Sir WILLIAM MACEWEN. Obituary. 217

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Sir WILLIAM MACEWEN, Glasgow.

It is hard to believe that Sir William Macewen is dead. All classes of the community have been united in universal regret and a feeling of irreparable loss. His Majesty, with his unfailing good sense and thoughtfulness, sent a message to Lady Macewen in terms which well express the thoughts of the nation:? " The King much regrets to hear of the death of Sir William Macewen. His Majesty will ever gratefully remember the services rendered by him to the Royal family during this and the past reign. I am commanded to express the King's true sympathy with you and your family in your sorrow.? Stamfordham." When Sir William returned in the beginning of the year from his Australasian trip as "Ambassador of the British Medical Association," he was, and expressed himself as being, in excellent health and bright spirits, full of great talk and stories about his world tour. When it was known that he was suffering from influenza and that pneumonia had developed, friends were apprehensive, but good news spread of his satisfactory progress, and our minds were easier. But sudden serious cardiac symptoms supervened, and he died late on the evening of Saturday, 22nd March. Perhaps it is too soon to try to form a true estimate of Sir William Macewen's work, and to suggest his real place amongst the Masters of Medicine. But it is important that some account, however imperfect, of his life and work should now be given. Most sympathetic notices appeared in the daily press intended, it is true, for the non-scientific public, and it will be necessary for us to make free use of these for the facts of his life, especially the admirable article in the Glasgow Herald, written, we believe, by his friend, Dr. Freeland Fergus. 218 Obituary.

Sir William Macewen was born in 1848 in the island of Bute, in a house on the Port Bannatyne side of the Skeoch Wood. His father was in business in Rothesay, and in his later years, shortly after the Disruption, was the Master of the Free Church " Yacht Breadalbane, a small schooner which cleared" from Rothesay and conveyed ministers to and fro amongst the Western Isles during summer months, visiting even St. Kilda at least once a year. Sir William Macewen's interest in yachting and his love of the sea are traceable to the hereditary influence. The only time the writer ever saw him excited was when the news that Lord Dunraven's Valkyrie, once a competitor for the America's Cup, had been sunk in a collision while racing off Dunoon. He was the youngest child of a fairly large family, losing both parents at an early age. His elementary education was obtained in Rothesay, and in Glasgow in the Collegiate School. He graduated in Glasgow University M.B., C.M. in 1869, and M.D. in 1872. There are no records of special brilliance as a medical student. The period of his student career was a notable one, in so far as at that time the University of Glasgow possessed some of the most brilliant men of the day. Allen Thomson, Professor of Anatomy, had already proved himself to be a teacher and an anatomist of rare ability, and a pioneer in the new science of embryology. William Tennant Gairdner, who was years afterwards to be a colleague on the Senate and in the Western Infirmary, was early distinguished as a physician and pathologist, and the first to put public health on a sound and practical basis. Andrew Buchanan was Professor of Physiology; he it was who first gave a clear account of the nature of the coagulation of the blood. And last, the greatest of them all, was Lister, with whom Macewen was a student and dresser. It might be supposed that each and all of those teachers should exercise an influence on the mind of Macewen. But there is no trace of any particular influence in the later work. He certainly showed no evidence of being a mechanical, systematic anatomist, nor did he manifest the metaphysical mind of Gairdner, nor the purely biochemical, experimental method of Lister. It is probably true to say of him, as was said of William Cullen, the founder of clinical medicinei "He was one-of the rarest species of the Obituary. 219 man of science?a masterless master." Macewen was not really influenced by any one individual, but was driven along his course by his own bent, his own indomitable will. He was more like John Hunter than any other of the great ones of science, in that he was both naturalist and pathologist and surgeon. It is easy to say that Macewen was born at the right time in the expansion of surgery, when its possibilities were opening up like great tracts of undiscovered country. But a genius such as his would have found undiscovered country to explore in any period. . After serving as resident in the Royal Infirmary he became, in 1870, superintendent of Belvidere Fever Hospital. This Hospital was opened in 1865 as a Municipal Fever Hospital, for up to that year fevers had been treated in the Royal Infirmary and in poorhouse hospitals. But he soon found that his scope in zymotic disease was too limited. The necessity of making a living forced him into general practice, and he also became a parochial medical officer. Dr. Alexander Robertson was physician-superintendent of the Parochial Hospital in Parlia- mentary Road, and he gave Macewen many opportunities for surgical practice. The facilities at Dr. Robertson's hand proved exceedingly useful in later years when Macewen was working at cerebral complications of middle-ear disease, Dr. Robertson proving himself to be an enlightened physician who early saw the surgical needs in his cases. In this period, too, he held the office of casualty surgeon to the Central Police Station, where he had ample opportunity of seeing emergency surgery of all kinds. We have often heard him speak of the extraordinary variety of cases and people met with in that work, and of his spending every Saturday night, far on into Sunday morning, in the office, filling in intervals of waiting for cases with fencing, an art in which his long reach made him a formidable antagonist. In 1874 he was admitted to the Fellowship of the Faculty of Physicians and Surgeons. After holding appointments on the junior staff of the Royal Infirmary, Sir William was, in 1877, at the extraordinarily early age of 29, appointed visiting surgeon. The years from 1877 to 1892, when he left the Royal Infirmary on his appointment a$ Regius Professor of Surgery in the University, were crowded with magnificent achievements. How 220 Obituary. great they were can only be contemplated by study of the list of his published works, and cool criticism of the scientific meaning of his researches. When it is considered that that work was done almost, if not quite, alone, except for the help of assistants, house surgeons, and nurses, that shorthand and the typewriter had not come into use, that a;-rays were not available, that he had to carry on private practice and make his own living, we wonder at the marvellous industry of the man, and think of numberless meals missed and of hours of sleep cut down to less than Napoleonic allowances. As early as 1874 it was evident that wound treatment occu- pied his attention, and that he had accepted fully the Listerian principles of antisepsis. In that year he contributed to this " Journal a paper, entitled Ovariotomy performed and treated antiseptically." The treatment of wounds continued to be of intense interest to him, and papers on the subject rapidly fol- lowed one another: "Wounds in relation to the instruments " which produced them," in 1878; On the immediate treatment of wounds," and "Chromic gut and chicken bone drainage tubes," both in 1881. It was his first article on "Antiseptic osteotomy for genu valgum," published in 1878, that attracted the attention of the medical profession of this country to the fact that a man of more than ordinary ability was at work in the Royal Infirmary of Glasgow. His fame spread throughout the world when his book on Osteotomy was given forth in 1880. This work was no mere record of a series of triumphs in surgical technique. It was a finished study of the etiology and pathology of the bone deformities of rickets, and their surgical treatment. Indeed, it was more; he found that the ordinary carpenter's cutting instruments were quite inadequate for his purpose, and he investigated for himself the toughening and tempering of steel, and ultimately had made for himself osteotomes and chisels, whose quality was tested many times on ox bones before any operation was performed on the rickety legs of the children of the East-End of Glasgow. This book quickly found its place amongst the classics of surgical literature. It was translated into every European language, and the instruments were sold in the German surgical instrument makers' shops almost as soon as they appeared at home. This work illustrates very well a peculiar quality in Macewen's writing. After reading Obituary. 221 it one feels as if there remained nothing more to be said on the subject, that finality had been reached. And, indeed, it was so. This quality permeates all his works. They all bear evidence of the utmost painstaking research, of most diligent inquiry into surgical literature, of enormous accumulation of facts and observations, of careful elaboration of symptomatology, of pathology, and of the operative procedure required?all his own individual work. A purist in English style may find plenty of occasion for criticism. Macewen had little or no time for excursions into general literature, and dipped but " seldom into the well of English undefiled." But no fault can be found with the definiteness of the meaning. Bone and its mode of growth always proved a subject of great attraction for Macewen. As early as 1881 he wrote " Observations concerning transplantation of bone." He soon passed from the stage of attempting to transplant heterogenous bone en masse, and found that he could build up a humerus by small transplants made up of wedges of bone cut from rachitic curved tibiae. The account of the classical case (first reported in 1878) in which the diaphysis was completely destroyed by acute osteomyelitis and a new diaphysis restored by bone-grafts from six tibiae is a fascinating story. The volume on The Growth of Bone, published in 1912, gives photographs of the patient, and traces the growth of that humerus over thirty years? a veritable monument of patient scientific skill. About the same period (1884), he found that osseous regeneration in flat bones denuded of periosteum was possible. The first experiment was a case in the Royal Infirmary, where in a boy of nine years, admitted with compound comminuted fracture of the vault of the skull with laceration of the scalp and of the dura mater and protrusion of brain matter, it was discovered that a mosaic work of the bones of the skull could be made by re-implantation of the fourteen fragments; and the majority of them lived. We are not here concerned with the periosteum controversy and the mode of the growth of bone. It is of interest to us that Macewen set out to convince the doubters by direct experiment, the details of which are to be found in the volume on The Growth of Bone. His observations and experiments began in 1878, and were continued intermittently till 1912. Once again, that final note No. 4. 0 Vol. CI. 222 Obituary.

" is heard like the clang of a great bell, While not under- estimating the periosteum as a limiting and protecting membrane of great use in physiological and pathological conditions, there are no data to indicate that it can of itself secrete or reproduce bone. It has no osteogenic function." Papers on transplantation of bone and on the regeneration of bone were read before the Royal Society. The importance of this work gained for him the Fellowship of the Society. He was admitted on 20th June, 1895. His certificate of candidature was signed by the following Fellows:?Lord Lister, Sir David Ferrier, Sir Wm. Turner, John Cleland, F. O. Bower, Sir Thomas Fraser, Sir George Humphry, Sir Victor Horsley, J. G. McKendrick, Sir W. T. Gairdner, and Sir Watson Cheyne; these signed from personal, the following signed from general knowledge:?Alfred Newton, Alexander Macalister, Sir Lauder Brunton, and H. Charlton Bastian. Since the day when the " " Merry Monarch founded the Royal Society no more worthy Fellow was ever admitted. To the period in Macewen's career, which embraces the first five years after his appointment as surgeon to the Royal Infirmary, belong many other contributions to the advancement of surgical knowledge. His explanation of the mode of pro- duction and of the cause of non-union by bone in transverse fracture of the patella resulted from a momentary observation. He had seen a man try to save himself from falling from a height backwards, and make a violent muscular effort of his quadriceps extensor muscles. Following up the case to the post-mortem room he found the transverse fracture of patellae and the interposition of the ragged pieces of aponeurosis over the " fractured surfaces. The paper on the Pupil in its semiological aspects" was the result of many observations in the Central Police Station on the pupillary reactions of persons brought in unconscious from alcoholism, apoplexy, or from injuries to the skull. In 1880 he anticipated O'Dwyer's tubes in his "Clinical observations on introduction of tubes into the trachea through the mouth instead of performing tracheotomy or laryngotomy." About this time also the operation for radical cure of hernia was introduced. He was the first to demonstrate a satisfactory open operation, and to show clearly that the first essential Obituary. 223 in operating for hernia was the obliteration of the sac. His method of employing the curled and transfixed sac as a buttress to the abdominal wall at the internal ring showed his ingenuity in employing a pathological structure for a physiological purpose. The application of the mattress suture with the well-known Macewen's hernia needle without slitting the external oblique aponeurosis shows his recognition of the necessity for preservation intact of structures already unduly stretched. The application of his knowledge of the phenomena of coagulation of the blood to the treatment of aneurysm is an example of the adaptation of physiology to surgery. Probably few more thrilling experiences have come to the writer than to have seen Macewen insert the long steel pin into a thoracic aneurysm, poise its point on the deep wall of the vessel, and watch the head of the pin oscillate with every heart beat. The combination of ordinary observation of a public speaker and anatomical knowledge is exhibited in the Macewen method of controlling the abdominal aorta for such an operation as disarticulation at the hip-joint. It has been the good fortune of the writer to have been called upon to perform this manoeuvre several times: the control of the bleeding is perfect, and the application of the method is both non-tiring and easy. We have suggested that Macewen accepted whole-heartedly the Listerian principles of antisepsis. Lister went to Edinburgh in the year that Macewen graduated. Lister had still to convert Edinburgh to his views, and London remained sceptical for ten years longer. It is more than probable that before the country had completely believed in and practised Listerism Macewen had travelled some way beyond antiseptic surgery into the fairer regions of aseptic surgery. Mr. J. H. Pringle has pointed out that for some years before the Schimmelbiisch demonstration at Berlin in 1890 Macewen was boiling gauze for dressings and swabs, and had abolished bone handles for his instruments. His technique for osteotomy and for pre- servation of bone grafts soon became an aseptic one. His strivings after perfection in wound technique led him to introduce absorbable ligatures and sutures and drainage 224 Obituary. tubes. Catgut thus prepared he continued to use up till the end. The surgery of the lung has not proved a fruitful field of enterprise, though the necessities of the war wounds did give an impetus to progress in this branch of surgery. Macewen was a pioneer in this work ; in 1895 he first performed the operation of removal of the greater part of a lung for tuber- culosis. An enthusiastic account of the case, with photographs, will be found in Surgery of the Lung, by Garre and Quincke, published in 1912. Macewen attempted even removal of sarcoma of the lung. His theory of molecular cohesion of the pleural surfaces to maintain full expansion of the lung is well known, though imperfectly understood. To demonstrate the meaning of molecular cohesion as something uninfluenced by atmospheric pressure, he employed a simple experiment. Two pieces of plate glass were placed together surface to surface without any intervening medium?the upper was suspended from the dome of a bell jar, and the lower had a weight fixed to it; when the vacuum was created within the jar the cohesion between the two pieces of glass continued uninterrupted. He showed that the cohesion of a boy's leather sucker was of the same physical kind. The writer remembers the amazement of a large lecture- room full of surgeons at the International Congress of 1913, when Macewen and the elder Kocher, a man quite a foot less in stature than Macewen, indulged in a miniature tug-of-war with the strings of two coherent suckers. It was, however, in the surgery of the brain that Macewen achieved his greatest triumphs. The address to the British Medical Association in Glasgow in 1888 is now historical. We have heard that at the close there was a scene of acclamation and enthusiasm almost unparallelled in scientific meetings. By that address he stepped at once out of the ranks of surgeons as one of the greatest leaders. In 1876 he first diagnosed the presence of an abscess of the brain in Broca's convolution following an apparently trivial wound of the head. Though permission to operate during life was not granted, the operation was performed post-mortem, and confirmed his opinion and vouchsafed his accuracy. In the following nine years many cases had been operated on by him, and he had fully worked out the pathology and the surgical treatment. Five years later, Obituary. 225 in 1893, his classic work on Pyogenic Infective Diseases of the Brain and Spinal Cord was published. The book made a deep impression on the surgical world. It contains an individual experience of ten years. There are records of sixty-five cases, some few in precis not under the care of the author, but the majority in extenso, elaborate reports with descriptive accounts of the symptomatology and operative procedures. Ordinary people can only marvel at the untiring industry, the meticulous accuracy of observation, the unwearied patience in recording symptoms, and the physical endurance of the man who did the work. At the same period of his career Macewen made a most notable contribution to pure anatomy in his Atlas of Head Sections. The Atlas consists of fifty-three engraved copper- plates of frozen sections of the head, and fifty-three key-plates with descriptive texts. Every section was cut by his own hand, and photographs innumerable were taken by him before he finally selected those for permanent record. As a commercial undertaking the Atlas must have been a colossal failure for the author, but who can gainsay the satisfaction of good work well done and the joy of making a real advancing contribution to anatomical science ? Macewen's last contribution on brain surgery was the address to the British Medical Association in Glasgow in 1922. This general address was more or less a resume of his work. In it he pointed out how the truth of his observations made many years ago had been established, and was now found in the current knowledge of text-books. He emphasised once again the importance of attention to small and apparently unimportant phenomena in the diagnosis of cerebral lesions, reminding the audience of the case of a lesion in the upper portion of the ascending parietal convolution where protospasm " of the hallux was preceded by sensory impressions, a curious " feeling of pain in the great toe; and of the patient who had a deep-seated tumour in the conducting sensory and motor paths of the left hemisphere, and whose first symptom was " a peculiar" sensation in the right hand. In this address he discussed many subjects in brain surgery, such as the prevention of post-operative adhesions between the brain and its membranes, the possibilities of operation in tubercle of the brain, the anatomy of the subdural space, and the reverence we 226 Obituary. should entertain for the intricate, delicate structure, the brain. His final dictum was that surgery of the brain had its limits, but these had not been reached; there was still a large field for careful observation and accurate work. Sir William Macewen was a born naturalist?virrjpero? (j>v(T?w. He possessed an intimate knowledge of the habits of birds. The manner in which woodcock carried their young, the ways of the owls, and the first spring song of the missel-thrush were as entrancing to him as studies in surgery. His only published work in natural history is that on The Growth and Shedding of the Antlers of the Deer, in 1920. This book bears evidence of much sustained effort and diligent collecting of deers' antlers, and of histological specimens and sections to illustrate the natural phenomenon which occurs yearly in the deer. The theories of the growth of the antler are interwoven with the author's well-known theories of the growth of bone. Macewen was essentially an individualist; all his work was done by his own hands. In a measure, his house surgeons used to regret that he should occupy his time so much personally with writing notes, taking photographs, making plaster casts, much of it purely mechanical work which might easily have been delegated. But it was characteristic of him that he fol- " lowed the old advice, If you want a thing done well, do it yourself"; and besides activity of the hands did not necessarily mean inactivity of the brain. Team work, as it is now re- cognised, apparently did not appeal to him. It has been said that every surgical operation is a new experiment, and in watching Macewen operate (one writes more of thirty years ago than of recent years), the practical truth of the saying becomes evident. He was a slow operator, methodical and unhurried, aiming at thoroughness rather than speed and dexterity. It is not likely that he had any use for the American phrase, " Get in quick and get out quicker." There were two main periods in his career: the first the creative period from 1877 to 1892, when surgeon to the Royal Infirmary and surgeon to the Sick Children's Hospital; and the second the professorial period from 1892 onwards. In the Royal Infirmary he had but few students, and no systematic lectures to deliver. When he became Regius Professor of Surgery he had to teach large clinical classes, and give a long Obituary. 227 course of systematic lectures. Such a change must have proved irksome, but he threw himself whole-heartedly into the new duties. As a teacher Macewen made a profound impression on the minds of the students; they saw in him one who swept tradition and text-book aside, who looked on every surgical condition with fresh eyes, to whom the only true knowledge was that gained from the study of the patient. It was his object not to cram students for examinations, but to endeavour to make them think, to observe, and to build up their know- ledge of surgery on a basis of pathology. He once advised a " class never to turii a page without asking why," and that eternal query seems to have been his own guide. As a lecturer he spoke in low, mellow tones, with as few words as were neces- sary, and with easy and clear diction. In his many public addresses and lectures he worked all round a subject, not leaving it until the utmost detail had been thoroughly elucidated. He took a large share in the public life of medicine. Very early in his career he was an active member of the Medico- Chirurgical Society of Glasgow, and for a short period was secretary of this Journal. His connection with the British Medical Association is of great interest. It was through an address to the meeting of the British Medical Association in Glasgow in 1888 that he gained at one stroke the fullest world-wide fame, and his last address in this country was delivered again before the British Medical Association at the Glasgow Meeting, 1922. As president of the British Medical Association he displayed an astonishing grasp of business, and surprised not only the members of the profession in Glasgow but the officials of the Association in London by his knowledge of the affairs of the Association, and by his adroit and courteous handling of difficult people and delicate situations. In the deliberations preceding the annual meeting of the Association he showed clearly that the Association must preserve its scientific side, and let the social side go rather than sacrifice the other. With this end in view, he suggested that surgeons in the infirmaries should operate in the mornings before the sectional meetings began, and he did his own share in the morning operations and afternoon demonstrations. 228 Obituary.

Similarly, in the organisation of sections he argued very strongly in favour of the new section on microbiology. He was one of those who came to a committee meeting prepared with a knowledge of the business to be discussed, though decisions were frequently made on the spur of the moment. He seemed to have the gift of concentrating on one thing at one time. The acclamation with which he was received in his recent tour to the Western States of America, New Zealand, and Australia, was a fitting testimony and recognition of his great work as a surgeon. The war found Macewen, as it found all of us, jogging along in even tenor, and possibly getting into some sort of rut. He, as also the whole world, was bestirred to the depths of his nature. He was one of the signatories of the manifesto in reply to the famous manifesto signed by the ninety-three German savants. He early found a sphere of usefulness in the service of the Navy, in which he was consulting surgeon with the rank of Temporary Surgeon-General. He made many journeys all over the country in connection with this appointment, and was untiring in his devotion to the public service. He operated regularly every week-end in the Hospital at Mount Stuart, the home of the Marquis of Bute. He recognised very early in the war the needs, both present and future, of limbless men, and the Princess Louise Scottish Hospital for Limbless Sailors and Soldiers was the fruit of that recognition. The work of setting this Hospital in order, and carrying on its unique services, was almost entirely due to Macewen's individual effort. He interested himself in the most minute details of the work of the Hospital, and fought the authorities in London on the question of the provision of limbs. With the assistance of Mr. Harold Yarrow, C.B.E., he showed that the making of artificial limbs need not be the prerogative of foreign limb makers, and in due time the workshops at Erskine were able to cope with the requirements of the limbless men. A word must be said about Sir William Macewen's interest in the nursing profession. When he began his work in the Royal Infirmary, nursing had not been raised to the dignity of a profession whose members are registered. He saw that good nursing was absolutely essential to good surgical work, and, in association with Mrs. Strong, then matron of the Royal Obituary. 229

Infirmary, he initiated the training of nurses, putting it 011 the sound basis of a preliminary course of lectures and a definite curriculum. He gave many addresses to nurses, speaking encouraging words. Sir William Macewen was the recipient of many honours. It was entirely fitting that his own University should make early recognition of such a distinguished alumvius in conferring upon him the degree of LL.D. in 1890. He received the Honorary F.R.C.S. of both England and Ireland. When the British Medical Association met in Newcastle, the University of Durham conferred upon him the degree of D.C.L. In 1895 he was elected a Fellow of the Royal Society. In 1902 he received the honour of knighthood from the King, and in 1920 he was made C.B. He was honorary member of many foreign surgical societies?the Imperial Academy of Military Medicine of St. Petersburg; the German Surgical Society; the Hungarian Medical Society; the Royal Medical Academy of Rome; the American Surgical Society?and he was also corresponding member of the Surgical Society of Paris, and one of the joint editors of the Annals of Surgery. In 1922, as has been already pointed out, he was President of the British Medical Association, and in 1923 President of the International Congress of Surgeons, London. The personality of this man of genius is by no means easy to define. He had a commanding presence, great stature, clean, chiselled features, piercing, penetrating, deep-set grey eyes. It is to be regretted that no painting of Macewen is in existence. A movement for obtaining a painting by some distinguished artist was first started in 1914, but the war intervened. Again, only a few weeks before his death, a committee had obtained his consent, and had made some arrangements for obtaining such a portrait. Macewen himself had a curious foible in an intense dislike to be photographed. A photograph of himself in the midst of a large group of nurses, assistants, and house surgeons, with Mrs. Strong, was taken in the Royal Infirmary in 1892, before he left to go to the Western Infirmary. No other photograph was taken in this country that we are aware of till immediately before the meeting of the British Medical Associa- tion in 1922. The only exception may be some group photographs taken during Earl Haig's visit to Erskine, in which 230 Obituary.

Macewen appears in Admiral's uniform, full bearded, as we had known him for so many years. His cosmos contained a large share of ego, and driven by the passion to unfold the secrets of nature, and to remove as he said " the blot on the brain," he pursued his course like some irresistible machine. Let us admit that he could not fulfil the apostolic injunction to "sutler fools gladly." There was no place in his world for the indifferent and the shirker, for the insincere and the futile. There were those who misunderstood him; men who said that he was forgetful of loyal service, pontifical in manner and speech, unappreciative of other men's distinguished work, selfish, egotistical. Others, again, found him gentlemanly, kind-hearted, friendly, a good talker, considerate of others. To some he was "Gulielmus Superbus"; " " " to others the great Mogul and the great Panjandrum "; to his house surgeons (even long after they had become chiefs them- " selves) he was always the Chief." Every nickname implied It to greatness. seemed be the misfortune of many to see in his nature only the malevolent Mr. Hyde, while to others he presented the benignant figure of Dr. Jekyll. No man of genius can avoid the man never detractors; who made an enemy or a mistake never made But one anything. does feel that in his many con- tests with bodies like boards of directors of the infirmaries he was actuated, not by selfish motives, but by really altruistic motives, having in his heart, not personal aggrandisement, but the ultimate welfare of his patients and the advancement of surgical science. It will ever redound to the credit of the board of of the managers Royal Infirmary of his day, among whom must be named with honour the late Mr. David " McCowan and Mr. William McEwan (the horse of knowledge"), that they recognised in Sir William a man of outstanding ability, whose work brought renown to the Royal Infirmary, adding additional lustre to the name made for it by Lister, and that they readily supplied his manifold demands for the work in the wards. And in his contest with the managers of the Western Infirmary, even before he entered its wards, he was fighting the battle of the University in demanding his to right wards in the Infirmary as holder of the Regius Chair of Surgery. Obituary. 231

Macewen, in a spirit of inquiry, made frequent journeys to other schools of surgery, especially on the Continent of Europe. He became personally as well known, and his work as highly appreciated, in the schools of France and Belgium, Germany and Austria, Russia and Italy, as in the schools of his own country ?perhaps, let it be confessed, more so. He raised the standard of British surgery in the estimation of Continental surgeons in a way that no other surgeon, with the exception of Lister, had ever done. As he was fond of travelling to other schools, so also he loved to receive the many foreign surgeons who flocked to Glasgow to see him. Yet, the debt that we in Glasgow owe Macewen is the greatest of all, and it is a debt, both personal and public, that cannot yet be adequately measured. It has been said that he might have done more for the Glasgow School, that if he had been gifted by nature with more of the milk of human kindness, the Glasgow School of Surgery would have been the greater. But even so, the Glasgow School of Surgery ranks high, and there can be little doubt that every Glasgow student, and every surgeon trained in Glasgow, is permeated by Macewen's influence. Sir William Macewen was possessed of a grim, if not very subtle, humour, and easily appreciated the funny side of a situation. In the Royal Infirmary days the pathologist was a most lovable and able man, whose temper was easily roused, showing most readily in hyperactivity of the erectores pilorum. Nothing delighted Macewen more than to indulge in a little baiting of the pathologist, to let his house surgeons see the irascible one's hair stand on end. A wealthy London merchant once consulted him concerning a vexatious tumour which worried him. Macewen's recommendation was

" complete extirpation of the growth. But," objected the " patient, Sir So-and-So in London thought operation was not necessary, and told me to have it painted." "Ah, yes! but? we?would?have it removed first." The writer remembers Macewen, in a talkative mood, telling of a walking party in Nor- way when he was out with Lauenstein, of Hamburg. An artist member of the company had sketched the party in walking, and Lauenstein was showing the picture afterwards to them, saying, "That long, lanky figure in front is Macewen." "Yes!" said 232 Obituary.

" Macewen, I am always in front." He narrated many amusing incidents of his recent world tour. Perhaps one of the funniest was when he was being driven in a motor car towards Niagara from Buffalo. The chauffeur, driving fairly rapidly, said to " him, Say, sir, are you fleeing from justice?" "No," was the " " reply; why do you ask ?" Because, sir, we are being pursued. But, sir, if you say the word I can easy get you to " safety from these three cars that are after us." But," said " Macewen, shall we not wait to see who they are, and what they want?" And the car was stopped. From the first pursuing car a gentleman jumped out and asked, "Are you Sir William Macewen?" "Yes!" "Sir, we wish to shake hands with you. We have heard that you passed through Buffalo, and we do not wish Sir William Macewen to pass through Buffalo without giving him a welcome, and without shaking his hand." If there was one feature in the life of Sir William Macewen specially worthy of note it was his intense desire for privacy in his family life. In his public life and in his work he courted publicity, but his private life was his own. Some years ago he had built to his own design the substantial farm of Garrochty in the Island of Bute, and there he spent long week-ends and most holidays. There, he loved to think of himself as a farmer, not the bucolic type of farmer, but a farmer interested in birds and beasts, in the chemical qualities of manures, in scientific breeding. When entertained to dinner on the occasion of his Knighthood in 1902, reference was made in a quiet way to his home life (the writer thinks it was John Chiene's beaming smile which prompted it), and Macewen, in reply, said that he had drunk deep of the cup of domestic happiness. Lady Macewen is the sister of Dr. J. W. Allan (the beloved " Allan of Belvidere "), and the part that she has played in her husband's life has been that of the guardian of the flame, the loving wife and mother, the quiet lady taking her share of his honours and his duties. Sir William and Lady Macewen had a family of three daughters and three sons. The sons are all members of the medical profession, one of them surgeon to the Royal Infirmary. It is hardly necessary to say that universal sympathy has been showered upon Lady Macewen Obituary. 233 and her family in their great bereavement. It was the express desire that the funeral of Sir William Macewen should be absolutely private.

" O strong soul, by what shore Tarriest thou now 1 For that force, Surely, has not been left vain ! Somewhere, surely, afar, In the sounding labour-house vast Of being, is practised that strength, Zealous, beneficent, firm !"

J. P.

LIST OF PAPERS, LECTURES, ADDRESSES, AND PUBLISHED WORKS OF SIR WILLIAM MACEWEN, 1870 to 1924.

" Injection of ammonia into the circulation in a case of opium poisoning," "Glasgow Medical Journal," 1872, vol. iv, p. 492. "Two cases of injury to the abdomen having a period of latency, and thereafter proving rapidly fatal," "Glasgow Medical Journal," 1873, vol. v, p. 30. "The effect of fear on a boy," "Glasgow Medical Journal," 1873, vol. v, p. 78. " Note on the introduction of the tube of the stomach pump and nasal tubes," "Glasgow Medical Journal," 1873, vol. v, p. 242. "Clinical record: ligature of the femoral artery at the apex of Scarpa's triangle, and the 'antiseptic' treatment for the cure of popliteal aneurysm," "Glasgow Medical Journal," 1873, vol. v, p. 262. "Clinical record : case of phosphorus poisoning," "Glasgow Medical Journal," 1873, vol. v, p. 407. " "Case of rupture of the bladder," Lancet," 1873, vol. ii, p. 448. " Ovariotomy: removal of both ovaries, performed and treated antiseptically," "Glasgow Medical Journal," 1874, vol. vi, p. 87. " Penetrating wounds of thorax and abdomen, treated antiseptically" (Glasgow Medico - Chirurgical Society, 1874), "Glasgow Medical Journal," 1875, vol. vii, pp. 1, 115. " Wounds in relation to the instruments which produced them," " Glasgow Medical Journal," 1876, vol. viii, p. 28. "Clinical observations on synovial bursse, with specific reference to those situated in the popliteal space," "Glasgow Medical Journal," 1876, vol. viii, p. 468. "Clinical record, illustrative of the antiseptic treatment of abscesses," "Glasgow Medical Journal," 1878, voL x, p. 193. 234 Obituary.

"Case of scrotal inclusion (dermoid cyst of the testicle), with summary of instances formerly met with," "Glasgow Medical Journal," 1878, vol. x, p. 433. " A consideration of the means we possess for distinguishing between coma arising from alcoholic intoxication and that produced by apoplexy, fracture of base of the skull, and other causes" (opening address, Glasgow Royal Infirmary, as Surgeon and Lecturer on Forensic Medicine), "British Medical Journal," 1878, vol. ii, p. 725; "Glasgow Medical Journal," 1879, vol. ii, p. 1. "An interesting pathological observation on the life of bone," "Lancet," 1878, vol. i, p. 895. " Antiseptic osteotomy in genu valgum and anterior tibial curves, with a few remarks on the pathology of knock-knee" (British Medical Association, Cork, 1879), "British Medical Journal," 1879, vol. ii, pp. 607, 619. "The method of preparing paraffin splints," "Lancet," 1878, vol. ii, p. 288. "Antiseptic transfusion of human blood in a patient, the subject of secondary " hiemorrhage : cure," Lancet," 1879, vol. ii, p. 4. "The introduction of tubes into the larynx through the mouth instead of tracheotomy or laryngotomy," "Glasgow Medical Journal," 1879, vol. xii, p. 218. "On osteotomy : with an enquiry into the etiology and pathology of knock- knee, bow leg, and other osseous deformities of the lower limbs," 1880. "Intracranial lesions" (tumour of dura mater), "Lancet," 1881, vol. ii, p. 581. " Chromic gut: its method of preparation and behaviour in living tissues," "Annals of Anatomy and Surgery," 1881, vol. iv, pp. 129, 232. " " Treatment of croup and diphtheria by introduction of tubes (International Medical Congress, 1881), "British Medical Journal," 1881, vol. ii, p. 523. "Treatment of wounds" (clinical lecture), "British Medical Journal," 1881, vol. i, pp. 150, 185. "On the radical cure of hernia" (Glasgow Medico-Chirurgical Society, 1883), "Glasgow Medical Journal," 1883, vol. xx, p. 213. "On the pathology and treatment of congenital talipes varus" (Glasgow Medico-Chirurgical Society, 1885), "Glnsgow Medical Journal," 1885, vol. xxiii, p. 363. " Cerebro-spinal lesions and their surgical treatment" (Southern Medical Society, 1884), "British Medical Journal," 1884, vol. i, p. 524. "On the radical cure of oblique inguinal hernia by internal abdominal peritoneal pad, and the restoration of the valved form of the " inguinal canal," Annals of Surgery," 1886, vol. iv, p. 89. " Carcinoma in its pathological and etiological aspects, with remarks on the principles of its surgical treatment" (discussion on cancer, Glasgow Pathological and Clinical Society, 1886), "Glasgow Medical Journal," 1886, vol. xxv, p. 271 ; vol. xxvi, p. 30. " On the pathology of transverse fractures of the patella and the olecranon," "Annals of Surgery," 1887, vol. v, p. 177. Obituary. 235

" The osteogenic factors in the development and repair of bone," "Annals of Surgery," 1887, vol. vi, pp. 289, 389. "Cerebral abscess due to otitis media," "Lancet," 1887, vol. i, p. 616. " The etiology, semiology, and morbid anatomy of cerebral abscess" " (contribution to a discussion on The pathology and treatment of cerebral abscess," Glasgow Medico-Chirurgical Society), "Glasgow Medical Journal," 1887, vol. xxviii, p. 119. " " On the surgery of the brain and spinal cord (British Medical Association, " Glasgow, 1888), British Medical Journal," 1888, vol. ii, pp. 302, 322. " Treatment of retention of urine from prostatic enlargement" (British Medical Association, Leeds, 1889), "British Medical Journal," 1889, vol. ii, p. 872. " Diagnosis of head injuries ; fracture of the skull; encephalitis, meningitis, and abscess of the brain ; compression of the brain ; concussion of the brain ; hernia of the brain; osteotomy; grafting; tracheal catheterism," " articles contributed to Dictionary of Practical Surgery," edited by Christopher Heath, third edition, 1889. " "A case of localisation of a limited lesion of the spinal cord," British Medical Journal," 1890, vol. i, p. 775. " On aneurism : its cure by inducing the formation of white thrombi within the sac" (inaugural address to the Midland Medical Society, 1890), " British Medical Journal," 1890, vol. ii, pp. 1107, 1164. Introduction to a discussion on anaesthetics (Glasgow Medico-Chirurgical Society, 1890), "Glasgow Medical Journal," 1890, vol. xxxiv, p. 322. Inaugural address at opening of course of surgery in Glasgow University, "Glasgow Medical Journal," 1892, vol. xxxviii, p. 322. " Surgical treatment of mastoid disease and its complications" (British " Medical Association, Newcastle-on-Tyne, 1893), British Medical Journal," 1893, vol. ii, pp. 567, 568. "Treatment of cerebral tumours," "British Medical Journal," 1893, vol. ii, p. 1567. "A mode of controlling the circulation through the abdominal aorta," "Annals of Surgery," 1894, vol. xix, p. 1. "Causation of intracranial abscess" (International Medical Congress, Rome, " 1894), British Medical Journal," 1894, vol. i, p. 857. " Atlas of head sections," 1893. " Pyogenic infective diseases of the brain and spinal cord," 1893. "Treatment of hernia in children" (British Medical Association, London, 1895), "British Medical Journal," 1895, vol. ii, p. 701. "Colectomy" (British Medical Association, London, 1895), "British Medical Journal," 1895, vol. ii p. 965. " " Cerebral complications in relation to middle-ear disease (British Medical Association, London, 1895), "British Medical Journal," 1895, vol. ii, pp. 1228, 1231. "Surgery of the lungs" (Nottingham Medico-Chirurgical Society), "Lancet," 1902, vol. ii, p. 1329, 236 Obituary.

" Taberculosis of the testis, &c." (British Medical Association, Manchester, 1902), "British Medical Journal," 1902, vol. ii, p. 1310. "Treatment of chronic enlargement of the prostate" (British Medical Association, Manchester, 1902), "British Medical Journal," 1902, vol. ii, p. 1495. "Cerebral invasion of pathogenic and pyogenic organisms," "Lancet," 1904, vol. ii, p. 351. "Appendicitis" (Cardiff Medical Society, 1904), "British Medical Journal," 1904, vol. i, p. 324. "On the function of the caecum and appendix" (Huxley lecture, 1904), "Lancet," 1904, vol. ii, pp. 995, 1026, 1796, 1841. "Otogenous cerebral abscess" (International Congress of Otology, Bordeaux, 1904), "Lancet," 1904, vol. ii, p. 636. " " The present position of the aseptic treatment of wounds (British Medical Association, Oxford, 1904), "British Medical Journal," 1904, vol. ii, p. 231. "Some points on the surgery of the lung" (Cavendish lecture, 1906), "British Medical Journal," 1906, vol. ii, p. 1. "Discussion on indications for operation in cases of intracranial tumour" (British Medical Association, Exeter, 1907), "Lancet," 1907, vol. ii, p. 333. "The rdle of the various elements in the development and regeneration of bone" (abstract of paper communicated to the Royal Society), "British Medical Journal," 1907, vol. i, p. 1479. " Modern methods in the treatment of tuberculous disease of joints" " (abstract), (British Medical Association, Belfast, 1909), British Medical Journal," 1909, vol. ii, p. 948. " Surgery of the brain and spinal cord" (International Medical Congress, " Budapest, 1909), British Medical Journal," 1909, vol. ii, p. 1164. " " Bone-grafting and re-implantation of bone," Annals of Surgery," 1909, vol. 1, p. 959. " Discussion on development and growth of bone, normal and abnormal" " (British Medical Association, Liverpool, 1912), British Medical Journal," 1912, vol. ii, p. 766. " The growth of bone: observations on osteogenesis: an experimental inquiry into the development and reproduction of diaphyseal bone," 1912. " " Intrathoracic surgery (Seventeenth International Congress of Medicine, London, 1913), "Lancet," 1913, vol. ii, p. 551. " The use of a divided mattress and pelvic elevator," " British Medical Journal," 1918, vol. i, p. 252. " Remarks on carcinoma of the extremities of the alimentary tract, tongue, and rectum" (Newcastle-upon-Tyne and Northern Counties Medical " Society), British Medical Journal," 1920, vol. ii, p. 922. " The growth and shedding of the antlers of the deer," 1921. "Brain surgery" (presidential address at British Medical Association, " Glasgow, 1922), British Medical Journal," 1922, vol. ii, p. 155. Obituary. 237

" On the study of nature as shedding light on the structure and functions of man : the antler of the deer and its relation to the growth of bone" " (International Congress of Surgery, London, 1923), British Medical Journal," 1923, vol. ii, p. 91. Address to California Academy of Medicine, San Francisco (20th September, " 1923), British Medical Journal," 1923, vol. ii, p. 940. "The physics of the lungs and pleurae" (Australasian Medical Congress, 1923), "British Medical Journal," 1924, 12th January, p. 71. " Account of world tour at meeting of the Council, British Medical Associa- " tion, London," British Medical Journal," 1924, 23rd February, p. 340.

The Editors are greatly indebted to Miss Mary G. Fleming for compiling this list of Sir William Macewen's works.