Although the eighteenth century London surgeon, John Hunter, has gone down in history for a number of great achievements, his work on collateral circulation is one of my favorite stories to tell. Before we dive in on John’s interaction with a troubled coach driver, let us first discuss look into the background of aneurysm treatment. An aneurysm is defined in the dictionary as “a localized, blood-filled dilation of a blood vessel caused by disease or weakening of the vessel wall.” Antyllus, a surgeon that lived in 2nd century Rome, discovered a way to treat aneurysms which became the standard form of treatment well into the 18th century (Lesney). The ancient surgeon’s treatment involved tying ligatures around the arteries that entered and left the aneurysm and then cutting open the sac, emptying it, and packing it (Lesney). As one can imagine, this procedure was messy and the risk of infection was very high. Large and unpredictable aneurysms were often declined for treatment by surgeons and the patient was either left to die of a painful rupture or endure an amputation if the location of the aneurysm would allow. Amputation was the standard solution in the days of John Hunter, but when a coach driver showed up St. Georges Hospital, aged 45, Hunter decided to give him a treatment option outside of amputation or death (Moore).

Oil painting of John Hunter. Photo credit: https://wellcomecollection.org/works/dp4t6euu

A popliteal aneurysm is one that occurs in the popliteal artery located behind the knee. The anatomy master, John Hunter, decided to run some experiments before the coach driver was to go under his knife. Collateral circulation is defined in the dictionary as being “circulation of blood established through the enlargement of minor vessels and anastomosis of vessels with those of adjacent parts when a major vein or artery is functionally impaired.” The operation took place in 1785 and involved Hunter litigating high on the patient’s thigh to avoid a disastrous build-up of pressure, and he left the aneurysm fully intact (The James Lind Library). Collateral circulation would allow blood to fully bypass the damaged area and eventually the sac would shrink in size (The James Lind Library).

Image of a Popliteal aneurysm in the popliteal artery located at the lack of the knee; the same condition that the coach driver suffered from when he was treated by John Hunter in 1785. Photo credit: https://www.flickr.com/photos/rblachut/533213932.

Amazingly enough, the coach driver recovered from the procedure and saw drastic improvement of his condition. He ended up passing away though just over a year later due to an unrelated illness (The James Lind Library). John had many ties with the body snatching community thanks to the years that he spent working alongside his anatomist brother, William Hunter (The James Lind Library). The coach driver’s leg was obtained by Hunter after his death and was studied to see if the surgery had been as successful as he thought. To his credit, the body had developed pathways around the aneurysm and his theories and experiments forever changed the way that aneurysms are treated.

Image shows how minor vessels can assist in blood flow even after the larger vessel has been damaged. Photo credit: https://nursekey.com/nursing-management-coronary-artery-disease-and-acute-coronary-syndrome/.

If that didn’t make you thankful for modern medicine, then I don’t know what will!

Until Next Time

N.F.

 

Sources:

Lesney, S. Mark. Vascular Specialist. “Ancient Aneurisms.” 20 June, 2013. https://www.mdedge.com/vascularspecialistonline/article/84043/ancient-aneurysms. 

Moore, Wendy. The Knife Man. https://www.worldcat.org/wcpa/servlet/DCARead?standardNo=0767916530&standardNoType=1&excerpt=true.

The James Lind Library. “Moore W. (2009), John Hunter (1728-1793).” https://www.jameslindlibrary.org/articles/john-hunter-1728-93/.

Vascular Specialist. “John Hunter and the Vasculature.” 6 August, 2012. https://www.mdedge.com/vascularspecialistonline/article/83827/john-hunter-and-vasculature.