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battlefield surgery

John Hunter, Surgeon General, (1728-1793)

Hunter was born on a small farm in Scotland, not far from Glasgow. The youngest of 10 children, he was considered a poor student who was never interested in the educational process. He dropped out of school at 13, and the likelihood of future success was slim.

In 1748 he wrote to his older brother William to ask if he could join him in London. William agreed and the young Hunter was given the task of preparing anatomical dissections. John Hunter demonstrated an amazing aptitude, and within a year began to attend some of his brother's lectures on surgery.

In the summer, he worked with Cheselden at Chelsea Hospital. In 1751 he enrolled as an apprentice to Pott at St Bartholomew's. From 1754 to 1756 Hunter was house surgeon at St George's Hospital, where he received most of his practical training. For 4 years Hunter spent countless  hours  making  thousands of anatomical preparations, in 1761

he became a victim of tuberculosis, which was attributed to the putrid air of dissecting rooms. Realising he needed rest and using the political connections of his brother, he secured a commission as an army surgeon. For 2 years he served at Belle Isle, in France and in Portugal.

Greatly improved in health Hunter returned to London, where he opened his own anatomical school and commenced the private practice of surgery. Hunter began to receive numerous honours, including election as a fellow of the Royal Society (1767). In 1768 he was appointed surgeon to St George's Hospital and in the following year was made a member of the Company of Surgeons.

In 1786 he was appointed deputy surgeon general of the army and three years later, surgeon general of the army and inspector general of hospitals. Among Hunter's fundamental pathological studies were those on inflammation, as described in A Treatise on the Blood, Inflammation and Gun-shot Wounds, published in London in 1794.

Not having a university education, Hunter relied little on the theories of past authorities but rather on his personal observations. This book included his experiences of military surgery which he had gained over thirty years previously while on active service in the Seven Years War. Gunpowder was introduced at the end of the thirteenth century and the severity of battlefield injuries was greatly increased. Such wounds were so much more complicated by suppuration and tissue necrosis that it was generally believed that these were specific poisonous effects of gunpowder, gunshot wounds were treated by cauterisation and dilation in order to extract foreign bodies and to help cauterise the deeper parts of the wound.

Although by Hunter's time cauterisation had been discarded, dilation was still widely practised. Hunter introduced a conservative regime in the early treatment of wounds. In his experience wounds healed more readily without surgical interference and enlargement. With the acceptance of his thoughts on these injuries, the old belief that gunpowder was a fatal poison was finally laid to rest, although his conservative management of gunshot wounds did come under criticism, it is maintained that in the surgical environment of his time Hunter's management of gunshot wounds was quite justified.

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