Percivall Pott
Percivall Pott (born January 6, 1714 - or December 26, 1713 - in London ; † December 22, 1788 ibid) was an English surgeon . He was an innovative surgeon and teacher and is considered an important specialist writer . Because of the great influence of his analytical descriptions of clinical and pathological-anatomical observations, his name is included in several medical terms.
Live and act
Environment and career
Percivall Pott's parents came from socially respected families. His mother Elisabeth, born Symonds, was the daughter of a wine merchant, and the widowed Houblon daughter-in-law of a powerful functionary . After the death of her first husband, she married Percivall Pott (father). This came from an old family of traders and craftsmen and acted as a public scribe and notary (scrivener-notary). When he too died, Little Percivall, who was born on Threadneedle Street in London, was still very young. The adolescent was sent to a private school in Kent . Since he was adept at dealing with classical texts , and one of his mother's relatives who supported him was Bishop Joseph Wilcocks , a career as a cleric would have been close to his family's wishes. But Percivall Pott opted for surgery.
After graduation, Pott was apprenticed to Edward Nourse Jr., a surgeon in London, for an apprenticeship fee of 200 guineas . In a seven-year apprenticeship he learned the trade of surgeon. There were no binding training regulations for practitioners of the healing arts in London in the early 18th century, but there were strict entrance exams for the organized professions. The pharmacists were probably the largest group . They engaged not only with the preparation and administration of medicines , but also with surgical procedures and obstetrics. An important group that no official organization had succeeded in were the midwives ; Their activities also extended beyond obstetrics. Like the pharmacists, the surgeons were united in a Livery Company , a form of association for professional groups that was also politically powerful in London and that were considered respectable. In this originally guild society, surgeons had been associated with the barbers since 1540 (Worshipful Company of Barbers and Surgeons).
The Royal College of Physicians, as the professional body for academic medical professionals, traditionally accepted almost only graduates from the English universities of Cambridge and Oxford and was increasingly put under pressure to argue with a qualified influx of experts from abroad. The fact that there was no university in the large, growing commercial metropolis until the 19th century was one reason why early modern forms of scientific knowledge production could develop there on a broad basis. With the Royal Society , an important international network had emerged that is better known than other scientific and scientific societies of the time , not least because of its center in the British capital and the situation there . In the local area in particular, many members came from the surgeon profession.
Some surgeons and doctors, who in their private practice often devoted themselves to socially privileged people, also dealt with the misery of the poor in hospitals . The charitable activity combined with the acquisition of extensive experience; both also increased the prestige of these doctors. Particularly capable and happy were appointed to official posts in the institutions. The surgeons also took their apprentices with them. In St. Thomas's Hospital and St Bartholomew's Hospital , it was also possible in the early 18th century to take part in hospital operations as a paying guest for a few months, even without personal relationships; other establishments followed suit. An organized school operation should develop from this and Percivall Pott should have a prominent role in this.
A systematic training in anatomy was by no means taken for granted during Pott's apprenticeship . However, precise knowledge of the structure of the human body was considered important, especially for ambitious surgeons. In London, lectures with demonstrations were partly organized by their society. Private anatomy schools became more and more important there in the 18th century . They were operated by surgeons and were also commercially oriented. In addition to the learned young generation, other interested audiences were also able to attend events there.
Studies and demonstrations with animal material were also important for the medical and natural history field of anatomy. St Bartholomew's Hospital had a separate area for anatomical examinations for a long time. Already William Harvey , who there 36 years was employed as a physician, this infrastructure has used for his research. However, autopsies of deceased in-house patients were only permitted in 1750.
With Edward Nourse, Pott had found admission to a teacher who worked at St Bartholomew's Hospital and also had his own school of anatomy. From the beginning the apprentice found himself involved in the care of hospitalized patients and worked for the anatomy school. Making and drawing specimens became one of his main tasks. This pro-sector activity was of great importance for his further work.
On September 7, 1736, the twenty-two-year-old was allowed to take the entrance exam for the Society of Barbers and Surgeons, even though he had appeared considerably late because of a patient visit. He passed with distinction. He opened his first practice on Fenchurch Street, where he lived with his mother and half-sister. In 1745 Nourse became a full surgeon at St Bartholomew's Hospital; Pott, who had already unsuccessfully applied for a vacancy there a few years earlier, was his successor in the office of assistant surgeon.
In the same year, after lengthy disputes, the surgeons were separated from the barbers involved in hair care and cosmetics and formed their own society. Pott belonged to the operating faction around William Cheselden and John Freke (who was a director of St Bartholomew's and there was an institutionalized specialist in eye diseases and the first curator of a still small collection of anatomical and surgical specimens). This event was the culmination of a development of emancipation and a rise in power for the representatives of the art and science of surgery, as they called themselves at their first meeting. The strength of organized surgeons in the metropolis was also evident in the marginalization of other surgical professions . As early as 1730, for example, the last stone cutter at St Bartholomew's Hospital had gone out of service; his tasks were carried out by professional surgeons. In 1800 the Society of Surgeons was to become the Royal College of Surgeons .
In 1745 Pott's mother also died. Shortly afterwards he married Sarah Cruttenden, daughter of a director of the British East India Company . The connection resulted in nine children, of which only the firstborn did not reach adulthood. Moved to Watling Street, he opened his own anatomy school. From 1749 Pott occupied a position as a regular surgeon at St Bartholomew's Hospital, where he remained until 1787.
On July 5, 1751, Percivall Pott and William Hunter were elected masters of anatomy in the Society of Surgeons . After the split, the surgeons initially used the premises of the Society of Printer-Booksellers (stationers) for meetings. With the new editors, they inaugurated their own headquarters at what was then the Old Bailey , where the criminal justice department was also located. A major reason for this association was surgeons' human anatomical interest in the remains of healthy young adults. With a criminal law reform in 1752, the anatomical section of the executed officially became an alternative to displaying the corpse in public places. Both were stricter versions of the death penalty, which were also intended to be a deterrent.
In 1764 Pott was elected to the Royal Society. In the following year he became the head of the surgeons (master) through another vote in the Society of Surgeons.
Percivall Pott's family grew, as did the demand for services from him and his staff in private practice and school. He often moved with his family, most recently he resided in a house on Hanover Square. From the later 1760s, his practice is said to have been considered the largest, hippest and most lucrative in what was then London. Among his patients were in their profession also outstanding personalities like Samuel Johnson , David Garrick and Thomas Gainsborough . His students included Charles Glances , John Abernethy, and John Hunter , among many others .
In the middle of the 18th century, Pott was one of the busiest and most experienced surgeons in England. His great fame drew many European surgeons and also studied medicine to St Bartholomew's, where he was a sought-after teacher.
He published a number of significant medical papers. As a result, Pott became very well known and some of his methods were widely used. He published consistently in the vernacular , as was quite normal among British surgeons of his time. His most important writings were translated into other European languages and made Percivall Pott's name known far beyond England.
Consequences of the accident
Already in 1739 a work by Pott appeared in the Philosophical Transactions . This case story is about the ailments and findings of a man from whom Pott had removed a tumor located between the muscles of the thigh . The patient was initially symptom-free, but then developed various problems; various medical therapies and a spa stay in Bath did not help. He passed away after two years. His surgeon was allowed to dissect him and described many other tumors in the area of the bones and other organs. (This paper, which was later ignored, may represent an early description of pronounced metastasis as a result of a liposarcoma .) No publications are known from the following years. From the second half of the 1750s he wrote and published the works that established his fame.
It is often argued that a broken bone should have given impetus to his literary productivity. Pott visited patients on horseback. On a cold January day in 1756 he had crossed the Thames to Southwark , to a lock hospital . (That was the name of the old leprosy hospitals and their successor institutions in England , which in his day housed patients with venereal diseases .) On the way home he had a riding accident in which he broke his leg. In order to get home as well stored as possible and with as little vibration as possible, the experienced surgeon sent around litter carriers and a door. Having arrived home on the improvised stretcher, he soon found himself facing several colleagues who had come together in the role of patients . He had already given his consent to amputation - a method that was quite common at the time to treat an open fracture and reduce the significant risk of fatal consequences from inflammatory complications - when Nourse appeared and gave a chance to conservative procedures . The repositioned bone grew back together , and the well-cared for external wound healed easily. After a while, Pott was able to move freely again.
During the time of his convalescence he put together observations on hernias in writing. An important finding was that such visceral displacements also occur, which are not the result of acquired fractures (tears in the tissue), but follow innate anatomical conditions. The soon-to-be publication almost led to a break with colleagues, which is explained in the next section.
Pott also made significant contributions to the diagnosis and treatment of head injuries. In Injuries of the Head from External Violence (so the short title of which appeared in the first version of 1760 work) are described several cases that, work, transport, and often also typical English sports of the time have occurred in connection with violence. One man was trampled down by a crowd trying to save another from forced recruitment. Many injuries had fatal consequences in the medium term; but sometimes Pott was able to help. He drew general conclusions from his experience and presented his therapeutic approach. For example, an apparatus designed by him is shown, which was used both for trepanation and for lifting inwardly pressed bone fragments in the case of impression fractures of the skull. The technical principle can be reminiscent of uncorking devices .
The medium-term consequences of violence are also discussed here, which sometimes develop without fractures or external injuries. Pott interpreted dullness , loss of consciousness , voluntary mobility, etc. as signs of intracranial pressure . He saw the cause in internal fluid leakage and anatomically differentiated its possible location in the substance of the brain , its ventricles , between its membranes or the outermost membrane and the skull. Quite conventionally he saw bloodletting as Inappropriate therapy that would already be displayed in head injury to prevent such complications. In doing so, he admitted that it was difficult to convince people of such a procedure who had only received one knock on the pate .
He warned that the dura mater should be surgically relieved as soon as possible in cases of inflammation of the dura mater and an accumulation of pus between it and the cranial bone. For this he described a circumscribed, painless swelling of the scalp as a typical sign , which he had repeatedly observed associated with fatigue , restlessness , headache , tremors and other symptoms . Pott's puffy tumor ( American , now more common internationally than British : tumor, Germanization unusual), which usually occurs in connection with bone involvement, is now considered to be comparatively rare and can also appear without prior injury and meningitis as a result of complicated frontal sinus infections .
Some Few Remarks upon Fractures and Dislocations , first published in 1768, is another treatise on traumatological subjects.
Pott differentiated bone fractures not only according to the skeletal anatomy, he also emphasized the role of the soft tissue involved and explained functional aspects. In this influential work, the description of dislocations of the foot with fractures in the ankle area should be emphasized. Pott's Fracture later became an umbrella term for these injuries; on the continent a special described herein was broken leg above the lateral malleolus as Pott fracture known, at the same time the inner ankle in the ankle and heel bone connecting tears through tape apparatus .
Regarding therapy, Pott emphasized the need for good positioning with relaxed muscles.
A scholarly dispute
A Treatise on Ruptures (1756) is considered to be the work that established Pott's reputation as an outstanding medical writer. Abdominal hernias were a big topic in surgery at the time. In such inguinal hernias, the abdominal viscera sometimes shift to the scrotum or the outer labia . Pott described a special species, to which he submitted more detailed explanations in a smaller publication that soon followed. In male newborns and sometimes also in adults, he had repeatedly seen cases in which loops of the intestine or parts of the tissue apron covering the abdominal organs touched the testicles directly and there were no separating covering structures that would have been expected according to current doctrine.
Pott wasn't the only one studying congenital hernias like this . Immediately he found himself exposed to accusations that research results of others were used in his publications and that the names of these others were not mentioned.
William Hunter was the phenomenon that the intestinal parts and the testicle can lie in the same shell, was brought to attention in 1748 by his colleague Samuel Sharp. Together they were soon able to dissect a man with bilateral scrotum hernias, in whom they observed a hernial sac made of peritoneum and the vaginal membrane as separating structures, and an open connection. Two years later, Sharp published his view that open fractures were caused by cracking the separating structures.
In 1755 Albrecht von Haller's Opuscula Pathologica was published . It is described here that the testicles of the unborn child lie in the trunk by the kidneys and get into the scrotum in a gradual process that has not yet been fully explained (according to Haller's view, through movements of the trunk muscles). Since the peritoneum is also bulging, the actual abdominal viscera can also get into the scrotum: congenital hernias (see: habenula Halleri ).
New investigations were carried out in the Hunter house. William was a respected obstetrician who always handled difficult cases. Since sometimes even the best is powerless, there was no lack of anatomical material. His younger brother John, just at the beginning of a great career, devoted himself intensively to the study of the descent of the testicle in the fetus in the time before Pott's accident . William Hunter claimed that John showed his old teacher Pott the preparations and told his thoughts; Pott claimed to have only seen an object briefly and had no conversation on the subject. Nor did he want to have known Haller's work while he was writing his work.
The older Hunter was already involved in similar disputes with the Monros . Disputes about the priority of personal discoveries and allegations of plagiarism were by no means uncommon among early modern anatomists. The numerous proper names of authors of influential descriptions in anatomical terms testify to the importance of the idea of authorship . In the scientific community of the Enlightenment period, little reluctance was often shown in the publication of polemics . Pott seems to have behaved relatively calmly; In any case, he stated that such disputes in scientific publications were only incomprehensible and disruptive for outsiders interested in the content and honored the others in the next edition. William Hunter later wrote that he might have overreacted on his part and that Pott had always treated him as a gentleman in the matter .
An occupational disease and an old age ailment
Pott, based in London during early industrialization, also occupies a special position in the history of medicine because it described the connections between illnesses, working conditions and irritants. That is why he is often cited as a thought leader in epidemiology , hygienic subjects and cancer research . A publication from 1775 is considered to be the first mention of a chemical agent as a carcinogen and the first assignment of a specific cancer to an occupational group.
Pott noted an increase in scrotum cancer in chimney sweeps . These had often got into their jobs as orphans . Pott described their living conditions as extraordinarily harsh. Even in their early childhood, they were usually treated very brutally and exposed to hunger and cold. An important task for little people was to clean the inside of chimneys, which often led to bruises, burns and a lack of air. After reaching puberty, they were particularly susceptible to a painful and fatal illness. The neoplasm located in the genital area usually presented an ulcerated appearance and was often thought of by doctors and those affected to be a venereal phenomenon. However, the industry also the term soot-wart (was soot waiting ) consistently. Pott stated that it was a cancer and that a causal relationship with the long-term deposition of soot in skin folds was very likely. (According to later, more differentiated terminology, the cancers observed by Pott should be interpreted as squamous cell carcinomas ; they have their origin in the damaged epidermis . A minimum age of eight years was legally stipulated for chimney cleaning work in the kingdom in 1788, increased to 21 years in 1840; the effectiveness is considered low .)
In the same book, Surgical observations relative to the cataract, the polypus of the nose, cancer of the scrotum, different kinds of ruptures, and the mortification of the toes and feet (1775), Pott also presented new observations on a well-known phenomenon. Gangrene wasn't just a problem that often followed major injuries (for example, with open broken bones) and then showed up as dead tissue in the inflamed wounds. Tissue loss and blackening have occasionally also been observed in the toes and feet of older people with no external injuries. As a rule, it affected already severely handicapped people who were not least found in hospitals. Even today amputation is the standard therapy for such conditions, which can sometimes extend the life of those affected. Pott dissected amputates and the deceased. He found time and again that supplying blood vessels in the legs were hardened and blocked . He saw this as the cause of blood emptiness , which is most pronounced at the lower end and leads to tissue destruction there. Even today, Pott's gangrene is a term used in Anglo-Saxon medical parlance for this terminal stage of peripheral arterial occlusive disease .
Pott's disease
Pott's name was used particularly frequently in later centuries in the terms Pott's disease (Pott's disease) and Pott's hump (Pott-Gibbus). Since ancient times people with pointed humps (angular kyphosis ) often suffered from other problems as well. Even in the Hippocratic literature ( de articulis ) frequent socialization with paralysis and also with lung disease can be found.
Pott's starting point was paralysis of the legs, which was repeatedly observed with this typical curvature of the spine and sometimes also preceded it ( Remarks on that kind of Palsy of the Lower Limbs which is frequently found to accompany a Curvature of the Spine and is supposed to be caused by it , 1779). Children were most frequently affected. The doctor often only considered the muscle paralysis, otherwise the assumption was common that displaced vertebral bodies compress the spinal cord . Pott took a differentiated look at paralysis and pointed out that in the paralysis associated with the curvature of the back, the muscles are not slack, but rather behave spastically and sensitivity is usually impaired. The paralyzes show very different forms; In the worst case, the affected person can no longer move their legs at all, whereby he then usually also noticed loss of control over the excretion of feces ( fecal incontinence ) and urine ( urinary incontinence ), inability to erect and other problems. The anatomist proved that it is not the vertebral bodies in their joints that are dislocated, but that a destructive process is taking place in the bone substance. At the beginning of the disease, the vertebral bodies appear soft and distended, which he compared with the picture of rickets . In the further course they show more and more carious decomposition. If there are signs of paralysis, at least two vertebrae are usually involved, sometimes three, rarely more. The process spreads to the intervertebral discs and leads to their decomposition. Pott usually also found the vertebral ligaments to be thickened. The involvement of surrounding tissue is also essential, according to his definition. Most abscesses are found in the muscles that originate in the spine. Increasing collapse of the porous vertebral bodies or acute collapse leads to hump formation. Sometimes violence plays a role; Pott stated that this is then often believed to be the sole cause.
Again, Pott was not the only one to explain the morbid anatomy of this phenomenon, which was increasingly common in Europe at the time . In the previous year, Jean-Pierre David had already presented comparable findings to the French Académie Royale de Chirurgie , which appeared in print around the same time as Pott's work. The long-term influence must have been much less, as the term mal vertébral de Pott was also used in France .
Various stretching machines were used for therapy, which Pott criticized as very dangerous and only effective in the short term. ( Therapeutic corsets were not to appear until the 19th century; the consequences of the clothing habits of European women, which seemed absurd to him, served Pott as an example of spinal curvatures without paralysis.) By a doctor and a surgeon in Worcester , Dr. Cameron and Mr. Jeffries, Pott learned a therapeutic strategy that the former had read about in Hippocrates' successful application. It consisted of creating and maintaining wounds on both sides of the affected vertebrae. Pott was convinced that in this way the carious process could be derived and the formation of ankylosis would be supported. (On the continent, such artificial suppurations were known as fontanelles , they were used in various internal ailments and are to be seen in connection with humoral pathological thinking.) Pott experimented with various methods and found cauterization to be the least painful and cleanest. He cited numerous successful cures or ameliorations of paralysis. (Modern authors pointed out the importance of rest and protection, which may have been a consequence of the procedure. Ankylosis in place of destroyed intervertebral discs and thus block vertebrae also arise naturally; without orthopedic measures, new bone formation also fixes the hump.)
Humpbacks, paralysis, and abscesses were later referred to as the Pott triad. For Pott, the clinical picture he described belonged to scrofula , which he also knew as a thickened upper lip, swelling of the glands in the chin and neck area, dry cough , caries in other bones and in many other forms. During the 19th century, Pott's disease became part of the emerging modern concept of tuberculosis . Pott'sche disease became a synonym for tuberculous spondylitis or tuberculosis of the spine ( ICD-10 : M49.0-, A18.01). It accounts for around half of all cases of bone tuberculosis . In areas of the world with a low prevalence of tuberculosis , it has become comparatively rare. Neurological failures and soft tissue involvement are not always present; like hump formation, they should be avoidable with timely care.
Even in old age, Percivall Pott rode long distances to see patients, even in bad weather. He is said to have caught a cold from which he no longer recovered.
He died on December 22, 1788, shortly before his 75th birthday, of complications from pneumonia .
Fonts (selection)
- An Account of Tumours, Which Rendered the Bones Soft (...) . In: Philosophical Transactions of the Royal Society. Volume 41, 1739, pp. 616-622.
- Observations on the nature and consequences of wounds and contusions of the head, fractures of the skull, concussions of the brain, etc. London 1760.
- Practical remarks on the hydrocele or watry rupture. London 1762.
- An Account of a Hernia of the Urinary Bladder Including a Stone (...) . In: Philosophical Transactions of the Royal Society. Volume 54, 1764, pp. 61-64.
- Remarks on the disease commonly called fistula in ano. London 1765.
- Surgical observations relative to the cataract, the polypus of the nose, cancer of the scrotum, different kinds of ruptures, and the mortification of the toes and feet . Hawes, London 1775.
- The Surgical Works of Percivall Pott, FRS, to which are added “A short Account of the Life of the Author,” by James Earle, Esq. Johnson, London 1790 (work edition with biography, edited by a son-in-law)
- The surgical works of Percivall Pott, FRS, surgeon to St. Bartholomew's Hospital, a new edition, with his last corrections. 1808. (P. Pott: The surgical works of Percivall Pott, FRS, surgeon to St. Bartholomew's Hospital, a new edition, with his last corrections. 1808. In: Clinical Orthopedics and Related Research . Number 398, May 2002, p. 4-10, PMID 11964625. )
- Some Few General Remarks on Fractures and Dislocations . 1758 (P. Pott: Some few general remarks on fractures and dislocations. 1758. In: Clinical orthopedics and related research. Volume 458, May 2007, pp. 40-41, doi: 10.1097 / BLO.0b013e31803dd063 . PMID 17473597. )
- Farther Remarks on the Useless State of the Lower Limbs, in Consequence of a Curvature of the Spine: being a supplement to a former treatise on that subject . 1782 (P. Pott: Farther remarks on the useless state of the lower limbs, in consequence of a curvature of the spine: being a supplement to a former treatise on that subject. 1782. In: Clinical orthopedics and related research. Volume 460, July 2007, pp. 4–9, doi: 10.1097 / BLO.0b013e318067b486 . PMID 17620803. )
literature
- F. Beekman: The hernia congenita and an account of the controversy it provoked between William Hunter and Percivall Pott. In: Bulletin of the New York Academy of Medicine. Volume 22, Number 9, September 1946, pp. 486-500, ISSN 0028-7091 . PMID 20997111 . PMC 1871545 (free full text).
- L. Belloni: Percivall Pott's disease of the spine, discussed in two letters of J. Hunczovsky from London, 1779, to GA Brambilla in Vienna. In: Medical history. Volume 16, Number 1, January 1972, pp. 78-80, ISSN 0025-7273 . PMID 4560450 . PMC 1034933 (free full text).
- ES Flamm: Percivall Pott: an 18th century neurosurgeon. In: Journal of Neurosurgery . Volume 76, Number 2, February 1992, pp. 319-326, ISSN 0022-3085 . doi: 10.3171 / jns.1992.76.2.0319 . PMID 1730964 .
- J. Dobson: Percivall Pott. In: Annals of the Royal College of Surgeons of England. Volume 50, Number 1, January 1972, pp. 54-65, ISSN 0035-8843 . PMID 4550865 . PMC 2388056 (free full text).
- Susan C. Lawrence: Charitable Knowledge: Hospital Pupils and Practitioners in Eighteenth-Century London . Cambridge University Press, New York 1996, ISBN 0-521-36355-1 .
- W. Maccormac: The Development of Surgery . In: Science. Volume 12, Number 294, August 1900, pp. 254-263, ISSN 0036-8075 . doi: 10.1126 / science.12.294.254 . PMID 17769240 .
- PR McCrory: Sir Percivall Pott - the first sports neurologist? In: British journal of sports medicine. Volume 35, Number 4, August 2001, pp. 278-280, ISSN 0306-3674 . PMID 11477030 . PMC 1724347 (free full text).
- Percivall Pott. In: Seyed B. Mostofi (Ed.): Who's Who in Orthopedics . Springer, London 2005, pp. 274-278, ISBN 978-1-85233-786-5 , doi : 10.1007 / 1-84628-070-2_206
- MA Rauschmann, B. Habermann, M. Engelhardt, G. Schwetlick: Von Pott-Trias and Schmorl-knot. In: The Orthopedic. Volume 30, No. 12, 2001, pp. 903-914, doi: 10.1007 / s001320170002 .
- Barbara I. Tshisuaka: Pott, Percival. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1177.
Web links
- Legacies in the Archives of the Royal College of Surgeons of England
- Entry to pot; Percivall (1714-1788) in the Archives of the Royal Society , London
- Pathology Department of St Bartholomew's Hospital at aim25.ac.uk (English)
- Percivall Pott at whonamedit.com (English)
| personal data | |
|---|---|
| SURNAME | Pott, Percivall |
| ALTERNATIVE NAMES | Pott, Percival |
| BRIEF DESCRIPTION | British surgeon |
| DATE OF BIRTH | January 6, 1714 |
| PLACE OF BIRTH | London |
| DATE OF DEATH | December 22, 1788 |
| Place of death | London |