Commentary on “The Origin of the Field of Vascular Anomalies”

Abstract

In the first place, it is necessary that all diseases be reduced to definite and certain species, with the same care which we see exhibited by botanists in their phytologies; since it happens, at present, that many diseases, although included in the same genus, mentioned with a common nomenclature, and resembling one another in several symptoms, are, notwithstanding, different in their natures, and require a different medical treatment. Thomas Sydenham—“Medical Observations Concerning the History and the Cure of Acute Diseases,” Preface to the Third Edition, 1676. It is nearly 40 years since John Mulliken and Julie Glowacki published their seminal article defining the difference between hemangiomas and vascular malformations.1 The journal, Plastic and Reconstructive Surgery, accompanied the article with a commentary by a leader in the field.2 The tone of this commentary reads today as condescending, and must surely have seemed so at the time. It mildly praised authors’ “honest attempt” to find a better way to classify vascular anomalies, and expressed hope that after this “preliminary, prospective investigation” future efforts might be more successful. Mulliken and Glowacki’s article has since been cited nearly 2000 times, and more tellingly, it continues to be cited over 50 times a year, the same rate on average today as for the whole period since its publication. Not bad for a “preliminary investigation.” In this historic first issue of the Journal of Vascular Anomalies, John Mulliken eloquently outlines the history of vascular anomalies as a specialty, and of the International Society which he helped found. To be asked to write a commentary on any work of another scientist or clinician is a weighty responsibility: as the quotation at the start of that article makes clear, to make a firm pronouncement on the past can be as risky as one on the future. But I venture nonetheless one criticism of an otherwise excellent review. In describing the history of vascular anomalies research, with characteristic modesty, John Mulliken has underplayed, or at best only alluded to his own substantial role in the development of the specialty. The contributions John Mulliken has made to the field of vascular anomalies are many and well-known. Take any seminal paper in the field, on a newly described entity or a novel genetic mutation, and it is more than likely that his name will appear in the list of authors. There are reasons why his contributions are so many and varied. One is his wide and well-documented clinical experience of vascular anomalies obtained over many years. Not only has he taken every opportunity to observe cases of vascular anomalies, like Sydenham he has meticulously recorded and analyzed at every turn. At the same time, under the influence of Judah Folkman and others, he has deeply engaged in laboratory research, taking problems from the clinic to the laboratory, and applying lessons from the laboratory in patient care. He is the consummate clinician scientist. But more than either, it has been John’s ability to engage others with the passion for the study of vascular anomalies and inspire them to devote their talents to exploring their many mysteries which has caused the field to grow and prosper. He, along with the other pioneers of the specialty who he has named in the article, established the modern field of vascular anomalies, of which this journal represents the future. It is entirely fitting that John Mulliken should open this first issue of the Journal of Vascular Anomalies.