1 - Technical Change, Practical Stasis: The Development of Arterial Repair through 1914

Summary

“My left leg is a great deal weaker than my right,” wrote Marvin Rynar, a forty-seven-year-old watchman from Georgia to his surgeon, William Halsted. In 1906, Rynar had been struck in the thigh by a metal hoop and subsequently developed an aneurysm of the femoral artery. Halsted treated it by ligating (tying off) his left iliac artery in 1909. Rynar recovered from the surgery and in 1912 wrote Halsted to tell him how he was feeling: the aneurysm had disappeared, but “I can't walk very much as I have pains in my left leg when I do any walking … it gets very cold.” Rynar's experience exemplifies the progress surgery made in the early modern era while simultaneously demonstrating its limitations. Rynar benefitted from John Hunter's proximal ligation procedure for aneurysm, a scientifically developed operation from the eighteenth century that saved both the lives and limbs of patients who previously faced amputation or death. This clinical success and its intellectual foundation made proximal ligation a hallmark of modern surgery for the next century.

Yet Rynar also suffered for years with a painful, barely functional leg. In an effort to improve patients’ outcomes, surgeons spent the decades between 1880 and 1914 devising new operations to repair and even replace injured blood vessels. They relied on the technologies of anesthesia and asepsis, superior training, and unprecedented global collaboration made possible by journals and international conferences. In 1880, the possibility of arterial repair did not exist; by World War I, surgeons had invented a series of innovative procedures to repair arteries and successfully applied them to a few patients. However, the clinical rarity of arterial repair in the 1910s revealed a gap between invention and widespread application.

Exploring the technical development of arterial repair unpackages how procedures are created, unveiling unique elements of surgical culture. It shows how surgeons operated—both specifically in their physical manipulation of tissue and more generally in how they worked in the laboratory and clinic. While research primarily remained a solitary endeavor, the results and their impact simultaneously created and depended on a sense of authority within this community. Investigating the process of invention and dissemination reveals the priority of practical demonstration over theorizing and the crucial reliance on vivisecting animals in providing compelling evidence.