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UTERINE CONTRACTIONS
JOHN HUNTER AS A MILITARY SURGEON
the use of a vocabulary of only 850 words-apart from technical terms-lends itself to incisiveness and
simplicity.
-
UTERINE CONTRACTIONS
ALL too little is known about the factors governing the contractions of the uterus-a subject of great practical importance. Knaus in 1927 published observations on the influence of the corpus luteum, and since then a good deal has been found out about the nature of spontaneous uterine activity, and the type of response of the muscle to chemical, hormonic, and physical stimuli. This varies, as is now well known, with the species of animal, the phase of sex cycle, pregnancy, and the stage of pregnancy. Knaus and others believed that spontaneous contractions, and the reaction of the muscle to posterior pituitary extract, are most noticeable about the time of full development of the follicles in the ovary, when the secretion of cestrin is high, and least during the dominance of the corpus luteum. The latter observation has been confirmed by several workers, but is disputed by others ; for Schultze, Moir, Tachezy, and now E. M. Robertsonhave been unable to demonstrate an altered activity in the response of the uterine muscle to posterior pituitary extract during the luteal phase of the ovarian cycle. Robertson’s observations were made with the use of a minute rubber balloon, inserted into the (non-pregnant) uterus, filled with fluid, and connected to a manometer. Twenty records were made in some twelve women, and several examples of tracings are reproduced in his paper. The experiments seem to demonstrate clearly the activity of the muscle and the existence of a response to posterior pituitary extract, while the uterus is under the influence of an active corpus luteum. Such findings throw doubt on the advisability of using preparations of progestin (the corpus luteum hormone) to discourage uterine contractions in a case of threatened abortion. But clinicians are persuaded that its use for this purpose is effective, and it is possible that during pregnancy progestin may have a desensitising action not apparent at other times. JOHN HUNTER AS A MILITARY SURGEON
IN 1762, towards the end of the Seven Years War, ancient ally Portugal was invaded by Spain and appealed for help, with the result that a British expeditionary force under John Campbell, fourth Earl of Loudoun, was sent to assist the Portuguese army. The Earl had seen service previously in the ’45 and in North America : he was an indefatigable worker who also kept his papers, and as commanderin-chief he then had charge of the medical service Three hundred documents as well as of the fighting. from his collection were acquired in 1934 by the Royal College of Surgeons on the recommendation of the honorary librarian, Sir D’Arcy Power, and they have now been investigated by Prof. George Gask who described their contents in a special lecture given at the College on Monday last. The papers are of much interest not only because of the light they throw on the conditions and equipment of the army medical service of the time, but also because John Hunter served in this expedition as a military surgeon. When John Hunter first came to London at the age of twenty he joined his brother William, but after ten years with him he contracted a pulmonary affection that it was feared might develop into tuberculosis unless he had a change. Accordingly our
1
Edinb. Med. J. January, 1937, p. 20.
457
in 1760 he obtained a commission as an army surgeon from the adjutant-general, Robert Adairthe original of the well-known song " Robin Adair "and was sent to Belle Isle, off the coast of Brittany, which was taken from the French in 1761. When in the following year Portugal was invaded by Spain, four regiments of infantry and detachments of the 16th Light Dragoons were sent on from Belle Isle to Portugal where they were joined by two more regiments from Ireland, bringing the total of The this B.E.F. to about seven thousand men. commander-in-chief of the allied forces was the Count of Lippe Buckenberg, the famous artillerist, and he seems to have succeeded in holding the Spanish invasion not by attack but by laying waste the country in front of the enemy, and by defending the line of the Tagus so as to cover Lisbon. The hospitals with which Hunter was concerned were thus situated all along this river. The military so that some historians were operations trifling ignore them altogether. In the returns of the sick there is no mention of a wound, and as a rule no diagnosis. From one paper, however, it seems that the chief complaints were fever, ague, and flux ; these, as Prof. Gask remarked, are the .age-long complaints of the army. One of the most interesting of the papers is a list of the officers of the hospital appointed for the use of this force, giving the rates of pay per diem. The director, William Young, received 25s. a day. Two physicians, Dr. William Cadogan (whose portrait hangs on the stairs of the Royal College of Physicians) and Dr. Michael Merris, got Eleach. The surgeons, John Hunter, Francis Tomkins, and William Maddox, had to be content with 10s., and likewise the two apothecaries. Finally came the surgeon’s mates at 5s. a day each. There were 18 of them and although Prof. Gask did not say so one suspects that they did most of the work. But there was also a female staff attached to the hospital consisting of a matron who received 2s. 6d. a day, two head nurses and five washerwomen at Is., and sixteen nurses at 6d. Prof. Gask endorsed the value of the washerwomen from his own war experience. There is a difference of opinion about the status of the nurses, some holding that they were selected from the camp-followers, but Prof. Gask gave reasons for believing that they had had some hospital training. The orders for the discipline of the hospital show that this was under the control of the combatant side and that the duties were not unlike those of the modern military police. As regards John Hunter, there are a number of official returns signed by him, one of which is a list of the sick on board the hospital ship Betty while bound from Belle Isle to Lisbon. He seems to have tried to secure the post of deputy-director of the hospital but without success, and when Dr. Cadogan was invalided home Hunter actually applied for the post of physician, but again without getting it. Probably the increased income was his chief object. He seems to have been in close touch with Lord Loudoun and to have discharged his duties often in difficult circumstances with the vigour and efficiency that all familiar with his character would expect. Transport appears to have been a constant trouble, for ambulances had not been invented and country carts had to be used unless the journey could be made by boat. When Hunter joined the troops at Belle Isle he described his colleagues in a letter home as "a dammed disagreeable lot," but the accusation of Jesse Foot that Hunter was quarrelsome on this expedition is not borne out by these Loudoun papers. On the other hand, they prove that the chief authority
the use of a vocabulary of only 850 words-apart from technical terms-lends itself to incisiveness and
simplicity.
-
UTERINE CONTRACTIONS
ALL too little is known about the factors governing the contractions of the uterus-a subject of great practical importance. Knaus in 1927 published observations on the influence of the corpus luteum, and since then a good deal has been found out about the nature of spontaneous uterine activity, and the type of response of the muscle to chemical, hormonic, and physical stimuli. This varies, as is now well known, with the species of animal, the phase of sex cycle, pregnancy, and the stage of pregnancy. Knaus and others believed that spontaneous contractions, and the reaction of the muscle to posterior pituitary extract, are most noticeable about the time of full development of the follicles in the ovary, when the secretion of cestrin is high, and least during the dominance of the corpus luteum. The latter observation has been confirmed by several workers, but is disputed by others ; for Schultze, Moir, Tachezy, and now E. M. Robertsonhave been unable to demonstrate an altered activity in the response of the uterine muscle to posterior pituitary extract during the luteal phase of the ovarian cycle. Robertson’s observations were made with the use of a minute rubber balloon, inserted into the (non-pregnant) uterus, filled with fluid, and connected to a manometer. Twenty records were made in some twelve women, and several examples of tracings are reproduced in his paper. The experiments seem to demonstrate clearly the activity of the muscle and the existence of a response to posterior pituitary extract, while the uterus is under the influence of an active corpus luteum. Such findings throw doubt on the advisability of using preparations of progestin (the corpus luteum hormone) to discourage uterine contractions in a case of threatened abortion. But clinicians are persuaded that its use for this purpose is effective, and it is possible that during pregnancy progestin may have a desensitising action not apparent at other times. JOHN HUNTER AS A MILITARY SURGEON
IN 1762, towards the end of the Seven Years War, ancient ally Portugal was invaded by Spain and appealed for help, with the result that a British expeditionary force under John Campbell, fourth Earl of Loudoun, was sent to assist the Portuguese army. The Earl had seen service previously in the ’45 and in North America : he was an indefatigable worker who also kept his papers, and as commanderin-chief he then had charge of the medical service Three hundred documents as well as of the fighting. from his collection were acquired in 1934 by the Royal College of Surgeons on the recommendation of the honorary librarian, Sir D’Arcy Power, and they have now been investigated by Prof. George Gask who described their contents in a special lecture given at the College on Monday last. The papers are of much interest not only because of the light they throw on the conditions and equipment of the army medical service of the time, but also because John Hunter served in this expedition as a military surgeon. When John Hunter first came to London at the age of twenty he joined his brother William, but after ten years with him he contracted a pulmonary affection that it was feared might develop into tuberculosis unless he had a change. Accordingly our
1
Edinb. Med. J. January, 1937, p. 20.
457
in 1760 he obtained a commission as an army surgeon from the adjutant-general, Robert Adairthe original of the well-known song " Robin Adair "and was sent to Belle Isle, off the coast of Brittany, which was taken from the French in 1761. When in the following year Portugal was invaded by Spain, four regiments of infantry and detachments of the 16th Light Dragoons were sent on from Belle Isle to Portugal where they were joined by two more regiments from Ireland, bringing the total of The this B.E.F. to about seven thousand men. commander-in-chief of the allied forces was the Count of Lippe Buckenberg, the famous artillerist, and he seems to have succeeded in holding the Spanish invasion not by attack but by laying waste the country in front of the enemy, and by defending the line of the Tagus so as to cover Lisbon. The hospitals with which Hunter was concerned were thus situated all along this river. The military so that some historians were operations trifling ignore them altogether. In the returns of the sick there is no mention of a wound, and as a rule no diagnosis. From one paper, however, it seems that the chief complaints were fever, ague, and flux ; these, as Prof. Gask remarked, are the .age-long complaints of the army. One of the most interesting of the papers is a list of the officers of the hospital appointed for the use of this force, giving the rates of pay per diem. The director, William Young, received 25s. a day. Two physicians, Dr. William Cadogan (whose portrait hangs on the stairs of the Royal College of Physicians) and Dr. Michael Merris, got Eleach. The surgeons, John Hunter, Francis Tomkins, and William Maddox, had to be content with 10s., and likewise the two apothecaries. Finally came the surgeon’s mates at 5s. a day each. There were 18 of them and although Prof. Gask did not say so one suspects that they did most of the work. But there was also a female staff attached to the hospital consisting of a matron who received 2s. 6d. a day, two head nurses and five washerwomen at Is., and sixteen nurses at 6d. Prof. Gask endorsed the value of the washerwomen from his own war experience. There is a difference of opinion about the status of the nurses, some holding that they were selected from the camp-followers, but Prof. Gask gave reasons for believing that they had had some hospital training. The orders for the discipline of the hospital show that this was under the control of the combatant side and that the duties were not unlike those of the modern military police. As regards John Hunter, there are a number of official returns signed by him, one of which is a list of the sick on board the hospital ship Betty while bound from Belle Isle to Lisbon. He seems to have tried to secure the post of deputy-director of the hospital but without success, and when Dr. Cadogan was invalided home Hunter actually applied for the post of physician, but again without getting it. Probably the increased income was his chief object. He seems to have been in close touch with Lord Loudoun and to have discharged his duties often in difficult circumstances with the vigour and efficiency that all familiar with his character would expect. Transport appears to have been a constant trouble, for ambulances had not been invented and country carts had to be used unless the journey could be made by boat. When Hunter joined the troops at Belle Isle he described his colleagues in a letter home as "a dammed disagreeable lot," but the accusation of Jesse Foot that Hunter was quarrelsome on this expedition is not borne out by these Loudoun papers. On the other hand, they prove that the chief authority