Philadelphia Examiner.

    ON   CURVATURES  AND  DISEASES  OF  THE  SPINE,
                   INCLUDING ALL THE  FORMS  OF  SPINAL  DISTORTION.
                                   By R. TV. BAMPFIELD,
        One of the Surgeons to the Royal Metropolitan Infirmary for Diseases of Children.
                               Edited by J. K. MITCHELL, M.D.,
    Professor of  the Practice of Medicine in the  Jefferson Medical College of Philadelphia, Ac.
  "Tho Tm best treatises on spinal diseases and their treatment extant."—Medical Examiner
  "We he^rtiS recommendthisP book to all who feel an interest in the matter, and especially in these days
 ^T^reatiX "iTa ve'rfvalulwe on^and Cheerfully recommend it to the profession."-^ OrUan,
 Medical Journal.
                              A  TREATISE ON  THE
 STRUCTURE, ECONOMY,  AND  DISEASES  OF  THE EAR.
                                   By GEORGE  PILCHER,
 Late Lecturer on Anatomy, Lecturer on Surgery, and Senior Surgeon to the Surrey Dispensatory.
   First American, from the second London edition, with Notes and numerous Illustrative Plates.
                                         1 vol. Svo. sheep.


 ^Jot^tr%l ^y^jffj£^^                             on the ear deserves
 to^ran^m^ 'tS^^t^^r^^^ but two generally neglected, depart-
 mentoTs'urgery  t^whlehU^"^^                             work, and must haye a great
 Ji^^SS^tffiS ahou^hf anatLy^iseasJs of the ea,"-.V. Y. HeraM.

                       A   TREATISE  ON   THE   TEETH.                     f
                                     By  JOHN HUNTER.
              With Notes bv  Thomas Bkll,  F.R.S.  With  Plates.- 1 vol. Svo. sheep.             1
                  \C ♦  Jh • „Hif«l bv Mr Bell  a Gentleman accomplished in his art.  Mr. Bell has studied'
    "The treatise on the teeth „ edted by Mr Ml  •^e          .^^ at thefoot of the page corrects the,
»eXb^^
»d pathology ."-Med. Gaz. 
12
BARRINGTON  AND  IIASWELL'S
                           THE NATURAL HISTORY AND

         DISEASES   OF   THE    HUMAN   TEETH.

                                By  JOSEPH FOX,  M.R.C.S.L.
           Lecturer on the Structure and Diseases  of the Teeth, at Guy's Hospital, Ac.

                         First American, from the third London edition.

       REM0DE1ED, WITH AN INTRODUCTION, AND NEARLY TWO-THIRDS OF ADDITIONAL MATTER.
                           By  CHAPIN A.  HARRIS, M.D.,  D.D.S.

Professor of Practical Dentistry and Dent Pathol, in  Baltimore College  of Dent Surgeons, Ac.

                  Illustrated with Thirty Plates.—1 vol. super-royal,  8vo. sheep.
  "On the whole, considering the vast amount of practical information it contains, the judicious arrangement
of its subjects, and last though not least, the great number of valuable engravings, many of which are not to
be met with elsewhere, it is a work which we  think every dental student, and especially practitioner, should
possess.  The plates alone are worth the price of the book."—Am. Journ. of Dental Science.
  " The known character of this work, together with the reputation of the American Editor, renders it unneces-
sary  for us to say anything in its  favor, except that the engravings are executed in  the best manner, and  the
paper and  type correspond; and though far superior to, it is sold at about one-third the price of the English
edition."—Dental Intelligencer.
  '• The present edition comes forth with the advantages of a careful revL-ion, and the sanction of a distinguished
teacher and practitioner of the dental art. That these additions are judicious, we need no better guarantee than
the .known competency of the editor."—Phil. Med. Examiner.
  " Its intrinsic scientific worth, the number and  beauty of the  engravings, and the paper and typography,
altogether entitle it to rank among the first if not the very foremost of the  many works issued of late years
on the anatomy and diseases of the teeth, and their curative treatment."'—Bulletin of Mul. Science.


                                MINOR   SURGERY,

     OR   HINTS   ON  THE  EVERYDAY   DUTIES  OF   THE  SURGEON.

                                By HENRY H. SMITH, M.D.,

            Lecturer on Minor Surgery, Fellow of the College of Phvsieians, etc., etc.

Illustrated by two hundred and forty-seven engravings.  1 vol. 12mo. 3d edition, much enlargod.
  " And a capital little book it is. . . Minor Surgery, we repeat Is really Major Surgery, and any thing which
teaches it is worth having.   So we cordially  recommend this little book of Dr. Smith'.-."—Med. Chir. Rev.
  "This beautiful little work has been compiled  with a view to the wants of the profession in the matter of
Bandaging, ic, and well and ably has the author performed his labors.  Well adapted to give the requisite in-
formation on the subjects of which it treats."—.V. I. Examiner.
  "The directions are plain, and illustrated  throughout with clear engravings."—London Lancet.
  " One of the best works they can consult on the subject of which it treats.''—Southern Journ. Med. and Pharm.
  " A work such as the present is therefore highly useful to the student, and we commend this one to their at-
tention."—Am. Journ. of Med. Sciences.
  " No operator, however eminent, need  hesitate to consult this unpretending yet excellent  book.  Those who
are young  in the business would  find Dr. Smith's treatise a necessary companion, after once understanding its
true character."—Boston Med. and Surg. Journ.
  " No young practitioner should be without this little volume; and we venture to assert, that it may be consulted
by the  senior members of the profession with more real benefit tiian the more voluminous works."—Western
Lancet.
         XKIDWXFZIXt.'X'  AND DI33ASES  OF  WOMEN.

     LECTURES   ON  THE  THEORY  AND   PRACTICE  OF  MIDWIFERY,
                               By  ROBERT LEE,  M.D.,  F.R.S.,
Fellow of the Royal College of Physicians, London; Physician  to the British Lying-in Hospital,
                       and Lecturer on Midwifery at St. George's Hospital.

                   Illustrated with numerous Wood Engravings.—1 vol. 8vo.

  " One important feature is the introduction of tables of the results of certain operations, as of craniotomy,
and of certain diseases uf the puerperal state, as puerperal fever;  which constitute a statistical ba^is for future
observations and a present support for active and available practice."—Bulletin of Med. Science.
  " It is the production of a highly cultivated and practical mind, and  has been elaborated with a degree of
judgment and care which must render the Lectures a valuable record of professional learning and experienoe."
— Western Journal of Med. S'-iences.
  •• Every passage will  indicate in the author a discriminating, practical mind, enlightened by learning, and ex-
tensive observations."  '• It is a store-house of facts from which the student may enrich his mind, and to which
the practitioner may apply to refresh his memory."—Western Jour.
  " The aim of the publishers was to give to the profession one of the very best  systems of midwifery in the
lanouage for the least money—to place a volume of unquestionable  excellence within the reach of every medical
man in the country. They have been successful."—Ibid.
  " The present production of Dr. Lee will always rank  high, as the offspring of a vigorous  mind, stored with
all the  learning relating to the  subject, and enriched with  the results of the most extensive experience."—X.
Orleans Med. Jour. 
MEDICAL   PUBLICATIONS.
13
r "I shall take advantage of the present occasion to refer you to that charming volume, < Lectures on the Theory
«nd Practice of Midwifery, by Robert Lee, M.D., F.R.S., Ac, &c.,' a book which I could desire to be in the hands
of every one of my pupils, as I look upon its author as the ablest man in all England, in this  part of science
and practice."—Meig's Letters on Female Diseases.                                                       <


              LECTURES  ON  THE  PRINCIPLES  AND  PRACTICE OF MIDWIFERY,

                                By JAMES BLUNDELL, M.D.,

                      Edited by Charles Severn, M.D.—1 vol. 8vo. sheep.

  "The eminently fluent and agreeable style—the large and accurate information—the great experience, tool
original mind of Dr. Blundell, have secured for him a very enviable reputation as a public lecturer.  It isim-
possible to read these lectures without beins delighted—it is equally impossible to avoid being instructed,   were
these discourses more generally diffused and studied here—were their sound and judicious directions rccoliectea,
and their salutary cautions observed, we would hear of fewer cases of malpractice. ^This work torms a com-
plete system of midwifery, with the diseases of the puerperal state and of the infant.'—X. Y. Lancet.



                 AN ACCOUNT OF SOME OF  THE  MOST IMPORTANT

          DISEASES   PECULIAR   TO   WOMEN.

                   By ROBERT GOOCH,  M.D.—1 vol.  8vo.  Second Edition.

   "Calmly and clearly ho investigates all thu phenomena of a disease, and simply registers precisely whatis
essential."—Boston Med. and Surg. Journ.                    „ ~  %r .   T
   "Dr. Gooch was an original thinker,  and excellent observer. '—Buff.  Med. Jour.



       A  PRACTICAL  COMPENDIUM   OF   MIDWIFERY.

                            By the late ROBERT  GOOCH, M.  D.

        Prepared by George Skinner, Member of the Royal  College of Surgeons, London.

                          Fourth American edition.—1 vol. 8vo. sheep.

   "Wherever civilization and science  have been introduced, there the name  and character of Dr. Gooch are

 ^We know Tno^medial wo7k Sicontains, in an equal number of pages, so much that is practically useful

 ^wetK^^^^


 content to^enend forknowledge on the compendium and text  books, prepared to facilitate the progress  of the
 Zdent  but are disposed to seek for information at its original source.  It may be well for the young s^tudent
 student, du; arc> "^V^,     iudement  to rely upon the digest prepared for his guidance; but the advanced
 stuaen? andX^Utton^hoJ wT^to  bTsmne^hing mo« than  a mere routinist, must consult the great
 ^ter^of our «cimc^ study their opinions in their own writings, compare their views, and form his own opinions.
 TmongthS                           always stand pre-eminent and  the profession are under  obhga,
 tion^ ^ the publfshersfor placing bis works within their reach."—W. Journ. Med. Science.



                   THE  HISTORY,  PATHOLOGY,  AND  TREATMENT  OF

       PUERPERAL  FEVER  AND  CRURAL  PHLEBITIS.

                      By  Drs.  GORDON,  HEY, ARMSTRONG,  and LEE.

                    With  an Introductory  Essay, by Charles D.  Meigs, M.D.,

  Professor of Obstetrics, and the Diseases of  Women and Children, in the  Jefferson  Medical Col-
  rr                            lege, Philadelphia.—1 vol. 8vo. sheep.

   "We  have peculiar satisfaction, in announcing the  publication of this very judiciously arranged series of
   "We  have^™»»r _■         't  t and interesting diseases, which demand the attention of the physician."
  ^Mei£s7nT^^                                   *° read with profit  He speaks in the highest
  1   « if .nmmendation of Dr". Gordon's invaluable treatise-a  treatise which  cannot be too generally diffused
  teTAudiedAlto^e her this volume  presents the  most acceptable and useful compend of the doctrines and prac
  and studied,  ^iw cuicr >,ur■»       ^   , Puerpcral Fever,' with which we  have ever met."—X. Y. Lancet.
  ti^^tbe^™x^o^^^rtrSu comprises presents an invaluable mass of facts  in relation to Child-bed

  WvJr^X^

  ^tTer^n'^
      « !Jp1 l's voluml I wouldnot take the trouble to write this letter; for I believe, that a study of that voumf
  Bnd ""*f""™^^wth«Treading of it, but a careful study  and a conscientious examination of that  volume
  alone^is enougK aSsStion on the subject of cbild-bed fever, whether sporadic or epidemic."-^
  Letters on Female Diseases. 
14
BARRINGTON  AND  UASWELL'S
    LECTURES ON THE FUNCTIONS AND  DISEASES OF THE WOMB.

                  By CHARLES WALLER, M.D.,  Bartholomew's Hospital.

       ON   DISEASES  OF  THE  UTERUS  AND  ITS  APPENDAGES.

                           By M.  LISFRANC, La Pitie Hospital.

         ON   DISEASES  OF  THE  PUERPERAL  STATE.

                     By J. T.  INGLEBY, Edinburgh.—1 vol. 8vo. sheep.

  "We can very cordially recommend them as affording a concise and practical exposition of the pathology
and treatment of a most important class of diseases, and which cannot be too attentively studied. — X. 1.

  "The present volume contains a short and succhict practical account of the principal morbid states either of
the functions or the structure of the womb, the best methods of distinguishing them, and the means which ex-
perience has shown to be the most effectual in removing them.  The reader will find that he obtains, in a small
compass, adistinct view of the nature and treatment of each disorder."—Edinb. Med.and Surg.Journ.
                                TOXICOLOGY.

                         A  TREATISE   ON   POISONS

  IN RELATION TO MEDICAL JURISPRUDENCE, PHYSIOLOGY AND THE PRACTICE OF PHYSIC.

                         By ROBERT CIIRISTISON, M.D., F.R.S.E.,

               Professor of Materia Medica in the University of Edinburgh, Ac, Ac.
   "We cannot but hail with satisfaction a new edition of this standard classical book.  Its merits are too well
 acknowledged for it to be necessary to say anything further in its behalf.  Wherever Toxicology is known as a
 science. Professor Christison's Treatise is received as an authority of the greatest weight. -Laruxt.
   "It has for a long period, been in the hands of barristers, who have not failed to make a good  use of it in the
 cross^xamlnation of medical witnesses; and we believe there are few medical men who venture into the witness
 DoTon atrial for poisoning, without having at least consulted it respectmg some point on which their evidence is

 "^Dr^hristison^i's a'v^'sjerior guide'for the general practitioner and student."-^. C/iir. Rev
   " We are freeto say that it is the best book on the subject in the Enghsh language.' - Western Lancet
   "This book is of the very highest authority on the subject of poisons, and may be said to exhaust it. —West-

 *"" The",a^thorrof it has, with singular industry, brought within the compass of a single volume every variety
 of ulfulhrfornlation and illustration  connected with the subject.  It is an invaluable addition to the library

 *£r£K^7^™&5^1>e™r>>rh* whole subject is clearly  and well arranged and the
- svmot^ "ffecstand tests of different poisons very fully and plainly stated  Accept my thank s for the book."
 ^eItrTct' Irom 1 Letter op Judge Story -" I return youmy sincere thanks for your kindness in presenting me
   Extract from a j.LiitK          Treatise on foi?ons.  I shall certainly recommend it to  be purchased for
 Zfll7d^"^S^^^ya^in& a high rank for the students of MedicalJurisprudence."

                                    ---------♦♦---------

                         DISEASES  OF  CHILDREN".

                   PRACTICAL TREATISE  ON THE DISEASES OF  CHILDREN.

    By JAMES M. COLEY, M.D., Member of the Royal College of Physicians in London,  Ac.
               •  I a- „„..= nr ,v,;i,ir»n r«inires the exercise of all our perspective faculties, and every aid
 J^^^^V^^t^S^^^ -ems reral^weU fitted for consultation on this
 ^throu^h the medium of the.pages which lie  *-^*-^ M JotirnaL

    ^gaS^^








        PRACTICAL  TREATISE ON THE DISEASES  AND  MANAGEMENT OF  CHILDREN,

                By RICHARD T. EVANSON, M.D., Professor of Medicine, and

       Henry Maunsell, M.D., Professor of Midwifery in the College of Surgeons,  Ireland.

        Edited by D  F. Cosdie, M.D., From the Fourth Dublin Edition.-l vol. Svo. sheep. 
MEDICAL   PUBLICATIONS.
15
  " The second chapter embraces the Management and Physical Education of Children.  This chapter ought to
be printed in gold letters, and hung up in tlie nursery of every family.  It would save many lives, and prevent
much suffering."—Medico-Chirurg. Rev.
  '• As this Practical Treatise on the Diseases of Children has before been made known to the medical public,
we dare not suppose it a new thing to any intelligent practitioner in this country : still, there may be those who
do not own a copy—and to such there is nothing ungenerous  in saying we with that they may always have it
in their power to consult such authority."—Boston Med. and Surg. Journ.
  " The present edition is enlarged, and in its present form constitutes one of the best works on the subject in
our language.'—1'ialad. Med. Exam.
     A  TREATISE  ON  THE  DISEASES  OF  CHILDREN.

                    WITH DIRECTIONS  FOR THE  MANAGEMENT OF INFANTS.

                        By the late MICHAEL UNDERWOOD, M.D.

      With Notes, by S. Merhiman, M.D., Marshall Hall, M.D., and John Bell, M.D.

                 From the ninth English Edition, with Notes, 1 vol. Svo. sheep.


                     A  MANUAL  OF  EXAMINATIONS

     UPON   ANATOMY AND  PHYSIOLOGY, SURGERY,

       PRACTICE OF MEDICINE,  CHEMISTRY,  MATERIA  MEDICA, OBSTETRICS, ETC.

TO WHICH IS ADDED A MEDICAL FORMULARY,  COMPRISING NEARLY  FIVE HUNDRED  OF THE MOST
                            RECENT ANO APPROVED PRESCRIPTIONS.

            Designed for the  use of Students of Medicine throughout  the United States.

       By J. L. LUDLOW, M.D.  Second Edition, revised and enlarged.  1 vol. 12mo.

  "In this 'Manual of Examinations' the questions are clearly put, and, with few exceptions, well and dis-
tinctly answered."  "The Manual will be found to be equally available at the three schools  in Philadelphia, as
at the two in New York, or those of Louisville, Lexington, and Cincinnati, or of Charleston, Augusta, and New
Orleans, not to mention the numerous confrcries for teaching down East."—Bull. Med. Science.
  " We have no hesitation in saying, that Dr. Ludlow's Manual is decidedly the best, both in relation to com-
prehensiveness and general accuracy, that has yet  been published in this country."—Western Lancet.
  " Dr. Ludlow discovers a minute knowledge with all the leading departments of professional lore, which h<
Imparts agreeably. lie is careful to be exact, without being redundant in any paragraph."—Boston Med. one
Surg. Jour.
  11 Between all the classes whose comfort the Student's Manual is  designed to promote, we should think ii
would obtain not a little currency."— West. Journ.


                       HISTORY   OF  EMBALMING,

      AND  ON  PREPARATIONS IN  ANATOMY, PATHOLOGY, AND  NATURAL HISTORY.

  Translated from the French of GANNAL, with Notes and additions, by R. HARLAN, M.D.   '
         IS  MEDICAL   SCIENCE  FAVOURABLE  TO   SCEPTICISM!

                     By  JAMES W. DALE, M.D., of Newcastle, Del.



                             ON   SUPERSTITIONS

      CONNECTED WITH THE  HISTORY AND  PRACTICE OF  MEDICINE  AND SURGERY.

                     By  THOS. JOSEPH PETTIGREW, F.R.S., F.S.A.

                 Doctor  of  Philosophy to the University of Gottingen, Ac, Ac.
  " The book will prove instructive, not only on account of the extensive learning which it displays, but tl
numerous and curious facts which it develops."—X. Orleans Med. Journ.
  " Mr. Pettigrew's book is amusing to such as are inclined to smile, and instructive to those who are willh
to reflect."—Med. Chir. Rev.
  " From the follies of the past we may derive wisdom  for the future, and there is much in the volume befo
us that may be profitably used for this purpose."—Med. Exam.
  " It is the common-place book of a literary physician, with a running commentary, giving a unity andoe
tinuity to the mosaic."—Brit, and For. Med. Rev.
  " We do not know of pleasanter reading, either for the physician in the between-wbiles of professional Mffic
or for the general reader who loves to study human nature in its external and often eccentric workings."
Bulletin of Med. Science.
  " We heartily commend this little work to the curious of all classes of readers."—X. Y. Journ. of Med.
  " Wo take leave of his book, from which we have derived not only entertainment but instruction."__Weste
Journal. 
16       BARRINGTON  AND  HASWELL's  MEDICAL  PUBLICATIONS.
      MEDICAL AND TOPOGRAPHICAL OBSERVATIONS UPON THE  MEDITERRANEAN,

                                       AND,UPON

              PORTUGAL,  SPAIN, AND OTHER COUNTRIES.
    Br G. R.  B. HORNER, M.D., U.S.N.  With Engravings.  1 volume  8vo. half sheep.

  6i An uncommonly interesting book is presented to those who have any disposition to know the things medical
in Portugal, Spain, and other countries," and -'will doubtless be read, also, with marked satisfaction by all who
have a taste for travels."—Boston Med. and Surg. Journ.
                        JOHN HUNTER'S WORKS.

Comprising hit Lectures on the Principles of Surgery ; A Treatise on the Teeth ; Treatises on Vene-
       real Diseases;  Treatise on Inflammation and Gunshot Wounds;  Observations on
          certainparts of the Animal Economy ; and a full and Comprehensive Memoir.

Each of the Works are edited by men  of celebrity in Medical Science, and the whole under the
                                     superintendence of

      JAMES F. PALMER, of  the St George's and St. James's Dispensary.—4 vols. 8vo.
  This is the only complete edition of the works of the distinguished physiologist ever published in this
country.
  " One distinctive feature of the present edition of Hunter's works has been already mentioned,, viz: In the
addition of illustrative notes, which are not thrown in at hazard, but are written by men who are already emi-
nent for their skill and attainments on the  particular subjects which they have thus illustrated.  Uy this
means, whilst we have the views of John Hunter in the text, we are enabled, by reference to the accompanying
notes, to see wherein the author is borne out by the positive  knowledge of the present day, or to what extent
nis views require modification and correction.  The names of the gentlemen who have in this manner assisted
Mr. Palmer, are guarantees of the successful performance of their task."—Med. Gaz.


I               THE   LIFE OF  JOHN  HUNTER, F.R.S.

                                 By DREWRY OTTLEY.

  "In the summing up of Mr. Hunter's character, Mr. Ottley exhibits equal judgment and candor."—Brit, and
%r.  Med.


 '                THE  PHILOSOPHY   OF   MARRIAGE,

*■             IN  ITS  SOCIAL,  MORAL, AND  PHYSICAL  RELATIONS,

o       WITH  AN  ACCOUNT  OF THE DISEASES OF THE  GENITOURINARY ORGANS.

      WITH  THE PHYSIOLOGY OF GENERATION IN THE ANIMAL AND VEGETABLE KINGDOMS.

                             By MICHAEL  RYAN, M.D.

           Member of the Royal College of Physicians and Surgeons in London, Ac.

   « Members of the Medical Profession will find in it much that is curious and entertaining, as rare <ro, anee-
  otes, recondite opinions of eminent men, interspersed with useful med.cal instruction."—-PhUad. Med. team
   '*Dr Kyanis  above reproach or suspicion; and with a singular degree of candor and independence cxplans^
  i atrue  and philosophical manner, every branch of the subject which he considers essential to be under-
 wood by all intelligent persons."—Boston Med. Surg. Jour.
THE  GUMS
%H  1ATE  DISCOVERIES ON  THEIR STRUCTURE, GROWTH, CONNECTIONS  DISEASES AND  SYMPATHIES.
         Er GEORGE WAITE, Member of the London Royal College of Physicians.
«^» BARRINGTON A HASWELL have constantly upon hand  a large and varied  assort-


   °SCH00L, THEOLOGICAL, MEDICAL,  CLASSICAL, AND  GENERAL LITERATURE,

            WHICH THEY WILL FURNISH AT JH&~ THE LOWEST  CASH PRICES.

*j * Orders from the country thankfully received and promptly  attended to. 
 
NLM011821728