The effectiveness, safety and universal availability of modern anaesthesia makes it almost impossible to appreciate the horrors of pre-anaesthetic surgery. Nor is it easy, from the perspective of the 21st century, to comprehend fully the extraordinary fortitude of our forebears who voluntarily underwent operations without the benefit of any form of pain control. This makes It difficult for us to fully appreciate the remarkable technical skills of surgeons such as Sir William Fergusson, whose operative speed and dexterity were his only means of mitigating the suffering of his patients.
As a result of the clash of personality with his senior colleague James Syme, Fergusson left for London, where he became Professor of Surgery at King’s College Hospital, President of the Royal College of Surgeons of England, and surgeon to Queen Victoria. He was the last, and perhaps the greatest of the 19th century surgeons whose success was based solely on knowledge of anatomy and technical expertise.
William Fergusson, who established his formidable reputation before the advent of anaesthesia, was born in 1808 in Prestonpans on the Firth of Forth just east of Edinburgh. His childhood was spent in Lochmaber, Dumfries-shire, where he received his primary education. Later, he attended the High School of Edinburgh after which he spent two years in a lawyer’s office with the intention of making his career in the legal profession, but the work did not appeal to him and in 1825 he entered the medical faculty of Edinburgh University which was what his father had always hoped he would do.
Fergusson was fascinated by anatomy and became the most dedicated and assiduous member of the large extra-mural class conducted by the brilliant anatomist Dr Robert Knox (q.v.), the first Conservator of the College Museum. Knox appointed him a demonstrator in 1828 and by spending long hours in the dissecting room, Fergusson acquired an almost encyclopaedic knowledge of anatomy along with impressive skills as a Prosector. His prowess as a dissector can be seen to this day in the College museum, where his dissections of the arteries of the foot and the cranial nerves elegantly attest to his skills. Soon he was assisting Knox with the task of lecturing to more than 500 students, a class size which made it necessary for each lecture to be given three times daily.
Knox’s professional reputation and his hopes of academic preferment were ruined by his involvement in the gruesome scandal of the Burke and Hare murders. While Knox ended his career inpenury and disgrace his assistants escaped blame, and there is no evidence that Fergusson’s career was harmed in any way by his association with Knox.
Having obtained the Licentiate of the College in 1828, Fergusson became a Fellow one year later and in 1831 was appointed Surgeon to the Edinburgh Royal Dispensary, on Liston’s move to London. Over the next few years, his reputation grew rapidly and by 1836 when he was appointed Surgeon to the Edinburgh Royal Infirmary and elected to the Fellowship of the Royal Society of Edinburgh. From his day book, still held in the College library, it is apparent that his practice was almost equal in size to that of James Syme (q.v.), then the most famous surgeon in Scotland. Sadly they developed a famous and ill-tempered rivalry, each complaining formally about the other to the Infirmary managers.
In 1840 Fergusson accepted an invitation to become Professor of Surgery at King’s College London and Surgeon to King’s College Hospital where he soon became even more successful than he had been in Edinburgh. His practice increased steadily and the fame of his outstanding operative ability brought many visitors to King’s, all of whom were as impressed by his calm imperturbability in the operating theatre as by the speed and boldness of his surgery.
He established a reputation which led to contemporaries regarding him as the greatest British surgeon of hid era.
Fergusson’s greatest surgical achievements were his operation for cancer of the maxillary antrum, his technique for the excision of tuberculous joints and his successful operative treatment of a large series of patient with hare lip and cleft palate. He was also renowned as a lithotomist performing the procedure in 30 seconds, in an era when speed was of the essence.
He was not an eloquent lecturer, his delivery to a London audience being further hampered by the broad Scots accent which he retained all his days. A more successful author, his “System of Practical Surgery”, first published in 1842, ran to five editions and was an extremely popular didactic textbook, particularly in America. His philosophy of “ conservative surgery advocating caution and discipline were in contrast to the radical, even ruthless approach that had held sway until then.
Fergusson was elected to the Council of the English College, on which he served for 16 years and was elected President in 1870. In 1855 he was appointed Surgeon Extraordinary to HM Queen Victoria, and was created a Baronet in 1866, taking the title Spittelhaugh, the estate near West Linton which his wife had inherited. He became Sergeant Surgeon the following year. Among other honours conferred upon him were the Fellowship of the Royal Society in 1848, the Presidency of the British Medical Association in 1873 and the honorary LLD of his alma mater, the University of Edinburgh, in 1875.
He was succeeded in the Chair of Surgery at King’s by Joseph Lister.
A tall, dignified, kindly man of genial disposition, Fergusson was famous for his hospitality and well regarded by his colleagues, his patients and his students, many of whom went on to attain surgical eminence. He had many extra curricular accomplishments and, in particular, he was a good violinist, a skilled carpenter and an expert fly fisherman.
When involved in surgical controversy he was always conciliatory and never more so than in his reaction to hostile criticism from James Syme to whom he paid a generous tribute in the Hunterian Oration which he gave to the English College in 1871. Equally commendable was his defence of the scientific reputation of his mentor, Dr Robert Knox, for whose distinction as an anatomist he always expressed his utmost respect.
William Fergusson died in London in 1877 and is buried at West Linton, some 17 miles south west of Edinburgh. Sir James Paget described him as “the greatest practical surgeon of our time”. He has the distinction of being the only ordinary Fellow of the College to have become President of the Royal College of Surgeons of England and occupies an honoured place in the history of both the Edinburgh and the English Colleges.
