Victor Bonney

William Francis Victor Bonney FRCP FRCS (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". Bonney is primarily remembered for the invention of an antiseptic solution known as "Bonney's blue", used to sterilise and stain the vagina, cervix and surrounding skin during gynaecological procedures, and therefore reducing post-operative infection. He became experienced in the radical extended Wertheim hysterectomy for treating cervical cancer, 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 for removing ovarian cysts and the myomectomy for removing uterine fibroids. Its preference over hysterectomy preserved the fertility of many women of reproductive age. He developed a surgical clamp to reduce post-myomectomy haemorrhage, 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 but transferred to the Middlesex Hospital, with his intention to become a physician. Sir John Bland-Sutton then invited him to the Chelsea Hospital for Women, 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 and subsequently became a fellow of the Royal College of Surgeons in 1899. He was accepted as a fellow of the Royal College of Physicians the following year.

Early surgical training In 1901 he was an assistant physician and held residential posts at Queen Charlotte's Hospital, the Middlesex Hospital and Chelsea hospitals. Subsequently, he studied anatomy at London University 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 surgery, operations that conserved fertility, antiseptic techniques, after care of the bowel following pelvic surgery and advocating Lower segment Caesarean section as an alternative to traditional caesarian section. 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, procedures including extracting bullets, and shrapnel. Chamberlain also later described Bonney as "a primary influence on world gynaecology in the years between the wars".

Lower-segment caesarian section His early work was on the causes of puerperal fever 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 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 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, 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, bladder and ureteric damage. The procedure later declined particularly after the advent of radiotherapy 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, 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.

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