533HUNTERIAN ORATION OF ROYAL COLLEGE OF SURGEONS OF ENGLAND.

THE LANCET.

LONDON: SATURDAY, FEBRUARY 21, 1903.

The Hunterian Oration of the RoyalCollege of Surgeons of England.THE Biennial Hunterian Oration was delivered on

Feb. 14th by Sir HENRY G. HOWSE, the President of the

Royal College of Surgeons of England, in the theatre of

the College. This oration was founded in 1813 byDr. BAILLIE, JOHN HUNTER’S nephew, and Sir EVERARD

HOME, his brother-in-law, and was intended to perpetuatethe memory of JOHN HUNTER by the delivery on Feb. 14thin every second year of an oration dealing with his workand the labours of others in the field of natural science

and its relation to the healing art. Feb. 14th (St. Valentine’s

Day) was chosen for the occasion because HUNTER cele-

brated that day as his birthday, though the register ofthe parish where he was born gives Feb. 13th as the

day of his birth. With such great latitude in the choice

of a subject many Hunterian orators have very variouslyinterpreted their functions and as a result the orations

have varied greatly. This year Sir HENRY HOWSE spokechiefly of HUNTER’S life and work with which many of

our readers may be familiar, but his career offers such anexcellent example of brilliant genius supported by indomi-table industry that it will bear recurring recital.JOHN HUNTER was the youngest child of a small Lanark-

shire farmer, and as his father died when the boy was onlyten years old he was allowed to run wild and his education

was grievously neglected. To this absence of parental con-trol the orator attributed much of the passionate naturewhich HUNTER displayed in his later life. There is prob-ably some truth in this view, but there is another aspectalso from which we may regard the free, open, and uncon-ventional life led by the boy till his twentieth year. It

is certain that while he ran wild on the farm he was

acquiring that love of the study of the ways of beasts andbirds which was so strikingly manifested later; he was

gaining the habit of close and accurate observation of

nature which is seldom learnt or fostered within the four

walls of a school. When about 20 years old he came

to London and was allowed to assist his brother

WILLIAM HUNTER; his talent for dissection soon showed

itself and his progress was rapid. He might have becomea dry-as dust professor but circumstances again conspired tobroaden his views, to vary his experiences, and to render hiswork unconventional and progressive. He was appointed tothe Belleisle expedition as an army surgeon and served alsoin Portugal, and in this way obtained opportunities for

many new observations. After his return to London his

original bent had full opportunity to display itself. His

powers of investigation were exceedingly great ; his

mind, well stored with facts, was quick to perceive un-

expected relations between facts, while theories were ever

ready to spring up to explain the correlation between two

phenomena, for he had an enormous range of accurate know--

ledge upon which to frame them. As a collector he was

remarkable. Though he was primarily an anatomist and a.

surgeon he collected not merely anatomical and pathological-I specimens, but also those illustrating zoology, botany,geology, and mineralogy. He was willing to enlist the aidof his friends in his observations, but in investigationsthus undertaken by different observers it is not sur--

prising that differences of opinion as to priority in dis-

covery should arise and of such disputes he had more

than most men. He quarrelled at one time or another with

many of those with whom he had to do and even with his-

brother WILLIAM. Both the HUNTERS were keen con-

troversialists and neither could brook contradiction.

WILLIAM HUNTER is said to have explained this bysaying that all anatomists were impatient of contradictionbecause they were accustomed to the passive submissionof the dead body.We hear much of HUNTER’S lack of skill in teaching ; we-

are told by Sir HENRY HowsE, and others have said the-

same, that his style was involved and that his phrases were-obscure. His books, indeed, do not excel in clearness ofdiction, but the lucidity of his writings must not be the test.of his power of teaching. By his fruits must a teacher be-known. Men do not gather grapes of thorns, nor can snccess-ful pupils result from bad teaching. It may with confidence

be affirmed that rarely, if ever, have so many brilliant men:been the pupils of one surgeon. The majority of the great.surgeons in London for some years after his death had been

the pupils of JOHN HUNTER. ABERNETHY, ASTLEY COOPER,CARLISLE, LYNN, EVERARD HOME, and BLIZARD may bementioned as examples. On the substance of lectures rather-

than on the presence of flowery periods depends their successand if the hearers learn what the lecturer would teach

them the exact words employed are only a matter of

secondary importance. And what HUNTER’S pupils learnedmay be summed up by saying that he laid a founda-

tion of physiology as the basis of pathology and so

furnished a true guide to treatment. Modern surgerydates from JOHN HUNTER. The importance of his museumwas recognised by HUNTER; to it he devoted many

years and much money, almost exhausting his pecuniaryresources. In his will he left directions that the museum

should be offered for sale to the Government. The British

Government can never be accused of over-estimating theclaims of science on the national purse-and this is

equally true of both political parties ; but occasionally it

happens that it does support a valuable project, and after

years of hesitation the Government purchased the museum.No small credit, too, is due to the then Corporation of

Surgeons, the Royal College of Surgeons of England, con-

senting to undertake the custody of this invaluable

collection.

The founders of the Hunterian Oration recognised thatmental food was not the only nutriment needed by man.So when they founded the Oration they founded at the sametime a biennial Hunterian Dinner to which the President

. of the Royal College of Surgeons of England invites

eminent members of the medical and other professions.At the dinner which followed the late oration Earl ROBERTS

534 THE ETIOLOGY OF CANCER.

had conferred on him the Honorary Fellowship of the Collegeto which he was elected two years ago. Lord ROBERTS,as will be seen by our report of his speech in another

column, took the opportunity of bearing eloquent testimonyto the work in South Africa of the Army Medical Serviceand its many and distinguished civilian coadjutors. We are

grateful to the Commander-in-Chief for recalling that workto the public mind, and we would beg him to believe thatin the Royal Army Medical Corps the country has a body ofmen who, if they receive fair and sensible treatment and

proper opportunities for keeping abreast with scientific

developments, can become some of the most valuable publicservants possessed by the Empire. We are proud to welcomeLord ROBERTS as a titular member of our profession.

The Etiology of Cancer.IN THE LANCET of Dec. 6th, 1902, p. 1558, we published a

leading article which drew attention to the arguments in

favour of the contagiousness of cancer and pointed out the

desirability of taking all possible precautions to prevent thespread of the disease. We have received a copy of a presi-dential address which Mr. W. GIFFORD NASH delivered at

the annual meeting of the South Midland Branch of the

British Medical Association in June of last year ; in this

address Mr. NASH discussed the whole question of the

causation of cancer. Much of the evidence brought forwardwas quoted in the article to which we have referred, butthere were several new facts of interest and importance.A striking case of auto-infection which he observed is the

following. Mr. NASH performed an abdominal hysterectomyfor malignant disease of the uterus and at the time of the

operation the vagina appeared to be healthy, but two monthslater numerous secondary nodules appeared in the mucous membrane where sutures had been inserted to close the

upper opening of the vagina. He quotes some instructiveobservations of Dr. BEHLA. The town of Luckau in Germanyconsists of a central portion with 3000 inhabitants, and easternand western suburbs called Kalau and Sando, each of the

suburbs having a population of 1000, thus making 5000 in all. i

From 1875 to 1898 no cases of cancer occurred in the western

suburb, Sando ; in the main portion of the town cases were

not infrequent, while in the eastern suburb, Kalau, 73

deaths from cancer occurred out of a total of 663 deaths.

The soil of Kalau and of the main portion of the town wasflat, low, and moist ; that of Sando was elevated, sandy, and

’dry. A stream or ditch encircled the main part of the

town and the suburb Kalau, and it appeared that the casesof cancer followed the course of the ditch, and in Kalau, thesuburb where cancer was very prevalent, all the gardenswere watered from this ditch. The data are insufficient for

the expression of any certain opinion, but there is great

probability in the view that the semi-stagnant stream was ’isomehow causally connected with the great frequency ofcancer in the suburb of Kalau. The portion of Mr. NASH’saddress which was of special interest dealt with some

investigations which he had made as to the distribution of ’,- cancer in Northern Bedfordshire. The total population of

the district was a little over 100,000 and so afforded amplematerial for statistics of value. The period investigatedcomprised the ten years 1890 to 1899. With regard to

the alleged increase in cancer in recent years Mr. NASH

thinks that the increase is apparent rather than real, andhe bases this opinion on the fact that the earlier death cer-tificates were frequently very inexact. For instance, manydeaths were attributed to "natural causes," "senile decay," and "consumption." Now it is not unreasonable to think

that many of the cases of " consumption " in old peoplewere cases of cancer. Be this as it may, good cause is

shown for thinking that some of the apparent increase

in cancer is due to error. Some very strong evidence in

favour of the infectivity of cancer is supplied by facts

collected by Mr. NASH. I I Duplicate cases " are instances

of cancer occurring in two or more patients in a house,or in near relatives who are in the habit of visitingone another, or in a person who has been nursing or

waiting on a patient suffering from cancer. 872 cases of

death from cancer were investigated by Mr. NASH and hefound 30 houses in each of which two or more cases of cancer

had occurred. A good instance was seen in the village of

Tingrith in the practice of Dr. J. WAUGH. A man, T. G.,died from cancer of the lip in 1894. He was waited on byS. D. who died in 1897 from cancer of the ovaries. T. G.’s

wife died from cancer of the stomach in June, 1899. These

were the only cases of cancer which occurred in that

village during the ten years. In another important series,W. C., aged 71 years, died from cancer at Campton in 1876.His wife had cancer of the breast for eight or nine yearsand died in another house in 1886. M. S., aged 74 years,nursed Mrs. C. and died in an adjacent house from cancerof the liver in 1893. Mrs. B., aged 73 years, occupied thesame cottage as Mrs. C. after her death, and died fromcancer of the umbilicus in 1892, and her daughter, aged 43

years, who slept in the same bed with her, died from

cancer of the breast in 1896. From observations as to the

altitude of the various villages in the district Mr. NASH

finds that there are more cases at heights above 300 feetthan below 150 feet. These results are important, as they donot accord with other observations. He considers that the

nature of the soil has very little influence on the occurrence

of cancer but that the large number of instances where twoor more cases occur in the same house or in persons

intimately associated points to the disease being infectious.

He urges that all the clothes and bedding used by a patientsuffering from cancer should be destroyed and that care

should be taken to disinfect thoroughly the room which thepatient has inhabited.

Lunacy Law and Practice in Regardto Private Patients.

THE address given at the meeting of the Medico-

Psychological Association in November last by Sir WILLIAMGoWERS, upon Lunacy and the Law,l has served to bringout important papers presenting other points for considera-tion. These papers were read at the last meeting of

the Medico-Psychological Association of Great Britain and

Ireland held at the County Asylum at Mickleover, near

Derby, on Feb. 12th, and one of them by Dr. ERNEST W.WHITE was published in THE LANCET of Feb. 14th, p. 427.

1 THE LANCET, Nov. 22nd, 1902, p. 1369.