Hunter: The Knife Man - Essay Example

Hunter: The Knife Man Medical knowledge has been gathered across the centuries as physicians have used willing test unknowing patients, andeven themselves as the subject of medical experiments. Such was the case when John Hunter, an 18th century surgeon, subjected himself to syphilis to ascertain its origins and record a treatment regimen. His findings would be hotly debated at the time of their release; hailed as a breakthrough and discounted as unscientific conjecture. Indeed, his methods did not adhere to the scientific methods and standards for conducting an experiment and his findings managed to prolong any more accurate information regarding gonorrhea and syphilis. Today, Hunters findings are used as an example of how not to conduct an experiment. Hunter, a surgeon that socialized in scientific circles, should have approached his early experiments on venereal disease in a more scientific and controlled fashion. By the middles of the 18th century, venereal diseases were rampant across Europe and in England. Since their appearance in the population just a few centuries earlier, the diseases of gonorrhea and syphilis had become the major concerns for most physicians. It is still widely debated as to where the venereal diseases originated, but once they came to England they came in massive proportions. The venereal diseases were spread by sexual contact, and this fact was well known in 18th century England. In addition, England was rife with the opportunity to engage in sexual activity. "Customers eager to pay for illicit sexual relations spanned all walks of life, from the soldiers and sailors swarming the streets on leave to the dukes and dandies who gratified their physical desires after an evenings gambling in West End clubs" (Moore, 2007, p.126). This liberal attitude towards sexual activity spread the disease rapidly and widely throughout the population. One of the major issues surrounding the venereal diseases was whether or not both gonorrhea and syphilis had a common origin. Many scientists, Hunter included, believed that both venereal diseases were caused by a single organism and they were simply different stages of the same disease. "In common with most of his fellow practitioners, he believed gonorrhea represented the local stage of the disease, while symptoms of lues venera emerged when the disease spread throughout the body" (Moore, 2007, p.135). In fact, many of the patients that Hunter had been treating were infected with both ailments. The symptoms were difficult to differentiate and gonorrhea would often subside, while syphilis would take time to manifest. Hunter viewed this as a progression of the disease, and not as two distinct diseases. Hunter had already subscribed to the hypothesis that they were the same disease, and his experiment would be designed to prove, or disprove, this important issue surrounding the venereal diseases. It was in this atmosphere of liberal sexual attitudes and an exploding population infected with venereal disease that Hunter undertook to conduct his experiments. One of the first considerations for designing a scientific experiment is the choice of subjects. The scientific method and its standards for experimentation had been evolving for centuries, though ethics were not as refined in the 18th century as they are today. A modern standard for medical experiments today demands that the subjects be fully informed and have given their consent to the test. Hunter had some previous experience with a few cursory experiments that he conducted on unwitting subjects. He has conducted tests using a placebo as a cure for gonorrhea, and given his wife plain water that was labeled as mineral spa water to observe the placebo effect (Moore, 2007, p.134). However, this experiment would be much more serious and involve infecting a healthy person that he could observe on a daily basis. For Hunter, there was only one subject that could be used as a test subject, fully informed and willing to be subjected to the horrors of venereal disease. That test subject would be himself. Hunter had designed a simple experiment that promised to yield results that could be accurately observed and recorded. "In the spring of 1767, he resolved to inoculate a person with gonorrhea and monitor the progress of the disease for signs of syphilis" (Moore, 2007, p.135). The experiment design was flawed as Hunter inoculated himself with the disease from a patient that was suffering from both diseases, as many patients were in this era. Hunter was well aware that many of his patients had both diseases, yet seemingly chose to ignore this possibility in the specimen he used for his self-inoculation. This may have been due to the fact that he had the pre-conceived notion that both diseases had a single cause. His belief in this was so strong that he failed to account for any other possibility in the experiments design. After inoculating himself with the infected specimen, Hunter watched for symptoms and recorded the long series of treatments that he applied to himself. He observed the onset of gonorrhea followed by the taking hold of syphilis. He reasoned that both diseases were one in the same, just as he had hypothesized. When his results were published, they only fuelled the ongoing debate on the subject. While many had confidence in Hunters conclusion and accepted it, others met the test with scorn and ridicule. In 1793 a similar test by Bell had yielded the opposite results (Moore, 2007, p.138). In fact the debate would rage across Europe until 1838 when American born French physician Phillipe Ricod proved that they were individual diseases with unique causes by a test conducted on 2500 uninformed patients (Moore, 2007, p.137). Modern ethical standards would condemn Ricords methods. However, Hunters published work was the standard for many years, but set back the meaningful research into venereal diseases for decades. The biggest error that Hunter made in the design of his experiment was the failure to control for the variables. An effect does not indicate a cause, simply because it is hypothesized or expected. Hunters experiment suffered from his preconceived conviction that they were the same disease and he did not allow for any other possibilities, such as the specimen containing both diseases. To eliminate, or at least greatly reduce this possibility, Hunter would have needed a larger subject base as was undertaken in Ricords experiments. However, Ricod violated ethics by failing to disclose the tests and Hunter would have had great difficulty finding sufficient numbers of healthy people willing to be infected with a venereal disease. Though we condemn his experiments, as well as Ricords, they are the basis of modern thinking on venereal diseases and opened the pathway to modern scientific methods and ethics. Since the days of John Hunter, gonorrhea has become better understood and there have been advances made in its treatment. However, the disease is still a public health concern. The rates of gonorrhea have been on the rise lately, and the disease is becoming especially more prevalent in girls aged 15 to 19 (Malhotra, 2008, p.88). The cause could range from the reaction of the immune system that has lost its immunity to a simple case of "prevention fatigue" (Daly, 2008). This may also be due to a false sense of security that has been promoted by the safe sex guidelines that call for the use of a condom. While condoms reduce the risk of HIV infection by as much as 85 percent, this number drops to 50 percent for gonorrhea (Malhorta, 2008, p.89). This reliance on condoms can have severe repercussions. According to Malhorta (2008), "Gonorrhea may damage joints, the heart, or the brain if untreated. Both chlamydia and gonorrhea also increase the risk of HIV infection by three- to five-fold" (p.88). While public health officials offer the well intentioned advice that condoms are safe sex, this may be a leading factor behind the rise of the rates of gonorrhea. The treatment for gonorrhea has undergone significant changes since the days of John Hunter and the application of mercury tot he open sores. Recent history has relied on a range on antibiotics to treat the disease once contracted. According to Campos-Outcalt (2007), "Since the early 1990s, fluoroquinolones have been one of the recommended treatments for gonorrhea because of their availability as effective, single dose oral regimens" (p.554). However, the use of fluoroquinolones has been accompanied by a rise in the rates of resistance to the drug treatment. To deal with the rising numbers of resistant cases, the CDC has recently ceased to recommend fluoroquinolones for the treatment of gonorrhea. In Hunters days of experimenting with the treatment of venereal diseases, there were few alternatives to the accepted practice of applying mercury. While there are more modern methods available today, there number is also limited. According to Campos-Outcalt, "The loss of quinolones as a recommended gonorrhea treatment leaves only ceftriaxone, 125 mg intramuscularly (IM), as the only readily available treatment for urogenital, anorectal, and pharyngeal gonorrhea" (p.555). As the rates of resistance to ceftriaxone begins to rise in the treatment of gonorrhea, the medical community will need to conduct more experiments in search of a new drug to combat this potentially lethal disease. John Hunters story is remarkable in the seeming lack of ethics, controls, and scientific standards. It should come as no surprise that the results would suffer from inaccuracy. While Hunter was faced with tracking the cause of both gonorrhea and syphilis, the medical community now must track and trace the resistant strains. This requires procedures and methods to insure the data is accurate. According to Campos-Outcalt, "The ongoing challenges with the evolving resistance patterns of gonorrhea illustrate the importance of physicians accurately diagnosing gonorrhea, treating with recommended regimens, reporting positive cases to the local public health department, and assisting with partner evaluation and treatment" (p.558). These were the same challenges that faced Hunter, but there is a greater awareness today for the implications of science, and a greater sensitivity to the needs and concerns for the health of the public. In conclusion, John Hunter performed his experiment on gonorrhea and syphilis with good intentions and bad science. His preconceived ideas that both were the same disease may have caused him to disallow for any other alternative. While his findings were faulty, his research kept the subject as an important debate on into the 19th century when new information would be discovered. This is important in todays world as gonorrhea continues to be a major concern of public health officials. The over reliance on safe-sex and condoms may in fact contribute to spreading the disease. While we know much more about its transmission and treatments, research into new drugs can barely keep pace with the ability of the disease to become resistant. The only available drug, ceftriaxone, is currently being utilized, but it is only a matter of time before the alert medical community begins to see signs of resistance. By then, we can hope that medicine has conducted new tests in an ethical and scientific fashion to produce a new treatment in the war on this centuries old disease. References Campos-Outcalt, D. (2007). Practice alert: CDC no longer recommends quinolones for treatment of gonorrhea [Electronic version]. The Journal of Family Practice, 56(7), 554-558. from EBSCO. Daly, M. (2008). Return of a Menace: Syphilis is back. Heres what you need to know about it [Electronic version]. Current Health, 35(3). from EBSCO. Malhorta, S. (2008). Impact of the sexual revolution: Consequences of risky sexual behaviors [Electronic version]. Journal of American Physicians and Surgeons, 13(3), 88-90. from EBSCO. Moore, W. (2007). The knife man: Blood, body snatching, and the birth of modern surgery. New York, NY: Broadway. Read More