Sir William Macewen, (; 22 June 1848 – 22 March 1924) was a Scottish

surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

. He was a pioneer in modern

brain surgery Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and ...

, considered the ''father of neurosurgery'' and contributed to the development of bone

graft Graft or grafting may refer to: *Graft (politics), a form of political corruption * Graft, Netherlands, a village in the municipality of Graft-De Rijp Science and technology *Graft (surgery), a surgical procedure *Grafting, the joining of plant t ...

surgery, the surgical treatment of

hernia A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin her ...

and of

pneumonectomy A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung first successfully done in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung. There are two ...

(removal of the

lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...

s).

Career

Macewen was born near

Port Bannatyne Port Bannatyne ( gd, Port MhicEamailinn) is a coastal village on the Isle of Bute, Firth of Clyde, Scotland that is home to many steamers. Port Bannatyne developed into the 1900s as a quieter and more unusual alternative to Rothesay. It is a pop ...

, near Rothesay on the

Isle of Bute The Isle of Bute ( sco, Buit; gd, Eilean Bhòid or '), known as Bute (), is an island in the Firth of Clyde in Scotland, United Kingdom. It is divided into highland and lowland areas by the Highland Boundary Fault. Formerly a constituent is ...

, in western Scotland in 1848. He studied Medicine at the

University of Glasgow , image = UofG Coat of Arms.png , image_size = 150px , caption = Coat of arms Flag , latin_name = Universitas Glasguensis , motto = la, Via, Veritas, Vita , ...

, receiving a medical degree in 1872. He was greatly influenced by Joseph, Lord Lister (1827–1912), who revolutionised surgery by developing

antisepsis 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 pu ...

, by the use of

phenol Phenol (also called carbolic acid) is an aromatic organic compound with the molecular formula . It is a white crystalline solid that is volatile. The molecule consists of a phenyl group () bonded to a hydroxy group (). Mildly acidic, it r ...

, thus decreasing drastically the enormous mortality of surgical patients due to infections. By following Lister and adopting systematically the use of scrubbing (deep cleansing and

disinfection A disinfectant is a chemical substance or compound used to inactivate or destroy microorganisms on inert surfaces. Disinfection does not necessarily kill all microorganisms, especially resistant bacterial spores; it is less effective than st ...

of hands and arms), sterilisation of surgical tools, use of surgical gowns, and (recently discovered)

anaesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), a ...

, Macewen became one of the most innovative surgeons of his time and was able to greatly advance modern surgical technique and improve the recovery of patients. In 1875, he became an assistant surgeon at the

Glasgow Royal Infirmary The Glasgow Royal Infirmary (GRI) is a large teaching hospital. With a capacity of around 1,000 beds, the hospital campus covers an area of around , and straddles the Townhead and Dennistoun districts on the north-eastern fringe of the city cen ...

, being promoted to full surgeon in 1877. Around 1880 he began a training programme for nurses (focussing upon sterilisation) at the infirmary under the charge of the Matron, Mrs Rebecca Strong (1843-1944). In 1881 he was appointed lecturer on Systematic Surgery at the Royal Infirmary School of Medicine. In 1883 he was appointed as Surgeon to the Royal Hospital for Sick Children in Glasgow. In 1892 Macewen became

Regius Professor A Regius Professor is a university professor who has, or originally had, royal patronage or appointment. They are a unique feature of academia in the United Kingdom and Ireland. The first Regius Professorship was in the field of medicine, and ...

of Surgery at the University of Glasgow (the post which Lister had held when Macewen was a student) and transferred his surgical activities to the

Western Infirmary The Western Infirmary was a teaching hospital situated in the West End of Glasgow, Scotland, that was managed by NHS Greater Glasgow and Clyde. It was opened in 1874 and closed in 2015. History After the University of Glasgow moved from the cit ...

. In 1896, Macewan was awarded the

Cameron Prize for Therapeutics of the University of Edinburgh The Cameron Prize for Therapeutics of the University of Edinburgh is awarded by the College of Medicine and Veterinary Medicine to a person who has made any highly important and valuable addition to Practical Therapeutics in the previous five ye ...

. He was

knighted A knight is a person granted an honorary title of knighthood by a head of state (including the Pope) or representative for service to the monarch, the church or the country, especially in a military capacity. Knighthood finds origins in the G ...

in the

1902 Coronation Honours The 1902 Coronation Honours were announced on 26 June 1902, the date originally set for the coronation of King Edward VII. The coronation was postponed because the King had been taken ill two days before, but he ordered that the honours list shou ...

for services to medicine, receiving the accolade from King

Edward VII Edward VII (Albert Edward; 9 November 1841 – 6 May 1910) was King of the United Kingdom of Great Britain and Ireland and Emperor of India, from 22 January 1901 until Death and state funeral of Edward VII, his death in 1910. The second chil ...

Buckingham Palace Buckingham Palace () is a London royal residence and the administrative headquarters of the monarch of the United Kingdom. Located in the City of Westminster, the palace is often at the centre of state occasions and royal hospitality. It ...

on 24 October that year. In 1916 Macewen helped to found the Princess Louise Scottish Hospital for Limbless Sailors and Soldiers in

Erskine Erskine (, sco, Erskin, gd, Arasgain) is a town in the council area of Renfrewshire, and historic county of the same name, situated in the West Central Lowlands of Scotland. It lies on the southern bank of the River Clyde, providing the l ...

(now th
Erskine Hospital
, near Glasgow, which was urgently needed to treat the thousands of military who had lost their limbs in the

First World War World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was List of wars and anthropogenic disasters by death toll, one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, ...

. Macewen was its first chief surgeon and with the help of engineers and workers at the nearby Yarrow Shipbuilders he designed the Erskine

artificial limb In medicine, a prosthesis (plural: prostheses; from grc, πρόσθεσις, prósthesis, addition, application, attachment), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through trau ...

. He trained a team of pattern-makers to manufacture them for the hospital. Macewen died in

Glasgow Glasgow ( ; sco, Glesca or ; gd, Glaschu ) is the most populous city in Scotland and the fourth-most populous city in the United Kingdom, as well as being the 27th largest city by population in Europe. In 2020, it had an estimated popu ...

on 22 March 1924. He lived at Garrochty on the Isle of Bute until his death and was buried nearby in the churchyard of St Blane's Church at

Kingarth Kingarth ( sga, Cenn Garad; gd, Ceann a' Gharaidh) is a historic village and parish on the Isle of Bute, off the coast of south-western Scotland. The village is within the parish of its own name, and is situated at the junction of the A844 and ...

Neurosurgery

Following the work of

John Hughlings Jackson John Hughlings Jackson, FRS (4 April 1835 – 7 October 1911) was an English neurologist. He is best known for his research on epilepsy. Biography He was born at Providence Green, Green Hammerton, near Harrogate, Yorkshire, the youngest s ...

(1835–1911) and

David Ferrier Sir David Ferrier FRS (13 January 1843 – 19 March 1928) was a pioneering Scottish neurologist and psychologist. Ferrier conducted experiments on the brains of animals such as monkeys and in 1881 became the first scientist to be prosecuted ...

(1843–1924) on neurological mapping of functions in the brain, Macewen demonstrated in 1876 that it was possible to use a precise clinical examination to determine the possible site of a

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

or lesion in the brain, by observing its effects on the side and extension of alterations in motor and sensory functions. Thus, in 1876 he diagnosed an abscess in the frontal lobe of a boy, but the family refused permission to operate. When the patient died his diagnosis and localisation were found to be correct. In 1879 he performed the first successful intracranial surgery where the site of the lesion (a left frontal

meningioma Meningioma, also known as meningeal tumor, is typically a slow-growing tumor that forms from the meninges, the membranous layers surrounding the brain and spinal cord. Symptoms depend on the location and occur as a result of the tumor pressing ...

) was localized solely by the preoperative focal

epileptic Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...

signs (twitching of the face and arms in the opposite site of the lesion). On the basis of these signs Macewen thought that there was good evidence of an "irritation to the lower and middle portions of the ascending convolutions…in the left frontal lobe". A trephined hole in the skull near the purported site of the lesion showed a big subdural tumor. The patient, a teenage girl, lived for eight more years, and a subsequent

autopsy An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any d ...

showed no trace of the tumor. He later used this many times to successfully operate on brain

abscess An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends ...

es (in 1876) and

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is ...

s and on the

spine Spine or spinal may refer to: Science Biology * Vertebral column, also known as the backbone * Dendritic spine, a small membranous protrusion from a neuron's dendrite * Thorns, spines, and prickles, needle-like structures in plants * Spine (zoolo ...

. This was a great triumph of medicine. According to one of his biographers, "his thorough knowledge of the natural history of pyogenic diseases of the

temporal bone The temporal bones are situated at the sides and base of the skull, and lateral to the temporal lobes of the cerebral cortex. The temporal bones are overlaid by the sides of the head known as the temples, and house the structures of the ears. ...

and

nasal sinus Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the ethmoidal sinuses are between the eyes and the sphenoid ...

es, in addition to his clear description of

cranial Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

anatomy, as illustrated in his ''Atlas of Head Sections'', were especially important in developing his successful treatment of brain abscess. The

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

had not yet been discovered; Macewen's diagnosis was based on clinical findings superbly illustrated by his three clinical stages of brain abscess development" (Canale, 1996).

Contributions to surgery

One of his earliest contributions while at the Royal Infirmary, in 1877, was in

orthopaedics Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeleta ...

, by means of the development of the first bone grafts, but also in knee surgery using a special instrument (Macewen's

osteotome An osteotome is an instrument used for cutting or preparing bone. Osteotomes are similar to a chisel but bevelled on both sides. They are used today in plastic surgery, orthopedic surgery and dental implantation. The chain osteotome, original ...

) both techniques becoming key treatments for the highly prevalent disease of

rickets Rickets is a condition that results in weak or soft bones in children, and is caused by either dietary deficiency or genetic causes. Symptoms include bowed legs, stunted growth, bone pain, large forehead, and trouble sleeping. Complications ma ...

(caused by a lack of

Vitamin D Vitamin D is a group of Lipophilicity, fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group ar ...

). Macewen was interested in the biology of

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...

and carried out a classical series of experiments on animals in order to determine how bones grow and may be repaired. He developed surgical treatments for mastoid disease and pyogenic cysts of the

and has identified an anatomical structure in this bone, the foveola suprameatica, which was named MacEwen's triangle in his honour. His method of surgical removal of lungs became a major medical weapon in the treatment of

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, ...

and lung cancer, thus saving many patients. His name was also immortalised in Medicine in two other instances: the Macewen's operation for

inguinal hernia An inguinal hernia is a hernia (protrusion) of abdominal-cavity contents through the inguinal canal. Symptoms, which may include pain or discomfort especially with or following coughing, exercise, or bowel movements, are absent in about a thir ...

and the Macewen's sign for

hydrocephalus Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. This typically causes increased pressure inside the skull. Older people may have headaches, double vision, poor balance, urinary i ...

and brain

. Another important contribution by Macewen to modern surgery was the technique of endotracheal anaesthesia with the help of orotracheal

intubation Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blake ...

, which he described in 1880, and still in use today. Macewen was noted for his early and creative use of photographs for documenting patients cases and for teaching surgery and medicine. He pioneered the use of photos of body parts and pathological specimens, as well as photos taken before, after and during treatment/surgery.

Honours

* Fellow of the

Royal College of Physicians and Surgeons of Glasgow The Royal College of Physicians and Surgeons of Glasgow, is an institute of physicians and surgeons in Glasgow, Scotland. Founded by Peter Lowe after receiving a royal charter by James VI in 1599, as the Glasgow Faculty, it originally ...

(1874) *

Fellow of the Royal Society Fellowship of the Royal Society (FRS, ForMemRS and HonFRS) is an award granted by the judges of the Royal Society of London to individuals who have made a "substantial contribution to the improvement of natural knowledge, including mathemati ...

(1895) * Honorary Fellow of the

Royal College of Surgeons of England The Royal College of Surgeons of England (RCS England) is an independent professional body and registered charity that promotes and advances standards of surgical care for patients, and regulates surgery and dentistry in England and Wales. T ...

(1900) * President of the

British Medical Association The British Medical Association (BMA) is a registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association's headqua ...

(1922) *

Knighted A knight is a person granted an honorary title of knighthood by a head of state (including the Pope) or representative for service to the monarch, the church or the country, especially in a military capacity. Knighthood finds origins in the G ...

(1902) * Companion of the

Order of the Bath The Most Honourable Order of the Bath is a British order of chivalry founded by George I on 18 May 1725. The name derives from the elaborate medieval ceremony for appointing a knight, which involved bathing (as a symbol of purification) a ...

(1917) After his death, a memorial fund was set up in his name. As part of the late 1970s redevelopment of Glasgow Royal Infirmary, where Macewen spent most of his career, a new laboratory block was named in his honour. It opened in 1981.

Career

Neurosurgery

Contributions to surgery

Honours

Archives

References

Further reading