Percivall Pott

Sir Percivall Pott (1714 – 1788)

Sir Percivall Pott (1714 – 1788) was a English surgeon.

Numerous eponyms. Worked and wrote extensively on inguinal and femoral hernias and their repair; hydrocoeles and repair and vertebral tuberculosis and it’s consequences

Wrote treatises on head trauma and consequences as well as defining management of the Pott fracture (which he sustained himself in 1756)

In 1775 was the first to report on occupational exposure leading to disease when he described the high rate of scrotal carcinoma in English chimney sweeps


Biography

  • Born 6 January 1714 Threadneedle Street, London (present site of the Bank of England)
  • 1729 – Apprenticed toEdward Nourse (1701-1761), surgeon at St. Bartholomew’s Hospital (paying £210 for the seven years apprenticeship.)
  • 1736 – Grand Diploma by the Court of Examiners of the Barber Surgeons Company.
  • 1745 – Assistant-surgeoncy at St. Bartholomew’s Hospital
  • 1749-1787 Surgeon to St. Bartholomew’s Hospital
  • 1753 – Master of Anatomy at Surgeons’ Hall.
  • 1764 – Fellow of the Royal Society
  • 1786 – Honorary Diploma of the Royal College of Surgeons of Edinburgh
  • Died 22 December 1788 ‘My lamp is almost extinguished: I hope it has burned for the benefit of others

Medical Eponyms

Pott fracture (1768) Fracture of the distal fibula, 2–3 inches proximal to the ankle joint. Effectively a fracture-dislocation of the ankle, involving a fracture of the fibula, disruption of the deltoid ligaments with an intact tibiofibular ligament resulting in lateral displacement of the talus.

Pott puffy tumour – Subperiosteal abscess secondary to frontal osteomyelitis. Swelling of the scalp secondary to osteomyelitis of the skull post trauma. First described in 1768 by Pott as a complication of head trauma, but it much more frequently represents a complication of frontal sinusitis. Complications include intracranial spread with epidural abscess, subdural empyema and cortical vein thrombosis.

Pott cancer – Coal tar-induced dermal neoplasia of the scrotum as a ‘a lodgement of soot in the rugae of the scrotum‘. More commonly referred to as the term he coined of ‘chimney-sweepers cancer‘.

Pott disease and the resultant Pott curvature and Pott paraplegia – osteitis of the vertebrae, secondary to tuberculosis (tuberculous spondylitis). Characterized by collapse of the vertebrae, with resultant kyphosis and hunchback deformity (Pott curvature) which may lead to spinal nerve involvement and resultant paralysis. [Pott 1782]


Key Medical Attributions

Surgical practice:

Pott critical on routine surgery and the pressure of time

Time has produced a most absurd custom of measuring the motion of a surgeon’s hand as jockeys do that of the feet of a horse, viz., by a stop-watch, a practice which, though it may have been encouraged by the operators themselves, must have been productive of most mischievous consequences.

Observations on the Fistula Lachrymalis 1758

Caution and fear are different things; where any good can be done, it ought to be attempted by every practicable and justifiable means; but where no good is reasonably to be expected, there is no warrant for doing anything.

Injuries of the Head. 1768

Pott on Surgical progress

Many and great are the improvements which the chirugical art has received within the last fifty years; and many thanks are due to those to have contributed to them; but when we reflect how much still remains to be done, it should rather excite our industry than inflame our vanity‘.’Our fathers thought themselves a great deal nearer to perfection than we have found them to be; and I am much mistaken if our successors do not, in more instances than one, wonder both at our inattention and our ignorance.

Ankle fractures:

Pott effectively defined the first malleolar based fracture classification system for the ankle referring to refers to unimalleolar, bimalleolar and trimalleolar fractures. Pott stressed the importance of the fibula as a support in the ankle region in spite of its slender structure as compared with the tibia.

Without the support of the fibula the body cannot be held erect, since abnormal movements of the foot may be expected at any moment.

Pott attached great weight to a good reduction by introducing ‘reposition in semiflexion‘ whereby the extremity is held half flexed in the hip joint and knee joint, by which the muscles are relaxed to the greatest possible extent and thus the least possible counteraction to the reduction is caused. He applied strips of adhesive tape over the lateral malleolus around the planta and up on the medial side of the crus, and by placing the injured extremity in semiflexed position he tried to secure retention


Controversies

1756 – Thrown from his horse whilst riding, Pott suffered a compound fracture of the leg ‘…the bone being force through the integuments‘. He sent to Westminster for two chairmen and purchased a door to which the men nailed their poles whilst he lay prostrate on the ground in Southwark. He was carried 2 miles to his home, over London Bridge to Watling St near St Pauls. Despite calls for immediate amputation, the fracture was reduced (by Mr Nourse) and Pott recovered to produce the quintessential documentation on fractures and dislocation in 1768.

1758 – accused of ‘stealing’ the work of William Hunter regarding priority in the discovery of the condition known as hernia congenita in his treatise on ruptures. Timothy Brand, Surgeon to the Greenwich Hospital also called out Pott following his 1758 publication of ‘Observations on the Fistula Lachrymalis’ accusing him of

…a trumpery ostentatious affectation of a knowledge that he does not possess‘ and ‘It is too often the misfortune of Mr. Pott’s language that it leaves room for conjecture where the utmost perspicuity is absolutely necessary.

1858 – Bouvier, Physician to the Children’s Hospital in Paris took exception to Pott’s treatise on disease of the spine (1779) – a condition referred to as ‘le mal vertebral de Pott‘ in France. This was in spite of the fact that Jean-Pierre David (1737-1784) had presented to the Royal Academy of Surgery in Paris (1778) cases of injury and disease of the spine where prolonged rest had made great improvement and his treatment is almost exactly that recommended by Pott.

The imaginings of Pott have been translated into all languages, but his methods were no different from those of the Arabs and their successors. But what of David’s book? Very few people have read it and it lies covered in the dust of the Libraries. Great men like Dupuytren, Roux, Marjolin and Cloquet, have scarcely been able to remove the shadow cast by Pott over the great truths expressed by the humble Normandy surgeon.


Major Publications


References


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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