Justin Barr, MD, PhD
Acknowledgment: The author thanks Dale C. Smith, Walton O. Schalick III, Peter C. Kernahan, James S. T. Yao, Norman M. Rich, and John Harley Warner.
Disclosures: Dr. Barr reports grants from Yale University, U.S. Army Heritage and Education Center, The Society for the History of Navy Medicine, and ABC-CLIO; other (honorarium for lecture) from Kansas University Medical Center; and applications for grants from National Library of Medicine during the conduct of the study. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2081.
Requests for Single Reprints: Justin Barr, MD, PhD, Duke University Medical Center, 10 Duke Medical Circle, PO Box 3443, Durham, NC 27710; e-mail, firstname.lastname@example.org.
Author Contributions: Conception and design: J. Barr.
Analysis and interpretation of the data: J. Barr.
Drafting of the article: J. Barr.
Critical revision of the article for important intellectual content: J. Barr.
Final approval of the article: J. Barr.
Provision of study materials or patients: J. Barr.
Obtaining of funding: J. Barr.
Administrative, technical, or logistic support: J. Barr.
Collection and assembly of data: J. Barr.
For centuries, physicians have recognized aortic aneurysms as an acute threat to life. Therapeutic approaches to the disease began in the 18th century when leading physicians, such as René Laennec and Antonio Valsalva, applied research on circulation and blood coagulation to devise whole-body fasting and bleeding regimens to prevent rupture. After John Hunter's success in ligating arteries to treat peripheral aneurysms, surgeons attempted analogous operations on the aorta, but even the renowned Sir Astley Cooper and William Halsted met with disastrous results. Other clinicians tried various methods of creating intraluminal clots, including the application of such new technologies as electricity and plastic. Vessel repair techniques, pioneered by Alexis Carrel and others in the 20th century, eventually provided a reliably effective treatment. In the past few decades, minimally invasive methods that approach aneurysms endovascularly through small groin incisions have been adopted. A successful 2005 congressional campaign to fund screening for aortic aneurysms brought the disease to national attention and symbolizes current confidence in curing it.
Drawing on various published and unpublished sources, this paper elucidates the development of specific treatments for aortic aneurysms over time and more broadly addresses how medicine and surgery apply the knowledge and technology available in particular eras to treat a specific, identifiable, and lethal disease. Examining the evolution of these therapeutic efforts unveils broader trends in the history of medicine. This allows aortic aneurysms to serve as a case study for exploring shifting philosophies in medical history.
Justin Barr. Battle of the Bulge: Aortic Aneurysm Management From Early Modernity to the Present. Ann Intern Med. 2017;166:291–296. doi: 10.7326/M16-2081
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Published: Ann Intern Med. 2017;166(4):291-296.
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