EDITORIAL

John Hunter: Recollections on his 250th birthday anniversary

0 rthodontists readily recognize the name of John Hunter, but they know little else about him. They recall his 1771 text entitled Treatise on the Natural History of the Human Teeth, but they are just as likely to quote from his more comprehensive revision that was published exactly 200 years ago in 1778. Since he was born on Feb. 14, 1728, it will be appropriate to honor him next month on the 250th anniversary of his birth.

Although we recognize him for his original contributions to dental research and practice, Hunter was a physician whose special interests were anatomy, pathology, and physiology-and, even more, in the application of all three in the daily practice of medicine and dentistry. He was a teacher and clinician as well as a researcher, and he spent all of his spare time dissecting the specimens that held his attention at the moment.

Hunter was a collector at heart, and he saved all of his specimens of some 30 years of study. After his death, it was regarded so highly that Parliament voted 15,000 pounds sterling to acquire the collection. In 1799, the responsibility for maintaining the collection was assigned to England’s Royal College of Surgeons. Today it is the nucleus of a unique teaching collection still known as the Hunterian Museum, and it has continued to serve as a source of study and inspiration for scores of students throughout the nineteenth and twentieth centuries.

Reasons for this are apparent, for Hunter always had the student in mind in the preparation, arrangement, and cataloging of his museum. His collection was not simply a random accumulation of specimens; they, instead, formed an orderly series of self- explanatory preparations that described the structures and demonstrated the theories that often seemed revolutionary to his colleagues. To which might be added that the theories were not only sound at the time, but that most of them are still sound today.

Even though he used expressions and capitalization from another era, today’s authors could benefit from a style of writing based on an economy in the use of words. He invariably is clear and concise, and he avoids the complicated or evasive terminology that often is seen in current literature. Here is an example of clarity and brevity on a complex structure that even today is of interest to dentistry as well as to orthodontics:

In this (TMJ) joint there is a moveable cartilage, which though common to both Condyle and cavity, ought to be considered rather as an appendage of the former than of the latter, being more closely connected with it; for as to accompany it in its motion along with the common surface of both cavity and eminence. This cartilage is nearly of the same dimension with the Condyle, which it covers; is hollowed on its inferior surface to receive the condyle; on its upper surface it is more unequal, being molded to the cavity and eminence of the articulating surface of the Temporal Bone.

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John Hunter (1728-l 793). Enamel on copper by Henry Bone, copied in 1798 from the original by Sir Joshua Reynolds. The artist wisely included Hunter’s essential needs: Wet and dry anatomical speci- mens, drawings, books, ink bottle, quill pen, and manuscript paper-and especially a studious appear- ance revealing perhaps a search for truth on unresolved matters of concern at the moment.

Not many orthodontists realize that the specialty went through a rather unfortunate experiment in nonextraction in the early 1900’s. Long ago, a contemporary of Hunter’s said that “when we make a discovery in pathology, we oniy learn what we have over- looked in his writings or forgotten in his lectures.” This is just as true in orthodontics, for what Hunter had to say about extraction had been overlooked or forgotten by our im- mediate predecessors. The following paragraphs have been taken from the 177 1 edition:

In cases of considerable irregularity for want of room, a principal object is to remove those (teeth) which are most out of their place, and thereby procure room for the others which are to be brought into the circle.

To extract an irregular tooth would answer but little purpose, if no alteration could be made in the situation of the rest; but we find that the very principle upon which teeth are made to grow irregularly is capable, if properly directed, of bringing them even again. This principle is the power which many parts (especially bones) have of moving out of the way of mechanical pressure.

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That it is from want of room in the jaw, and not from any effect that the first set produce upon them, is evident; first because in all cases of irregularity we find that there is really no room in the jaw to allow of placing all the teeth properly in the circle, or that some are necessarily on the outside of the circle, others within it, while others are turned with their edges obliquely as it were, warped; and secondly, because the bicuspides are not out of the circle, although they are as much influenced by the first set as any of the others.

If the above-mentioned two teeth (canine and lateral incisor) are not in the circle, but still not far out of it, and yet them is not room for both, in such a case I would recommend the extraction of the first bicuspidati, although it should be perfectly in the row, because the two others will then be easily brought into the circle; and, if there is any space left, it will be so far back as not to be at all observable.

Hunter proved in the eighteenth century that he was as precise and accurate a research worker as his counterparts in the twentieth century, for his dissections led to original observations that had never been fully described before. In orthodontics, his most fre- quently quoted paragraphs are on craniofacial growth, and these paragraphs bear repeating in this commentary:

As the lower jaw is extremely moveable and its motion is indispensably necessary in all the various operations of the Teeth, it requires to be more particularly described. It is much more simple in its form than the Upper, having fewer processes, and these not too irregular. Its anterior circular part is placed directly under that of the Upper-Jaw; but its other parts extend farther backward. The Jaw is at first composed of two distinct bones but these, soon after birth unite into one, at the middle of the chin. This union is called the Symphysis of the Jaw. Upon the upper edge of the body of the bone is the Alveolar Process, a good deal familiar to that of the Upper-Jaw.

The jaw still increases in all points till twelve months after birth, when bodies of all the six teeth (five deciduous and first permanent molar teeth) are pretty well formed; but it never after increases in length between the symphysis and the sixth tooth; and from this time too the alveolar process, which makes the anterior part of the arches of both jaws, never becomes a section of a larger circle, hence the lower part of a child’s face is flatter, or not so projecting forwards as in the adult.

After this time the jaws lengthen only at their posterior ends; so that the sixth tooth, which was under the coronoid process in the lower jaw and in the tubercles of the upper jaw of the foetus, is at last, viz., in the eighth or ninth year, placed before these parts; and then the seventh tooth appears in the place which the sixth occupied, with respect to the coronoid process and tubercle; and about the twelfth or fourteenth year the eighth tooth is situated where the seventh was placed. At the age of eighteen or twenty, the eighth tooth is found before the coronoid process in the lower jaw and under, or somewhat before the tubercle in the upper jaw, which tubercle is no more than a succession of sockets for the teeth till they are completely formed.

Hunter had an essential quality that is enjoyed by few professional men-he not only was a capable research worker, he also was, an exceptionally competent clinician. He recognized that research was not an end in itselc instead, he encouraged a principle known today as applied research. No one could state it more clearly than he did in this statement:

Experiments should not be often repeated which tend merely to establish a principle already known and admitted, but the next step should be the application of that principle to useful (clinical) purposes.

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When the Royal College of Surgery assumed responsibility for the Hunterian Collec- tion in 1799, it consisted of 13,682 specimens. Subsequent additions from other sources brought the collection to a total of 63,536 specimens. To the great loss of the health professions, much was lost on the night of May 10, 1941, when the heaviest of all air attacks on London destroyed many national buildings, including Parliament’s House of Commons and a large part of the College museum. More than 26,000 specimens were recovered, but they included only 3,466 of the 13,682 preparations in John Hunter’s original collection.

Hunter participated in an exciting age of accomplishment in medicine, for it was not until 1745 that surgery formally ceased to be associated with “the art and mystery of barbers. ’ ’ Hunter’s special skills brought him high recognition as “surgeon extraordi- nary” to King George III. At home he was elected a Fellow of the Royal Society; abroad, he was honored with membership in the American Philosophical Society and in the Royal Academy of Surgery of Paris. Today he lies buried in Westminster Abbey along with many of England’s other illustrious men and women of the past.

Although Hunter died on Oct. 16, 1793, he is still remembered by a series of twelve Hunterian lectures that are given every year, a Hunterian Oration that is given every second year, and a John Hunter Medal and Triennial Prize, which has been awarded fewer than ten times since it was instituted in 1820. His greater honor lies not only in his contributions to professional thought and theory but also in the influence he has even to this day on the practice of medicine and dentistry.

B.F.D.

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