Percivall Pott

1714-1788

English Physician and Surgeon

Percivall Pott was one of eighteenth-century's preeminent physicians and surgeons. In a time which predated surgical specialization, he made historic contributions to orthopedics, urology, neurosurgery, and oncology. No less than three disorders bear his name as a result of his precise and accurate clinical descriptions: Pott's disease, Pott's fracture, and Pott's puffy tumor.

Born in London in 1714 to a woman who was twice widowed, Pott nonetheless obtained a privileged education, developing a taste for classical knowledge and literature. Apprenticed at 16 to Edward Nourse, surgeon at London's St. Bartholomew's Hospital, he prepared Nourse's dissections, gaining invaluable training in anatomy. In 1736, at age 22, Pott was admitted to the Company of Barber Surgeons and established his own practice. At age 31 he was elected Assistant Surgeon at St. Bartholomew's, and four years later attained full surgeon, a post he held until 1787.

Pott discovered his propensity for writing as a result of an accident. Thrown from his horse in 1756, he suffered compound fractures of the tibia and fibula. He refused to be moved until a door had been purchased and two men procured to carry him home on an improvised stretcher. His colleagues advised immediate amputation, but as they were about to begin, Pott's old teacher Nourse arrived and saved the limb. During the long recovery Pott occupied himself by writing "A Treatise on Ruptures," an essay on hernia, considered by many to be his finest work.

In his 1760 and 1768 works on head injuries, Pott described the "puffy tumour," or the swelling of the scalp over the affected area, later named after him. He was one of the earliest to note the importance of neurological symptoms as markers of brain injury in the absence of external lacerations.

In 1768 Pott published his treatise on fractures and dislocations, providing the first definitive description of the various forms of ankle fractures and their attendant soft tissue injuries. Thus "Pott's fracture" is a generic term rather than the definition of a single fracture.

Because of Pott's observation in 1775 that cancer of the scrotum in chimney sweepers was caused by long-term exposure to soot, he is regarded as a pioneer in the fields of chemical carcinogenesis and occupational medicine.

In 1779 another of his significant works dealt with spinal curvature resulting in paralysis of the lower limbs. Although he did not recognize tuberculosis as the cause of the collapsed vertebrae, he was the first to give a complete clinical picture of what is now known as "Pott's disease."

Pott became a prosperous and sought-after surgeon, numbering among his patients David Garrick (1717-1779), Thomas Gainsborough (1727-1788), and Samuel Johnson (1709-1784). He was also a generous mentor and clinical teacher; one of his students was the brilliant surgeon John Hunter (1728-1793). Upon his retirement from St. Bartholomew's after 50 years, Pott continued to practice. Journeying in severe weather to see a patient, he caught a chill, developed pneumonia, and died in 1788.

In our highly specialized era it is hard to imagine how one surgeon could have excelled in so many areas. His books went through many editions and were translated into several European languages, underscoring his influence and position in eighteenth-century surgery.

His son-in-law, Sir James Earle, collected and published all of Pott's known works in The Chirurgical Works of Percivall Pott, Including a Short Account of the Life of the Author (1790). His writings are marked by precision and discipline carried over from his surgical training, and are models of clarity and elegance. His genuine concern for the welfare of patients and his insistence on skillful technique and good judgment, at a time when speed was the usual benchmark, advanced a more rational and humane approach to surgery.

DIANE K. HAWKINS