William Francis Victor Bonney
FRCP FRCS
Fellowship of the Royal Colleges of Surgeons (FRCS) is a professional certification, professional qualification to practise as a senior surgeon in Republic of Ireland, Ireland or the United Kingdom. It is bestowed on an wikt:intercollegiate, in ...
(17 December 1872 – 4 July 1953) was a prominent British
gynaecological surgeon.
He was described by
Geoffrey Chamberlain as "a primary influence on world gynaecology in the years
between the wars
In the history of the 20th century, the interwar period lasted from 11 November 1918 to 1 September 1939 (20 years, 9 months, 21 days), the end of the First World War to the beginning of the Second World War. The interwar period was relati ...
".
Bonney is primarily remembered for the invention of an
antiseptic
An antiseptic (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") is an antimicrobial substance or compound that is applied to living tissue/skin to reduce the possibility of infection, sepsis, or putre ...
solution known as "Bonney's blue", used to sterilise and stain the
vagina
In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hy ...
,
cervix
The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes durin ...
and surrounding skin during
gynaecological procedures, and therefore reducing
post-operative infection
A hospital-acquired infection, also known as a nosocomial infection (from the Greek , meaning "hospital"), is an infection that is acquired in a hospital or other health care facility. To emphasize both hospital and nonhospital settings, it is so ...
. He became experienced in the radical extended
Wertheim hysterectomy for treating
cervical cancer
Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...
, performing more than 500 of these in his lifetime.
Personal tragedy directed Bonney towards conservative surgery and he became a pioneer in the field of the less drastic procedures of
ovarian cystectomy
The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. ...
for removing
ovarian cysts
An ovarian cyst is a fluid-filled sac within the ovary. Often they cause no symptoms. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. The majority of cysts are harmless. If the cyst either breaks open or causes ...
and the
myomectomy
Myomectomy, sometimes also called fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy, the uterus remains preserved and the woman retains her reproductive potential.
Indicati ...
for removing
uterine fibroids
Uterine fibroids, also known as uterine leiomyomas or fibroids, are benign smooth muscle tumors of the uterus. Most women with fibroids have no symptoms while others may have painful or heavy periods. If large enough, they may push on the bl ...
. Its preference over
hysterectomy
Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries ( oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures.
Usually performed by a gynecologist, a hysterectomy may ...
preserved the
fertility
Fertility is the capability to produce offspring through reproduction following the onset of sexual maturity. The fertility rate is the average number of children born by a female during her lifetime and is quantified demographically. Ferti ...
of many women of reproductive age. He developed a surgical clamp to reduce
post-myomectomy haemorrhage
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
, established operative techniques to reduce
post-operative haematomas and modified the Reverdin needle.
In addition, he wrote more than 200 medical papers and co-authored and illustrated ''A Textbook of Gynaecological Surgery'' (1911), still in print in 2004 as ''Bonney's Gynaecological Surgery''.
Early life and education
Victor Bonney was born on 17 December 1872 at Chelsea. He was the eldest son of William Augustus Bonney, a physician, and Anna Maria Alice Polixene. Both his father and paternal grandfather were medical practitioners.
He received his basic education at a private school.
Bonney was trained at
St Bartholomew's Hospital
St Bartholomew's Hospital, commonly known as Barts, is a teaching hospital located in the City of London. It was founded in 1123 and is currently run by Barts Health NHS Trust.
History
Early history
Barts was founded in 1123 by Rahere (died ...
but transferred to the
Middlesex Hospital
Middlesex Hospital was a teaching hospital located in the Fitzrovia area of London, England. First opened as the Middlesex Infirmary in 1745 on Windmill Street, it was moved in 1757 to Mortimer Street where it remained until it was finally clo ...
, with his intention to become a physician. Sir
John Bland-Sutton
Sir John Bland-Sutton, 1st Baronet (21 April 1855 – 20 December 1936), was a British surgeon.
Biography
He was the son of Enfield Highway farmer Charles William Sutton and was educated at the local school. From there, he entered a private a ...
then invited him to the
Chelsea Hospital for Women
Queen Charlotte's and Chelsea Hospital is one of the oldest maternity hospitals in Europe, founded in 1739 in London. Until October 2000, it occupied a site at 339–351 Goldhawk Road, Hammersmith, but is now located between East Acton and White ...
, where he became a gynaecologist. He was awarded with
MBBS in 1896, and
MD two years later. In 1899, he was awarded with the
Master of Surgery
The Master of Surgery (Latin: Magister Chirurgiae) is an advanced qualification in surgery. Depending upon the degree, it may be abbreviated ChM, MCh, MChir or MS. At a typical medical school the program lasts between two and three years. The p ...
and subsequently became a fellow of the
Royal College of Surgeons
The Royal College of Surgeons is an ancient college (a form of corporation) established in England to regulate the activity of surgeons. Derivative organisations survive in many present and former members of the Commonwealth. These organisations ar ...
in 1899.
He was accepted as a fellow of the
Royal College of Physicians
The Royal College of Physicians (RCP) is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded by royal charter from King Henry VIII in 1 ...
the following year.
[
]
Early surgical training
In 1901 he was an assistant physician and held residential posts at Queen Charlotte's Hospital
Queen Charlotte's and Chelsea Hospital is one of the oldest maternity hospitals in Europe, founded in 1739 in London. Until October 2000, it occupied a site at 339–351 Goldhawk Road, Hammersmith, but is now located between East Acton and Whit ...
, the Middlesex Hospital and Chelsea hospitals. Subsequently, he studied anatomy
Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its ...
at London University
The University of London (UoL; abbreviated as Lond or more rarely Londin in post-nominals) is a federal public research university located in London, England, United Kingdom. The university was established by royal charter in 1836 as a degr ...
and achieved a BSc with first-class honours in 1904. A year later, he became obstetric registrar and tutor at the Middlesex and in 1908 he was elected assistant gynaecological surgeon.[
]
Surgical career
Bonney, subsequently spent the next four decades developing techniques in gynaecological cancer
Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer, and vulvar cancer. As specialists, they have extensive ...
surgery, operations that conserved fertility, antiseptic techniques, after care of the bowel
The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...
following pelvic surgery and advocating Lower segment Caesarean section
A lower (uterine) segment Caesarean section (LSCS) is the most commonly used type of Caesarean section. Most commonly to deliver the baby a transverse incision is made in the lower uterine segment above the attachment of the urinary bladder to ...
as an alternative to traditional caesarian section
Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or ...
. He was acknowledged for his speed and utilised two chauffeur driven cars when travelling to perform surgery in peoples private homes and nursing homes, with one car transporting the operating equipment ahead of his arrival. He also had his own operating clothing which was washed at home. His surgical operations were not merely confined to the pelvis; gynaecologist and historian, professor Geoffrey Chamberlain, reported in his biography of Bonney in 2000 that Bonney had also performed fourteen breast removals, eight gallbladder excisions and five varicose vein resections.[
Bonney also had the experience, with his colleague Berkeley, of operating on thousands of wounded soldiers who arrived at Clacton, Essex throughout the ]First World War
World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fig ...
, procedures including extracting bullets, and shrapnel. Chamberlain also later described Bonney as "a primary influence on world gynaecology in the years between the wars".[Chamberlain, Victor. (2000) ''Victor Bonney: The Gynaecological Surgeon of the Twentieth Century''. New York: Parthenon. p. ix; ]
Lower-segment caesarian section
His early work was on the causes of puerperal fever
Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial infections of the female reproductive tract following childbirth or miscarriage. Signs and symptoms usually include a fever greater than , chills, lower a ...
and techniques in caesarean section, being one of the first to advocate the delivery of babies through the lower segment of the caesarean section. This brought down the mortality and infection rates of caesarean deliveries. He regarded the traditional caesarean section as bloody and when he gave the Bradshaw lecture
The Bradshaw Lectures are prestigious lectureships given at the invitation of the Royal College of Physicians and the Royal College of Surgeons of England
The Royal College of Surgeons of England (RCS England) is an independent professional ...
in 1934, he referred to it as a "smash and grab raid". He endorsed the lower segment caesarean section and prevented excessive bleeding by making use of his uterine compresser.
Gynaecological cancers
He was a pioneer figure in the domain of cervical cancer
Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...
and commanded immense fame in the radical procedure of Wertheim hysterectomy, performing 500 of these in the course of his career.
Having previously watched Ernst Wertheim
Ernst Wertheim (21 February 1864 – 15 February 1920) was an Austrian gynecologist born in Graz.
Ernst Wertheim was the son of Theodor Wertheim, an Austrian chemistry professor at the University of Graz, remembered for his chemical studies of ...
, Bonney achieved an initial mortality rate of 14%. This was before blood transfusions, chemotherapy, antibiotics and radiotherapy and with only early anaesthetics and little understanding of water and electrolyte balance. Complications of Wertheim's hysterectomy included bowel
The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...
, bladder
The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...
and ureter
The ureters are tubes made of smooth muscle that propel urine from the kidneys to the urinary bladder. In a human adult, the ureters are usually long and around in diameter. The ureter is lined by urothelial cells, a type of transitional e ...
ic damage. The procedure later declined particularly after the advent of radiotherapy
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Ra ...
for use in cervical cancer in the late 1930s. Blood transfusions were relevant only in the last 100 of his Wertheim hysterectomies.[ The procedure was later improved by ]Joe Vincent Meigs Joe Vincent Meigs (October 24, 1892, Lowell, Massachusetts – October 24, 1963), was an American obstetrician and gynecologist.
Meigs was a grandson of Captain Joe Vincent Meigs, who invented an experimental steam monorail known as the Meigs ...
, after he visited Bonney in 1933 and who also commended Bonney for his work.
In 1949, Bonney reported a 40% cure rate from his Wertheim's hysterectomies.[
]
Organ-preservation
Bonney was a strong proponent for organ-conservation, including preserving the ovaries using techniques in ovarian cystectomy in the case of ovarian cysts
An ovarian cyst is a fluid-filled sac within the ovary. Often they cause no symptoms. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. The majority of cysts are harmless. If the cyst either breaks open or causes ...
and played a pioneer role in the reintroduction of myomectomy-procedures to mainstream surgery in place of radical hysterectomy. At a time, when myomectomies fell out of favour due to the associated blood loss
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
, post-operative haematomas and frequent post-operative infections, he developed an ingenious surgical clamp
A clamp is a fastening device used to hold or secure objects tightly together to prevent movement or separation through the application of inward pressure. In the United Kingdom the term cramp is often used instead when the tool is for temporar ...
, the "Bonney myomectomy clamp
The Bonney myomectomy clamp is a surgical clamp developed in the interwar years by gynaecologist Victor Bonney to provide a blood free environment when performing a myomectomy
Myomectomy, sometimes also called fibroidectomy, refers to the surgi ...
",[ to temporarily halt the blood supply of the uterus during the operation. It allowed the shelling out of the uterine fibroids while still preserving the fertility of women of reproductive age, thus giving them a chance to have children later on.][
Bonney's first myomectomy was recorded in 1913, when he successfully removed six fibroids from the uterus of a 30‐year‐old ]nulliparous
In biology and medicine, human medicine, gravidity and parity are the number of times a woman is or has been pregnant (gravidity) and carried the pregnancies to a viable gestational age (parity). These terms are usually coupled, sometimes with add ...
woman. He went on to perform over 700 myomectomies across his career-span. With a death-rate of around 1.1% and around 38% of the patients being able to bear children, they were highly successful. In 1934, he made it clear that he "strenuously advocated myomectomy in preference to hysterectomy in all those cases in which the removal of the uterus is liable to be followed by undesirable psychological effects."
Post-operative bowel obstruction
As a consequence of his wife's experience with gynaecological procedures, Bonney took interest in a number of surgical scenarios including the functioning of bowel after major surgery.
The subject of intestinal drainage in bowel obstruction
Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs ...
and peritonitis
Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part or ...
was later much discussed as a result of the work of Bonney in 1910.
Bonney's blue
He established a skin-procedure to provide a sterile area for gynaecological procedures. During the First World War
World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fig ...
and his time as a surgeon to the military branch of the Middlesex Hospital and at the County of London and Royal Masonic Hospitals, with bacteriologist C. H. Browning, he developed an antiseptic, a 1% solution in 50% alcohol from equal parts of crystal violet
Crystal violet or gentian violet, also known as methyl violet 10B or hexamethyl pararosaniline chloride, is a triarylmethane dye used as a histological stain and in Gram's method of classifying bacteria. Crystal violet has antibacterial, ant ...
and brilliant green. This was used to sterilise and stain the vagina
In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hy ...
, the outer surface of the cervix and the body from breast to mid-thigh prior to the gynaecological procedures.
It has since been known as "Bonney's blue" and its use in staining and dyeing has continued and has been shown to be an effective antiseptic
An antiseptic (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") is an antimicrobial substance or compound that is applied to living tissue/skin to reduce the possibility of infection, sepsis, or putre ...
solution for generic purposes. He later described how the staining of the vagina with his solution "is a great advantage when – as, for instance, in total hysterectomy – that canal has to be opened from above, for the deep coloration defines it very clearly."[
]
Other surgical instruments
Bonney modified the Reverdin needle
The Reverdin needle is a surgical instrument designed to pass through a surgical suture and is named after the Swiss surgeon Jacques-Louis Reverdin
Jaques-Louis Reverdin (28 August 1842 – 9 January 1929) was a Swiss surgeon who was a native of ...
. Other instruments attributed to Bonney include Bonney's round ligament forceps
Bonney's round ligament forceps, sometimes known as Berkely-Bonny's round ligament forceps, is a surgical instrument used in gynaecological surgery named after Victor Bonney
William Francis Victor Bonney Fellow of the Royal College of Physician ...
and the Bonney's vaginal clamp.
Surgical writing
Bonney's most significant books were the ''Textbook of Gynaecological Surgery'' (1911) with Comyns Berkeley
George Harold Arthur Comyns Berkeley (16 October 1865 – 27 January 1946) was an obstetric physician, gynaecological surgeon and medical writer. Berkeley was most notable along with William Blair-Bell and Sir William Sinclair for creating the ...
and ''The Technical Minutiae of extended Myomectomy and Ovarian Cystectomy'' (1946). He took lessons at a drawing school in order to learn how to produce the illustrations for each and contributed 611 drawings to the ''Textbook'' and 242 to ''The Technical Minutiae''.[ His ''Textbook'' was still in print in 2004, in its 10th edition, as '' Bonney's Gynaecological Surgery'' with new editors and authors. The authors observed, in the introduction to that edition, that the work retained Bonney's philosophy and the first chapter was almost as Bonney originally wrote it because it had not dated since 1911.
]
Other appointments
He was elected as the vice-president of the Royal College of Surgeons
The Royal College of Surgeons is an ancient college (a form of corporation) established in England to regulate the activity of surgeons. Derivative organisations survive in many present and former members of the Commonwealth. These organisations ar ...
and vociferously objected to the formation of the Royal College of Obstetricians and Gynaecologists
The Royal College of Obstetricians and Gynaecologists (RCOG) is a professional association based in London, United Kingdom. Its members, including people with and without medical degrees, work in the field of obstetrics and gynaecology, that ...
(RCOG), with the opinion that obstetricians and gynaecologists were surgeons too.
He was also the first honorary fellow of the Royal Australasian College of Surgeons
The Royal Australasian College of Surgeons (RACS) is the leading advocate for surgical standards, professionalism and surgical education in Australia and New Zealand.
Known by its common acronym RACS, it is a not-for-profit organisation, sup ...
and an honorary fellow of the Association of Surgeons, the American Gynaecological Society, and did eventually become an honorary fellow of the RCOG.
Personal life
Bonney was an accomplished baritone and was also a skilled salmon-fisherman. He shared a lifelong friendship with Rudyard Kipling
Joseph Rudyard Kipling ( ; 30 December 1865 – 18 January 1936)''The Times'', (London) 18 January 1936, p. 12. was an English novelist, short-story writer, poet, and journalist. He was born in British Raj, British India, which inspired much o ...
. He also kept Pekingese
The Pekingese (also spelled Pekinese) is a breed of toy dog, originating in China. The breed was favored by royalty of the Chinese Imperial court as a companion dog, and its name refers to the city of Peking (Beijing) where the Forbidden City ...
dogs.
Bonney met his future wife Annie, while he was a resident and she was a sister at the Chelsea Hospital for Women in London. They married in May 1905. Two years later, Annie suffered from very heavy periods which in turn resulted in severe anaemia
Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, t ...
and was corrected by a hysterectomy
Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries ( oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures.
Usually performed by a gynecologist, a hysterectomy may ...
, thus preventing her having children. This setback led to Bonney's lifelong advocacy for the more conservative surgery of myomectomy
Myomectomy, sometimes also called fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy, the uterus remains preserved and the woman retains her reproductive potential.
Indicati ...
over the more radical hysterectomy, arguing that "Since cure without deformity or loss of function must ever be surgery's highest ideal, the general proposition that myomectomy is a greater surgical achievement than hysterectomy is incontestable." It is believed that she had submucous fibroids.[ The bowel obstruction she experienced ten days after her hysterectomy led Bonney to also research bowel function after surgery.]
Death and legacy
Bonney died in the Middlesex Hospital on 4 July 1953, aged 81. In 1956 his wife gave the Royal College of Surgeons the portrait of Bonney painted by Oswald Birley
Sir Oswald Hornby Joseph Birley (31 March 1880 – 6 May 1952) was an English portrait painter and royal portraitist in the early part of the 20th century.
Early life and family
Birley was born in New Zealand to Hugh Francis Birley (1855–19 ...
. The college also holds three bound volumes of his published papers and his autobiography, which he donated to them.
Selected publications
Bonney wrote more than two hundred medical articles and a number of books:[Chamberlain (2000), p. 125.]
Articles
*
*
*
*
*
"The Standardised Reverdin Needle Holder"
'''', 1931, Volume 38, Issue 3.
Books
* ''A Textbook of Gynaecological Surgery''. Cassell, London, 1911. (With Comyns Berkeley
George Harold Arthur Comyns Berkeley (16 October 1865 – 27 January 1946) was an obstetric physician, gynaecological surgeon and medical writer. Berkeley was most notable along with William Blair-Bell and Sir William Sinclair for creating the ...
)
* ''The Difficulties and Emergencies of Obstetric Practice''. Churchill, London, 1913. (With Comyns Berkeley)
* ''A Guide to Gynaecology in General Practice''. Churchill, London, 1914. (With Comyns Berkeley)
* ''The Annals of the Middlesex Hospital at Clacton-on-Sea, 1914–1919''. London, 1921. (With Comyns Berkeley)
* ''Cancer of the Uterus. Postgraduate Lectures''. Bale, Son and Danielson, 1925.
* ''The Technique of Myomectomy''. 1936.
* ''The Abnormal in Obstetrics''. Edward Arnold, London, 1938. (With Comyns Berkeley and Douglas Macleod)
* ''The Technical Minutiae of Extended Myomectomy and Ovarian Cystectomy''. Cassell, London, 1946.
References
External links
Portrait of Victor Bonney, MD, FRCS, 1872–1953
Bonney's myomectomy clamp
Bonney-Reverdin Needle Holder
Victor Bonney's operating table
{{DEFAULTSORT:Bonney, Victor
1872 births
1953 deaths
Fellows of the Royal College of Surgeons of England
English surgeons
English gynaecologists
Alumni of the University of London
Fellows of the Royal College of Physicians
People from Chelsea, London
Physicians of the Middlesex Hospital
Medical illustrators
History of surgery