The Prince of Surgery: Sir Astley Cooper

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Imagine ligating an arterial aneurysm in the early 1800s, when clipper ships were the fastest mode of transport. Thomas Jefferson was still President and not just the face on the $20 bill, and there was no anesthesia beyond plenty of rum or gin, and when sterile operations were more than 70 years in the future.

This was the world of Sir Astley Cooper, dubbed by his compatriots as “The Prince of Surgery,” when he performed what he reported as the “first successful operation on the common carotid artery for aneurysm in the year 1808.”

Born on August 23, 1768, Cooper received his medical training at Guy’s Hospital in London, where his uncle, William Cooper, was senior surgeon. But his main medical influence was Henry Cline, a student of the famous surgeon, John Hunter. Rather than embracing a career solely as a private practitioner, Cooper focused on teaching and clinical research at Guy’s, where he became senior surgeon in 1800.

Attractive in person, personality, and station (both as surgeon and through the benefit of a wealthy wife), Cooper became the darling of the influential class of his day, with patients such as various Lords, Dukes, and the Prince of Wales, soon to become King George IV, the obese, profligate, and much despised son of and successor to the “mad monarch” who lost the American Revolution.

It, it is ironic, for a man who was considered the premier teaching surgeon of his era, that Cooper had as his most famous student one of the England’s greatest poets – John Keats. In the Keats’ collection there are disparaging notes he took at one of Cooper’s lectures. Vascular surgeons may be more impressed that Cooper taught Valentine Mott, pioneer American surgeon, and one of the first to ligate the innominate artery.

A hallmark of Cooper’s technical approach was extensive animal experimentation, among them, a dog in which he ligated the carotid and vertebral arteries. The animal turned out to be, as Cooper said, “a good house dog.”

In 1805 the 44-year-old Mary Edwards presented to Cooper with an aneurysm of the right common carotid artery, which Cooper ligated. She did well initially, but died 16 days later.

Cooper was convince that she would have survived had the aneurysm not been so large initially. So he tried again on June 22, 1808, when Humphrey Humphreys, a 51-year old porter presented with a left carotid artery aneurysm “the size of a walnut. ” This was treated by Sir Cooper by means of a double ligation and a division of the common carotid artery. Humphreys survived until 1821. Sir Cooper did the autopsy and found a left-sided cerebral hemorrhage.

According to his report in the first issue of Guy’s Hospital Reports in 1836, Cooper noted that “[the cerebral hemorrhage] of which he died sufficiently attested the freedom of circulation as well as its force in the cerebral vessels on the side of which the carotid had been tied.” Valentine Mott witnessed this operation.

That same afternoon as Cooper performed the carotid operation, he also ligated an external iliac artery for a large femoral aneurysm in a patient who survived another 18 years. Cooper performed this same operation nine more times in his career.

In 1813 Cooper achieved the plum position of professor of comparative anatomy at the Royal College of Surgeons.

In 1817 he developed the use of the buried catgut suture in a patient with a popliteal aneurysm, this allowed a completely closed wound, which prevented the fatal hemorrhage which often resulted from the usual procedure in which silk was used to ligate the artery, with the ends of the ligature brought through the wound. Also in1817, he stretched his talents and the technology too far when he ligated just above the aortic bifurcation in an attempt to save a patient, Charles Hutson, with a large ruptured external iliac aneurysm. Hutson died 40 hours after surgery from the failed attempt that occurred more than 100 years before Rudolph Mataas performed the first successful abdominal aortic aneurysm ligation in 1923.

Sir Astley Cooper died on February 12, 1841 from congestive heart failure. A fervent dissectionist to the end, he left detailed instructions on conducting his own postmortem.

Sources and Additional Information

1) Friedman, S. G. A History of Vascular Surgery.Futura Publishing Company, Inc. 1955.

2) Astley Cooper: His Life and Surgical Contributions (J. Hand Surg. 2011;36A:316-20).

3) Thomas Wakely, Astley Cooper, and the Death of George IV (J. R. Soc. Med. 2007;100:314–20).

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