Sir Astley Paston Cooper, 1st baronet

A pupil John Hunter, Astley Paston Cooper made great strides in surgical technique, most notably in the area of vessel ligation. As a teacher, he stressed practical demonstrations over didactism and gained the respect and admiration of his students, many of whom eventually became famous in their own right.

In 1785 Cooper was apprenticed to Henry Cline (1750-1827), the well-known surgeon at St. Thomas’s Hospital, London, and was taken into his house. This close connection with a famous anatomist and surgeon was to be of great importance to him. Besides this he attended lectures by John Hunter (1728-1793) in London, and in the winter of 1787 visited Edinburgh. In 1789 he became demonstrator of anatomy at St. Thomas’s Hospital, and in 1791 Cline let him give some of his lectures.

In 1792, just married, Cooper went to Paris with his wife to study with Pierre Joseph Desault (1744-1795) and François Chopart (1743-1795), but soon was driven off by the revolutionary disturbances. That year he commenced giving his first lectures on surgery, and in 1793 was appointed professor of anatomy at Surgeon’s Hall. He came to Guy’s Hospital in 1805 as a surgeon, succeeding his uncle William Cooper, who laid down his post. In this period he concerned himself with animal experiments and comparative anatomy, and dissected, among many things, an elephant. He was also in close contact with the resurrectionists, the body snatchers that were the only suppliers of corpses in those days.

In 1813 Astley Paston Cooper became professor of comparative anatomy at the Royal College of Surgeons, succeeding Sir Everard Home (1765-1832), but left his chair already in 1815 because of the burdens of his enormous private practice, as a surgeon at Guy’s Hospital and his lecturing of anatomy and surgery at the St. Thomas’s Hospital. His annual income from his hospital and private practice amounted to more than 21.000 pounds. In 1815, after the battle of Waterloo he sent several of his assistants to Brussels to attend to the wounded.

At the beginning of the year 1825 ailing health made him abandon his lecturing at the St. Thomas’s Hospital. He was then approached by the directors of Guy’s Hospital about establishing a medical school at that Hospital. Cooper, feeling offended by the directors of St. Thomas’s, agreed, and thus came the separation of the two schools of the United Borough Hospitals, which they had been termed until them, and thus the independence of the medical school at Guy’s goes back to that time. Although Cooper was active at the hospital as consulting surgeon only, and rarely gave a lecture, he was quite busy in science and published several works. He was one of the first to applaud the recent invention of the gastric pump by a simple man, a gardener named Read.

In 1821 he was made a baronet for removing a sebaceous cyst from the scalp of King George IV. In 1828 he became Sergeant-Surgeon to the king, a dignity he retained with the successor, William IV.

As a teacher of surgery he was considered unsurpassed among British surgeons by his contemporaries. One of his pupils was the poet John Keats (1795-1821), who had been apprenticed to a surgeon and apothecary. He later studied at Guy's Medical School and in 1816 was licensed to practice medicine. His notes from the lecture by Astley Cooper have been preserved. Keats, however, did not spend much time practicing medicine. As early as in 1817 his first large collection of poems was published, and at that time he had already decided to devote the rest of his life to poetry. That was not very long however, as Keats died from tuberculosis in 1821. Perfectly aware that he was about to succumb to the disease, he observed his symptoms with the skill of a professional. He writes: "The blood comes from my mouth . . . i know the colour of that blood, it is arterial blood; i cannot be fooled by that colour, this drop of blood is my death sentence. I must die!"

Cooper was not a prolific writer, but his publications were of the highest quality and were the result of personal knowledge and observation gained from long hours of practice, dissecting, and experimentation. Among his several publications were two papers entitled Observations on the effects that take place from the destruction of the membrana tympani of the ear that he read before the Royal Society in the early 1800's. In the first paper he showed that two patients with perforations of both eardrums could hear perfectly well although it had always been thought that this condition resulted in deafness.

In the second paper he demonstrated that deafness caused by obstruction of the Eustachian tube could be relieved by myringotomy, which equalized the ear pressure on each side of the tympanic membrane and restored the patient's hearing. Cooper was awarded the Copley Medal of the Royal Society, the highest honour the society could bestow, for noteworthy contributions to medical knowledge.

In 1805 Cooper was one of the founders of the Royal Medical and Chirurgical Society of London, and in the Transactions of this society, A case of aneurysm of the carotid artery, he reported the first ligature ever of carotis communis (1805). It was unsuccessful, but in 1809 he repeated the operation in a similar case, now successfully.

Quotations

«An old Scotch physician, for whom I had a great respect, and whom I frequently met professionally in the city, used to say, as we were entering the patient’s room together, "Weel, Misster Cooper, we ha’ only twa things to keep in meend, and they’ll searve us for here and herea’ter; one is always to have the fear of the Laird before our ees; that’ll do for herea’ter; and t’other is to keep your bool open, and that wil do for here.»
Lectures on surgery, Lect. 3.

«Nothing is known in our profession by guess; and I do not believe, that from the first dawn of medical science to the present moment, a single correct idea has ever emanated from conjecture: it is right therefore, that those who are studying their profession should be aware that there is no short road to knowledge; and that observation on the diseased living, examination of the dead, and experiments upon living animals, are the only sources of true knowledge; and that inductions from these are the sole bases of legitimate theory.»
A Treatise on Dislocations and Fractures of the Joints

«If you are too fond of new remedies, first you will not cure your patients; secondly, you will have no patients to cure.»

«In the collecting of evidence upon any medical subject, there are but three sources from which we can hope to obtain it: viz. from observation of the living subject; from examination of the dead; and from experiments upon living animals.» Surgical essays

« I have made many mistakes myself; in learning the anatomy of the eye I dare say, I have spoiled a hatful; the best surgeon, like the best general, is he who makes the fewest mistakes.»
Lectures on surgery

«It is the surgeon’s duty to tranquillize the temper, to beget cheerfulness, and to impart confidence of recovery.» Lectures on surgery, Lect. 1

«My lectures were highly esteemed, but I am of opinion my operations rather kept down my practice.» Quoted by F. H. Garrison in
Bulletin of the New York Academy of Medicine, 1929, 5: 155.

• A case of strangulated hernia, in which a part of the abdominal viscera was protruded into the left cavity of the chest.
  Medical Records and Researches, selected from the papers of a Private Medical Association. London, 1798.
• Three instances of obstruction of the thoracic duct, with some experiments showing the effects of tying that vessel.
  Medical Records and Researches, selected from the papers of a Private Medical Association. London, 1798, 1801.
• Farther observations on the effects which take place from the destruction of the membrana tympani of the ear; with an account of an operation for the removal of a particular species of deafness.
  Philosophical Transactions of the Royal Society, 1891, 91: 435-450.
  Sir Astley Cooper reported three cases of Eustachian obstruction deafness relieved by perforation of the membrana tympani (myringotomy), an operation first performed by Eli, a quack, in 1760. Cooper’s earlier paper on the subject appeared in volume 90 of the Philosophical Transactions. He also demonstrated air and bone conduction by watch (precursor of Rinne’s test). For this work he received the Copley Medal.
• Observations on inguinal and congenital hernia.
  London, 1803.
• The anatomy and surgical treatment of inguinal and congenital hernia.
  London, Cox, 1804; 2nd edition with supplements by C. Aston Key, 2 volumes, London, 1827, 1828; German translation by Johann Friedrich Michael Kruttge (1771-1843), Breslau, 1809.
• The anatomy and surgical treatment of crural and umbilical hernia.
  London, Longman, 1807.
• A case of aneurism of the carotid artery.
  Medico-Chirurgical Transactions, London, 1809, 1:1-12.
  Cooper ligated the common carotid artery on Nov. 1, 1805. The patient died, but a second case (June 22, 1808) proved successful.
• Surgical Essays. Written with Benjamin Travers (1783-1858).
  2 volumes. London, Cox & Son, 1818-1819.
  3rd edition, 1820; American edition, Philadelphia, 1821.
  German translation in Chirurgische Handbibliothek, volume I, Weimar, 1821.
  French by Guillaume Bertrand, Paris, 1823.
  Travers was surgeon to St. Thomas’s Hospital, and particularly distinguished himself in vascular surgery and ophthalmology. The book contains a description of Cooper’s tumour.
• A treatise on dislocations, and on fractures of the joints.
  London, Longman, 1822.
  Through this and numerous subsequent editions this was the principal reference work on the subject in England and America for 30 years.
• Observations on fractures of the neck of the thighbone etc.
  London, 1824; German translation, also in London, 1824, and in Chirurgische Handbibliothek, volume VII, Weimar, 1824.
• The lectures on the principles and practice of surgery..... by Fred Tyrrell.
  3 volumes, London, 1824-1827; American edition, Boston, 1831.
  German translation in 3 volumes, Weimar, 1825-1828.
• Illustrations of the diseases of the breast.
  2 parts. London, Longman, Rees & Co., 1829; German translation, Weimar, 1836.
  Includes the earliest descriptions of hyperplastic cystic disease in the breast, which Cooper referred to as “hydatid disease”.
• Observations on the structure and diseases of the testis.
  London, Longmans, 1830; 2nd edition by Bransby B. Cooper, 1841.
  American edition, Philadelphia, 1845.
  German translation, Weimar, 1832, 1833.
• The anatomy of the thymus gland.
  London, Longman, 1832 (1829?)
  French translation by Pigné and W. Tobin, 1832.
  American edition, Philadelphia, 1845.
• Case of a femoral aneurism, for which the external iliac artery was tied, with an account of the preparation of the limb, dissected at the extirpation of eighteen years.
  Guy’s Hospital Reports, London, 1836, 1: 43-52.
  The artery was tied in 1808, and the patient died in 1826.
• Account of the first successful operation, performed on the carotid artery, for aneurism, in the year 1808; with the post-mortem examination in 1921.
  Guy’s Hospital Reports, London, 1836, 1: 53-58.
• Some experiments and observations on tying the carotid and vertebral arteries, and the pneumo-gastric, phrenic, and sympathetic nerves.
  Guy’s Hospital Reports, London, 1836, 1: 457-475, 654.
• The principles and practice of surgery, founded on the most extensive hospital and private practice, during a period of nearly 50 years. Edited by Alex Lee.
  London, 1836.
  German translations by J. Schütte, 3 volumes, Cassel, 1836-1845.
  4th edition, 1856; also translated by Buchard, 4 booklets, Erlangen, 1844, 1845.
  Also published under the title of:
  Oeuvres chirurgicales complètes d’Astley Cooper.
  Trad. de l’anglais avec des notes par E. Chassaignac et G. Richelot. Paris, 1835.
  The translators are Édouard Pierre Marie Chassiagnac, 1804-1879; and Gustave-Antoine Richelot, 1807-1893.
• On the anatomy of the breast.
  2 volumes. London, Longman,1840.
  One of Coopers last works, this is an anatomical sequel to Illustrations of the diseases of the breast (1829). It covers the physiology as well as the anatomy of the breast.
• Bransby B. Cooper:
  The life of Sir Astley Cooper. 2 volumes, London, 1843.