Smoking Ears and Screaming Teeth - Trevor Norton (2010)

He came, he sawed, he chancred

‘Speak with caution of what may be passing here, especially with respect to dead bodies’ – William Hunter

In the eighteenth century medical men were either cultured physicians well-versed in the theory of medicine, or surgeons, practical men with saws. Both were steeped in ancient lore and received wisdom. Medical research was stagnant and patients were little better off than their great-great-grandparents had been. Then along came a Scottish farmer’s lad called John Hunter who changed surgery from a trade into a science.

John’s education was basic, but he had an unquenchable curiosity for nature that remained with him throughout his life. In 1748 he departed for London to join his elder brother William. Although he had trained as a surgeon, William sometimes fainted at the sight of blood so he was changing careers to become a fashionable physician and male midwife. John was enlisted to handle the bloody side of the business and was set to work preparing cadavers for teaching purposes. His skill at dissection was astonishing and he soon graduated to supervising William’s students. After being apprenticed briefly to two famous surgeons he became a house surgeon at St George’s Hospital, which had been set up to treat the ‘deserving poor’. It also gave surgeons licence to practise on the uncomplaining poor. Those who unknowingly offered their bodies for the training of surgeons were the vulnerable and the beneficiaries were mostly the wealthy. John spent his mornings visiting paying clients, and devoted the afternoons to treating the poor for no fee. At St George’s he attracted more poor patients than all the other surgeons combined.

John hoped that the hospital would give more emphasis to educating young surgeons, but failed to persuade the senior surgeons to give lectures. Eventually he gave evening lectures in his own home and over the years these became the inspiration for all young medics in London. They were well attended although on one occasion only a single student turned up. To augment the audience John hauled in a skeleton and began with his usual opener – ‘Gentlemen.’

John Hunter never blindly followed current practice: he always observed, then improved. A stint as an army surgeon during the Seven Years War made him an authority on gunshot wounds. Battlefield surgery involved opening the wound to scrape out any debris and extract the bullet. Almost invariably the soldier died from an infection. Hunter achieved a much higher survival rate by simply staunching the blood and leaving the bullet in place. He learned that the human body could sometimes heal itself.

He dissected over a thousand corpses and knew the interior of the human body better than the layout of his own house. The more he knew, the fewer surprises there would be on the operating table. The acuteness of his mind matched the dexterity of his hands. He came to know not just the parts of the body, but ‘their uses in the machine, and in what manner they act to produce the effect’,

Hunter was not alone in his obsession; the artist George Stubbs spent eighteen months dissecting horses, working on each carcass for weeks. The rank smell would have turned the stomach of a less determined man, but the end result was his meticulous and monumental treatise on the anatomy of the horse.

John’s brother William founded a private medical school in Great Windmill Street, where almost two centuries later the public’s interest in anatomy would be satisfied by London’s first strip club. William’s aim was to provide the practical anatomical skills neglected elsewhere. Medical examinations, even for surgeons, were usually verbal affairs with no practical test whatsoever. Most courses taught surgery with students witnessing a dissection, or examining sample dissections prepared earlier. A parsimonious Scottish professor made a single cadaver last for an entire course of a hundred lectures. In those days it wasn’t just the students that got high.

The first cut that an aspiring surgeon made might well be on a live patient. Both William and John believed that surgical mistakes were best made on the dead, not the living. John taught his students that: ‘Anatomy is the basis of surgery, it informs the head, guides the hand and familiarises the heart to a kind of necessary inhumanity.’

In Hunter’s school each student would have a corpse of his own to practise on. That meant a lot of bodies and they had to be fresh, although not fresh as Tesco and Sainsbury’s know it. Dissection was largely a winter activity. Summer warmth rapidly dried the skin of a corpse as stiff as wood and turned its internal organs into glutinous porridge.

The school needed several bodies per week and John was given the task of finding them. There were over two hundred crimes – including pickpocketing – that carried the death penalty. The Murder Act of 1752 allowed anatomists to claim the bodies of executed murderers, so the surgeons converged on the gallows at Tyburn Tree. The bodies had to be warm from the scaffold and this led to unseemly tugs-of-war with the relatives of the deceased. One tussle was so vigorous that it revived the felon, who was reprieved and rechristened ‘Half-hangit Maggie’.

The new provision of the Murder Act was not designed to help the progress of medicine but to punish criminals. Being dissected was feared as a fate worse than death; it added ‘a further terror and peculiar mark of infamy’. Also, on Judgement Day when all the dead would rise again, some would reappear with important pieces of themselves missing and might be refused admission into Paradise on the grounds of their incompleteness.

For many criminals the real fear was that they might awaken on the dissecting table with their entrails out on display. In the days before ‘long-drop’ hanging that broke the neck the condemned were slowly strangled by the noose – sometimes it took thirty minutes or more. In the melee that followed, the doctor often had no opportunity to pronounce the victims dead and there were several examples of their ‘corpses’ sitting up under the surprise of the anatomist’s knife.

With an understandable dearth of volunteers there was no legal way to acquire sufficient cadavers, so anatomists often had no choice but to bribe undertakers to put stones in the coffin and hand over the dead loved one. Gravediggers were also obliging as it was no more trouble to bury an empty casket than a full one. Even these means could not meet demand so John Hunter began ‘hobnobbing with the resurrection men’ – body-snatchers who dug up the recently deceased.

During Hunter’s working life grave robbing grew from the occasional ‘uplifting’ experience to resurrection on a scale to rival the Day of Judgement. Cadavers were being supplied to order and transported all around the country in hampers and barrels. A body in a box was found on the stagecoach heading for Leeds. A similar incident in Dublin caused the local paper to request that ‘for the sake of decency, they packed their treasures a little more carefully’. The price rose sixteen-fold and children’s bodies were charged for by the inch. Some ‘Sack ’em up’ gangs complained of the frequency with which they dug up a coffin only to find it had already been vacated.

Grave robbing was not a criminal offence. Stealing a pig or a goose was punishable by death, but in the eyes of the law a body was not property and therefore couldn’t be stolen. The body-snatchers were careful to leave the shroud and clothes behind in the coffin because they were property.

The public were alarmed and there were violent anti-anatomist riots from Carlisle to New York. A medical journal protested that ‘If the traffic in human flesh be not prevented, the churchyards will not be secure against the shovel of the midnight plunderer, nor the public against the dagger of the midnight assassin.’

In the interests of ensuring freshness, some criminals streamlined the process by snatching the body before it was dead. The papers were full of the escapades of Burke and Hare who murdered sixteen people and sold them to Edinburgh surgeon Robert Knox.

Burke’s the butcher, Hare’s the thief,

Knox the man who buys the beef.

When the murdered body of ‘Daft Jamie’, a well-known local character, was brought in, Knox decapitated the corpse before giving it to the students lest the victim be recognised.

Burke and Hare spawned a tribute gang, ‘The Burkers’, who supplied the still-warm to King’s College London. The ringleaders were convicted of multiple murders and for ‘resurrecting’ a thousand newly buried bodies. The scale of this scandal led to the Anatomy Act of 1832 that gave anatomists the right to dissect all unclaimed’ bodies from workhouses and morgues. Now the fate that terrorised the most hardened rogue was visited on the innocent poor.

To Hunter, acquiring dead bodies was a surgical necessity that in the long run would save lives. It was also a game. The President of the Royal College of Surgeons boasted to a Royal Commission that: ‘There is no person, let his situation in life be what it may, whom, if I were disposed to dissect, I could not obtain.’

The problem of too few cadavers is not entirely buried in the past. Today anatomy teaching involves anatomical dummies, medical imaging techniques and students being encouraged to examine their own bodies and those of others. I seem to recall that students always examined each others’ bodies at every opportunity. Even so, the classes at Guy’s, King’s and St Thomas’ Hospitals need eighty bodies a year and only about sixty are donated. The dilemma is not helped by rejecting those that are obese, which will soon exclude everybody.

Most hospitals do their best to encourage people to donate their bodies, but some contrive to do the opposite. In 2004 a Californian medical school was found to have sold parts from around eight hundred corpses donated for medical research over a six-year period. A university in Louisiana had disposed of surplus cadavers to a broker and had no idea where they ended up.

The trade in organs is worth over one billion US dollars a year. Heart, lung or liver transplants are only a minor portion of it. The increasing longevity of people in the developed world has fuelled the demand for replacement parts such as corneas for failing eyes and bones for worn joints, not to mention skin grafts for burns, tendons and ligaments to mend injured athletes and collagen to make lips pout.

In Britain there were almost two thousand kidney transplants in 2007, but that left 8,600 patients on the waiting list for new kidneys. Over a thousand people each year die waiting for an appropriate organ to become available. The shortage of donors pushes up the price of parts. If fresh and sold separately, the marketable parts from a single cadaver can fetch $200,000; a head sells for $900 and fingers are $15 apiece. What a killing the body-snatchers would have made. But that was in the bad old days …

In 2004 the new owner of a New York funeral parlour was shocked to find that it had a concealed operating theatre and much of its income had come from tissue-transplant companies. The previous owners had treated the dead as commodities to be exploited. The ‘operating theatre’ had been a cutting room for harvesting human organs. Instead of embalming clients’ loved ones they had pillaged their interiors. Stolen bones were replaced with plastic piping and the space left by filched organs was packed with cloth and the morticians’ discarded surgical gloves. Then the bodies were sewn up and returned to the family for burial. One of the victims was the revered broadcaster Alistair Cooke. He was ninety-five and his bones were riddled with cancer. The morticians are thought to have made $4.7 million from their sideline.

To make the organs more marketable they had faked the paperwork: a 104-year-old woman was listed as dying aged seventy, those who had nasty diseases that should have precluded their tissues from being used for transplants were said to have succumbed to heart failure. The organs were dispatched all over the world by unwitting tissue-supply companies. Forty people in Britain received transplants from this source. All the known recipients of these dubious organs were tested for HIV, hepatitis C and syphilis, but some diseases don’t show themselves for years.

The case is not unique. A doctor in Denver uncovered an identical scam perpetrated by a funeral director who handed relatives any old ashes with one hand while sawing the deceased into useful bits with the other. The total number of bodies desecrated by these two firms was well over a thousand.

Even living patients may be harvested for profit. Human cells that grow readily in culture are useful for studying cancer. In 1990 the California Supreme Court ruled that patients do not own tissue removed from their body. Doctors are entitled to exploit and even patent these cell lines. They are worth millions of dollars and the only person who doesn’t profit is the donor.

Like many anatomists, the Hunter brothers collected specimens of organs and bones in their museum. Eventually it contained 13,500 specimens. The poet Southey paints a lurid picture: ‘I have made candles of infant’s fat … I have bottled babies unborn, and dried hearts and livers from rifled graves.’ Medical museums were for educational purposes, but anatomists were also fascinated by anatomical oddities and abnormalities and were ruthless collectors. At Guy’s Hospital a patient with a curiously enlarged head died. While a mock funeral took place for the unsuspecting relatives, his skeleton was on the slab being prepared for the hospital museum. When Charles Byrne, the nearly eight-feet-tall ‘Irish giant’, was dying, he made the undertakers promise to sink him in the sea in a lead coffin to avoid the anatomists. But John Hunter offered them £500 (approximately £30,000 in today’s money) and Byrne’s reluctant skeleton now has pride of place in the Hunterian Museum at the Royal College of Surgeons.

When he became more successful John moved into a new house in Leicester Square – in fact, two houses that he linked together. This gave ample space for his museum and a dissecting room in the attic. Few families can have had quite so many skeletons in their cupboards. Only once was an over-ripe cheese mistaken for a parcel of anatomical over-ripeness. It was a Jekyll-and-Hyde house, for while his cultured wife held soirées in the drawing room to entertain Haydn, dead bodies were being sneaked in by the rear door and dragged up the back staircase. I recall that Stevenson’s Dr Jekyll bought his London house from ‘the heirs of a celebrated surgeon’.

John Hunter was the most accomplished and innovative surgeon of his day. William Hazlitt described how he ‘set about cutting up a carcass of a whale with the same greatness of gusto that Michelangelo would have hewn a block of marble’. Unlike most of his contemporaries he never favoured theory over experience and firmly believed in autopsy (literally, ‘to see with one’s own eyes’).

Surgeons routinely amputated infected or damaged parts of the body, but John’s superior skill and perception led to new and better treatments. Aneurysm is a fatal condition which arises when the walls of a blood vessel weaken so that the vessel inflates with blood and can burst. Hunter operated on a patient with a large aneurysm at the back of his leg. By tying off the affected length of the artery, in the belief that the blood would naturally find an alternative route through adjacent blood vessels, he saved the man’s leg. It wasn’t a wild guess; he had previously done similar surgery on a dog and a deer to see if it would work. When a year later the man died of a fever unrelated to the operation, Hunter bought his body and re-examined the blood vessels in the leg to confirm that his conjecture was correct. By this time his ‘bypass’ technique was becoming the standard procedure for aneurysms of the leg in all the best hospitals of Europe.

The Hunter brothers made significant advances in medical knowledge. Sometimes their joint projects were William’s idea, as when they revealed the extent and function of the lymphatic system, but John did all the dissections and experiments, and it was he who recognised that the lymph system was implicated in a certain type of cancer.

It was also William’s plan to reveal all the stages of foetal development inside the mother’s womb. Unfortunately, there was a dearth of pregnant women to dissect because felons ‘with child’ were not hanged. Even if a lass wasn’t pregnant when she was arrested, she made sure she was before being sentenced. It was over twenty years before the work was completed. William published it as a huge atlas in ‘elephant’ folio with every stage of gestation brilliantly illustrated by the Dutch artist Jan van Rymsdyk. It was one of the finest anatomical books ever produced. Although John had done all the work, William gave only a brief acknowledgement that his brother had assisted in ‘most of the dissections’ – and the artist was not mentioned at all. The text revealed for the first time that the placental blood circulation was independent of the mother’s, something that had been discovered by John and a colleague. William took the credit, creating a permanent rift between the brothers.

John published under his own name and again used van Rymsdyk to illustrate his brilliant treatise on human teeth, which introduced the terms ‘incisors’ and ‘molars’. He also recognised that dental plaque was connected with tooth decay and recommended its removal by daily brushing.

John Hunter’s experimental methods were the mark of his genius. He once said to his pupil Edward Jenner, who went on to develop vaccination against smallpox, ‘I think your solution is just, but why think, why not try the experiment?’ It seems obvious now, but this was at the dawn of the age of experimentation.

Hunter investigated the possibilities of artificial insemination and instructed a couple, for whom normal copulation was impossible, how to get pregnant – and the woman did. He also pioneered tissue transplantation by successfully moving organs from one animal to another. He erroneously thought he had got a human tooth to bond into a cockerel’s tissue. In those days dentures were manufactured from elephant’s tusks. Not surprisingly, they looked better on the elephant. Human teeth were clearly more ‘natural’ and grave robbers had a lucrative sideline in extracting teeth no longer required by their original owner. Hunter had heard of a better idea. He pulled sound front teeth from paid volunteers and immediately implanted them into the vacant mouths of rich dowagers. A poor girl who would later become Lady Hamilton made a good career choice when at the last moment she changed her mind and didn’t donate her smile. None of the transplanted teeth became permanent fixtures, although some lasted for six years and in one case reputedly for twelve years. Hunter inadvertently stimulated a craze for dental implantation, but even false teeth can bite back. Enthusiasm for the implantation of human teeth waned when a woman caught syphilis from her new choppers.

Hunter never shunned controversy. His museum was arranged to demonstrate that ‘Every property in man is similar to some property … in another animal’ and that simian and human skulls fell into a graded series that led to man. These were not popular notions at the time, seventy years before the publication of Darwin’s The Origin of Species. Equally blasphemous was his assertion that Adam and Eve were indisputably black. It is now accepted that the first humans did indeed arise in Africa.

He soundly refuted the widespread belief that masturbation caused impotency. His logic was persuasive: impotency was rare but masturbation was exceedingly common, so it was unlikely that one led to the other. In his publication declaring that masturbation was not harmful, the embarrassed editor added a footnote to say that it was. In certain circumstances it can have serious consequences, as in Indonesia where the penalty for masturbation is decapitation. Recent research indicates that ‘self-dating’, as it’s now called, is beneficial. The more men ejaculate earlier in life, the lower their chances of developing prostate cancer later on.

John Hunter was aware that many sexual problems might be psychosomatic, for ‘the mind is subject to a thousand caprices, which affect the action of those parts’. When a patient complained that he was a failure in bed, Hunter instructed him to sleep close to his partner for a week without touching her. Seven days later the problem was solved.

Although Hunter had unruly hair and an unruly manner, his reputation was such that the great and the good (and the not so good) flocked to his door. He attended the economist Adam Smith, Benjamin Franklin, Lord Byron, and became ‘Surgeon-extraordinary’ to King George III.

In 1767, aged thirty-nine, he was elected a Fellow of the Royal Society. That same year he took his studies of venereal disease to a new and dangerous level. All eighteenth-century doctors were familiar with morbus venereus (the sickness of Venus) as its victims made up about a quarter of their business. It was well understood that these infections were sexually transmitted. London was a bustling commercial centre for tea, sugar, spices and the most spicy commodity of all – sex. There was one prostitute for every twenty-seven men. Harris’s Man of Pleasure’s Kalendar guided clients around the ‘Covent Garden Ladies’. The guide was explicit in praising the pretty doxies and damning the infected, like poor Miss Young who had ‘thrown her contaminated carcass on the town again’. No wonder VD was rife among Hunter’s patients. James Boswell had nineteen or more bouts of gonorrhoea without learning his lesson. A distinguished husband and wife both consulted Hunter, the approaches of each unknown to the other. The old adage that ‘love passes, but syphilis endures’ was confirmed by Mrs Beeton who caught syphilis on her honeymoon.

There were two main venereal conditions, clap (gonorrhoea), and pox (syphilis). Clap was common and caused painful peeing and an unpleasant discharge. Although it might lead to complications if you were as keen a devotee as Boswell, it wasn’t life-threatening. Pox, on the other hand, was a far more virulent and insidious beast. Initially there would be a lump on the penis and the lymph glands would swell. Within a few weeks all might seem well, but a month or two afterwards wartlike growths would appear, accompanied by patchy hair loss and fever, which could recur repeatedly. Syphilis can remain dormant for years and then reappear, but progressively over time the skin and bones become ulcerated. One patient’s penis was so ulcerated that he pee’d over his shoulder. Internally the organs – including the brain – are in meltdown.

Hunter felt sure that clap was a self-limiting disease that could clear up even if left untreated, so he ran clinical trials on patients suffering from it. He gave half of them the usual remedy and the others got pills made from rolled-up bread. In time they all recovered. He also hypothesised that two diseases couldn’t occupy one body at the same time, and therefore clap and pox must be different phases of the same disease – clap was the localised infection, which later spread through the body to become pox.

The way to settle the matter was clearly by an experiment. Hunter’s idea was to infect someone with the clap and then wait for the symptoms of the pox to appear, thus supporting his hypothesis, or fail to appear, indicating that he was wrong. Clearly, the only volunteer whom he could guarantee wasn’t infected with either disease and whose genitalia were close at hand for daily inspection was himself.

So Hunter carefully transferred some of what Boswell called ‘the loathsome matter’ from a patient with clap into incisions that he had cut on his own penis. Imagine the satisfaction he felt when a few weeks later the characteristic nodule of pox called chancre appeared on his penis. It was later designated ‘Hunterian chancre’.

What John hadn’t considered was that the patient he had used for the inoculum might be suffering from both clap and pox. He had inadvertently given himself syphilis which, if not stopped early on, leads inexorably to the corrosion of the nose, blindness, paralysis, insanity and death. You can always rely on a rational man to do something completely irrational.

To cure his pox Hunter repeatedly swilled his mouth with ‘corrosive sublimate’ and toxic mercury. These substances give mouth ulcers, loosen the teeth and produce pints of black saliva. Some hospitals had ‘salivating wards’ where one could dribble in private. He later stated ‘I knocked down the disease with mercury’, suggesting that the treatment was successful. He used his experience in his lectures to students, making it clear that he had caused himself to develop a syphilitic chancre. He also wrote an illustrated treatise describing sexually transmitted diseases that was so graphic it even put Boswell off sex for a week, although he went on to incur the symptoms twice more.

For his cardiac problems Hunter tried all manner of poisons before resorting to ‘Madeira, brandy and other warm things’ – the efficacy of which I can confirm from my own experiments.

When researching into sexually transmitted diseases, doctors have never baulked at experimenting on others. In the infamous Tuskegee project in Alabama, poor black sharecroppers with syphilis were monitored by doctors for forty years to see if the symptoms progressed in the same way as they did in white men. Syphilis was never mentioned; the men were told that they had ‘bad blood’. Although they had to endure invasive tests, not one of them was given any treatment for the disease. The doctors were merely observers. None of them felt any guilt since they hadn’t actually given the men syphilis – they’d already had it. Many of the ‘patients’ went on to suffer horrendous symptoms as the disease progressed.

The study was funded by the United States Public Health Service and was known to the medical community and local politicians. It continued until 1972, when a journalist broke the story nationwide, but it was not until 1997 that President Clinton apologised to the surviving human guinea pigs.

In Hunter’s day many surgeons considered that they had no investment in keeping non-paying patients alive. Sir Astley Cooper wrote: ‘The patients in our hospital, from whom practical knowledge is to be derived are … just as much within the surgeon’s power, as dead bodies are at the disposal of Parliament.’ John Hunter experimented on patients, but did not disdainfully consider them as mere guinea pigs, ‘nor,’ he said, ‘do I go further than … I would have performed on myself were I in the same situation’. He taught his students that: ‘No surgeon should approach the victim of this operation without a sacred dread and reluctance.’

Only John Hunter had the courage to experiment on himself. But where he led many others would follow.

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A watchman nabs a bodysnatcher while William Hunter exits at speed.