The Best Surgeon in England

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Illustrations

Cover: Percivall Pott, Stipple engraving by J. Heath, 1790, after Sir J. Reynolds, V0004763. Courtesy of Wellcome Library, London.

Figure 1: Entry from the Freedom Admission register for Edward Nourse, September 1730, Indenture signed by Edward Nourse, surgeon, and Percivall Pott, apprentice, COL/CHD/FR/02. Courtesy of London Metropolitan Archives.

Figure 2: Portrait of Percivall Pott by Joshua Reynolds, 1784, SBHX7/16. Courtesy of St. Bartholomew’s Hospital Archives.

Figure 3: Emily Warren (Emily Pott) Thäis by Sir Joshua Reynolds, D14709, Mezzotint, 1837. Copyright of National Portrait Gallery, London.

Figure 4: St. Bartholomew’s Hospital. Copper line engraving on paper by Benjamin Cole, produced to accompany William Maitland’s History of London, published 1754–6, hand coloured. Author’s private collection.

Figure 5: A surgical operation to remove a malignant tumour from a man’s left breast and armpit in a Dublin drawing room, 1817. Watercolour, after Robert Power, V0016861. Courtesy of Wellcome Library, London. ← ix | x →

Figure 6: Trochlea, 1771 from Illustrations on the nature and consequences of those injuries to which the head is liable from external violence, London, by Percivall Pott. Facing page 205. L0007378. Courtesy of Wellcome Library, London.

Figure 7: John Heaviside, coloured mezzotint by R. Earlom, 1803, after J. Zoffany, L0017574. Courtesy of Wellcome Library, London.

Figure 8: Pott, Percivall, Surgical Lectures, Vol. 2. Title Page. Taken down by J. Grigg. MS 3958, 1782, L0073681. Courtesy of Wellcome Library, London.

Figure 9: Illustration of surgical instruments, from Pott, Percivall, “Lectures on the Practice of Surgery,” Surgical Lectures, Vol. 2. Trochars. Taken down by J. Grigg. MS 3958, 1782, L007368. Courtesy of Wellcome Library, London.

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Acknowledgments

I would like to thank the many institutions and people that have provided financial and professional support over the years I have been researching and writing this monograph. My colleagues and students in the History Department at the University of Missouri–Kansas City (UMKC) have remained steadfast in their interest in Pott and his world. I was fortunate to receive the support of a Women and Gender Studies Research Grant at UMKC and a University of Missouri Research Board Grant to help fund this project. Susan Sykes-Berry, a reference librarian at UMKC’s Health Sciences Library, spent hundreds of hours collating primary research materials. At the University of Kansas Medical Center, Dawn McInnis at The Clendening History of Medicine Library provided invaluable help in locating surgical manuscripts and rare books. A Eugene W. J. Pearce, M. D. and Lunetta A. Pearce, M.D., Fellowship in the History of Medicine, Library and Archives at the University of Kansas enabled me to dig deeper into the wonderful collections of the Clendening Library. I also spent a summer in the Ebling Library for the Health Sciences funded by a Friends of the University of Wisconsin Libraries Research Grant-in-Aid. I wish to thank Mary E. Hitchcock and Micaela Sullivan-Fowler at the Ebling Library for their hard work in helping with my research.

Several visits to London allowed me to spend time at the Royal College of Surgeons, the Wellcome Library, Barts and The London NHS Archives, the ← xi | xii → Royal College of Physicians, Kings College Archives, the London Metropolitan Archives, The National Archives, and the British Library. Librarians and archivists were invariably kind and knowledgeable in aiding my work. Janice O’Brien carried out an extensive enquiry into the life of Bob Pott in the British Library’s India Office Records and at The National Archives. I am grateful for the primary materials she discovered and sent to me.

Finally, I would like to acknowledge the support of the late Dr. Marjorie Sirridge and her family, the wisdom and friendship of Mrs. Patricia Burton and the late Dr. Jerry Burton, and the love of my spouse, Professor William Everett and our canine companions, Beatrice and Bridget. This book is dedicated to them.

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Introduction

“What Brought Each Leaden-Headed Lad to Town, What Drew Them Hither but the Name of Pott?”¹

In 1784 there were 148 physicians, 600 apothecaries and 220 surgeons working in London. Percivall Pott (1713–1788) was one of those surgeons, and he was also the fortunate holder of one of the 62 hospital posts available in the city.² This book analyses the long career of Mr. Pott for what it can tell us about a period of great transition in the rank and respectability of hospital surgeons in England. Pott completed his apprenticeship with the last barber-surgeon to be elected assistant surgeon to St. Bartholomew’s Hospital in 1731 and then became the first member of the new Company of Surgeons to be elected assistant surgeon to the hospital in 1745. For nearly forty years he offered a series of annual lectures on surgery to pupils, took on apprentices and trained dressers and built up a large and lucrative private practice in London and its outskirts. Pott was widely recognized for being the best practical surgeon of his generation, and his numerous publications replete with case histories were praised for the elegance of their language and clarity of approach to the bloody business of surgery. His works were avidly translated into other languages and went through many editions on the continent and in America.

Focusing on the character, pedagogy, writings and correspondence of Pott allows us to explore issues such as how did surgeons present and position themselves in a competitive world of medical men and women, what did it entail to become known as an authority in surgery, and how was knowledge structured and ← 1 | 2 → restructured to create a professional identity.3 Surgery was a risky business both for patients and practitioners of the art and it aroused strong feelings of fear and hope in the minds of those who were cut upon and in those who did the cutting. Tolerance of uncertainty was required along with the ability to change a planned course of treatment based on what a surgeon discovered when he opened the body. Pott taught pupils, apprentices and dressers how to behave and think as surgeons through narratives composed of words, emotions, and actions. He sought to construct certain patterns of behavior and inculcate reserve in how his young charges acted when making a diagnosis, carrying out a treatment, or offering a prognosis. Surgery for Pott was an intellectual and sensory experience, where emotional engagement with the patient was a necessity and honesty was the best policy. Long before amphitheatres became common in London hospitals, Pott opposed heroic measures, theatrical performances, and displays of temper by surgeons.⁴ He instructed his pupils to maintain an unruffled composure and to have the fortitude to cut as deep and wide as needed to allow a surgeon to effectively treat the patient.

At the age of forty-three Pott had a horse accident that badly injured his leg. During several months of enforced rest, he wrote A Treatise on Ruptures. It was published in 1756 and discussed one of the most common ailments a surgeon treated, namely hernias. It was to be the first in a prolific stream of books and treatises. A cursory glance at the titles of some of Pott’s books provides a view into the workaday existence of a London hospital surgeon in the eighteenth century and the sorts of conditions he would encounter: An Account of a Particular Kind of Rupture, Frequently Attendant upon New-Children; and Sometimes Met with in Adult; viz. that in which the intestine, or omentum, is found in the same cavity, and in contact with the testicle, 1757; Observations on that disorder of the corner of the eye, commonly called fistula lachrymalis, 1758; Observations on the nature and consequences of those injuries to which the head is liable from external violence, 1760; Practical Remarks on the Hydrocele or Watery Rupture, and Some Other Diseases of the Testicle 1762; Remarks on the disease, commonly called a fistula in ano, 1765; Some few general remarks on fractures and dislocations, 1773; Chirurgical Observations relative to the Cataract, the polypus of the nose, the cancer of the scrotum, and the mortification of the toes, 1775; Remarks on Curvature of the Spine, 1779; Observations on the necessity and propriety of amputation, in certain case and under certain circumstances, 1779; and Farther Remarks on the useless state of the lower limbs in consequence of a Curvature of the Spine, 1782.

Along with the production of books on various conditions, a significant part of Pott’s life was spent teaching surgery. Notes from his apprentices and pupils survive in surprising numbers in manuscript form, some anonymous and some not, some as fair copies and some as scribbles. As Susan Lawrence has posited, lecture ← 2 | 3 → notes reflect an interaction between the instructor and the student, rather than a verbatim account of what an instructor said and the student understood.5 Read in this way, the surviving manuscripts of Pott’s lectures, often completed by boys between the ages of fourteen and seventeen, offer glimpses into how knowledge and practice was passed on from teacher to student. The gentlemanly virtues Pott considered requisite for a successful surgeon are constantly stressed: courage, a cool head, a steady hand, a keen eye, and the ability to gain and keep the trust of patients upon whom you were going to generally inflict great pain. The notes also reveal how Pott trained and influenced other surgeons, ways in which surgical knowledge was produced and transmitted, and how surgeons learned to judge what to treat and what to leave alone. Case histories included in the lectures and Pott’s many publications establish that certain conditions and parts of the body were viewed as being so closely linked with particular operative surgeons that they became part of that surgeon’s professional identity. Pott had several conditions named for him, and the terms were in use soon after his death if not just before. They were “Pott’s puffy tumor” (periosteal abscess formation in the brain that is often recurrent⁶), “Pott’s disease of the spine” (tuberculous spondylitis⁷), and “Pott’s dislocated fracture of the ankle” (a complicated break). Pott was the first medical man to argue that an external agent could cause cancer, namely that soot trapped in the skin folds of young chimney sweeps could lead to scrotal cancer in adulthood.⁸ Cancer Scroti was often referred to as “Pott’s disease” in the twentieth century. Not for nothing did Sir D’Arcy Power dub Pott the “Prince of Eponyms.”⁹ Such labeling of disorders in the late eighteenth century reveals the importance and power of rhetoric in crafting the increasingly rigid definition of medicine as a sophisticated scientific activity rather than a mundane lay experience of treating sickness. It also helps lay bare the power of surgeons to classify and essentially come to own certain disorders in the body.

The appearance, the smell, and the feel of infected body parts are vividly recorded in Pott’s lectures and books. Surgeons saw patients in acute crises and in chronic disorder and pain. Networks of care and neglect, conditions for living and working, and the dangers of child play and innocent games are revealed through case histories of accidents, violence, paralysis and deformity. Questions of power and control in the history of medicine arose when surgeons sought to coerce patients into revealing information about their illnesses and to get them to agree to an operation. Equally such questions arose when patients insisted on surgery or a more forceful therapy. Surgery before the availability of general anesthesia has been viewed as brutal for the patient and potentially brutalizing to the surgeon. An analysis of Pott’s and his patients’ rhetoric helps reveal when surgery was resorted to and when it was not. Piecing together some of the details of the lives and deaths ← 3 | 4 → of men, women, and children Pott encountered and contextualizing their experiences results in a rich social history of events generally neither shared nor captured in non-medical sources.

The scholarship on early modern English surgeons is limited, and consideration of the social and cultural history of surgery has largely been overshadowed by studies on the lives of physicians and medicine in general. Where surgery and surgeons are addressed, it has been largely in terms of technology (the development of instruments, anesthesia, asepsis) and innovation (new techniques in operating).10 Notable exceptions include Wendy Moore’s The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery and Peter Stanley’s For Fear of Pain: British Surgery, 1790–1850. Andrew Wear and Roy Porter have considered connections between early modern surgery and pain, as have I within my study of the development of dispassion.¹¹ The rise of general anesthetics, not surprisingly, has received considerable attention from historians. Only recently, however, has its transformative effects on surgery been problematized. Stephanie J. Snow has discussed the social, economic, and political aspects of anesthesia, noting that its genesis has been celebrated and treated as a watershed moment in medical history, for this was when pain was banished from operative practice and surgery became modern, meaning painless.¹² But much remains to be written about the history of surgery. Thomas Schlich has noted that we are especially lacking histories that tackle “What surgeons actually did in their jobs …”¹³ Pott’s training in surgery began when he was 15, and he treated his last patient at age 73. Examining and contextualizing what Pott did over the course of his life to earn the epithet of being the best surgeon in England is one of the principal goals of this book.

The first chapter examines how Pott successfully clambered up the ladder of surgery and business over a half century to become a gentleman of means and respectability. Pott’s origins, apprenticeship, patrons, marriage and the lives of his eight children are explored to establish the social, cultural and economic contexts within which Pott found fame as a hospital surgeon. He achieved a high degree of respect through producing well-trained apprentices and dressers, holding authoritative roles in the new Company of Surgeons, obtaining a senior post at a major hospital, demonstrating calm dexterity in operating, treating well-known patients, and writing praiseworthy books. A biography written by Pott’s son-in-law, the surgeon James Earle has achieved canonical status among scholars as the source on Pott’s life. It is analyzed for what it reveals of sentiments toward the barber-surgeons of Pott’s youth and the characterization of Pott as the epitome of the new professional surgeon.

The next chapter analyzes how Pott visualized the doing of surgery. It was a risky occupation that required physical strength, dexterity, and a strong amount ← 4 | 5 → of authority. Pott’s words and deeds as captured in his pupils’ lecture notes signify changing professional and cultural ideologies. They allow us to examine the interplay of forces and structures in shaping surgical aspiration and status. Pott’s life both impacted on and reflected broader historical changes in what it meant to be considered skilled in surgery. His systematic and focused approach to carrying out surgery, which he both practiced and taught, reveals the physical and sensory experiences of pre-modern surgeons and their patients. Pott advised his pupils to cultivate certain comportments, values, and traits in order to become successful and authoritative surgeons that point to the ambitions and anxieties of medical men in the mid to late eighteenth century.

The third chapter focuses on acute injuries, especially ones to the head, and those to the limbs that meant amputation was recommended. Pott published a seminal text on wounds to the head that includes many case histories which vividly depict the dangers and violence of daily life in Georgian England. Case histories were key components in the education of pupils and fellow medical men in the art of surgery, and Pott’s are quite numerous and lengthy in comparison to other hospital surgeons of the era. They typically contained information on the context for the injury, the appearance of the injured body part, and the treatment and outcome of the intervention; however, they were far from being just accounts of diagnosis, treatment and prognosis. Pott constructed his narratives to warn of common mistakes in surgery, criticize quackery and mediocre surgeons, explain women’s bodies, and teach the correct way to interact with other medical men and patients. Over decades of lectures he used his vast store of case histories to educate, persuade and occasionally amuse his pupils. Finally Pott expressed strong views in person and in print on the need to amputate when a wound was fresh. He entered into debates with medical men in Europe that show what a surgeon did well was promoted as evidence of the superiority of their physical approach to operating and of being bred in a country with higher morals.