The third and fourth decades of the twentieth century are historically regarded as a “Golden Age” for Edinburgh surgery largely because of the distinction of two remarkable men, Sir David Wilkie (qv) and Sir John Fraser, who, during most of that period occupied respectively, the University Chair of Systematic Surgery and the Regius Chair of Clinical Surgery. Comparison of the achievements of these two surgical giants is pointless except in order to dismiss the erroneous belief that there was a degree of coolness between them.
Their personalities were different but each of them in his own way, Wilkie the Lowlander and Fraser the Highlander, embodied in his character all the virtues and none of the vices of the stock from whence he sprung.
John Fraser whose forebears on both sides of his family were farmers in Easter Ross was born at Tain in 1885. His father died a few months later and he was brought up as an only child by his widowed mother. He always retained a deep affection for his birthplace and no honour that he received in later life gave him greater pride than the Freedom of the Royal Burgh of Tain. He was educated at Tain Academy and entered the medical faculty of Edinburgh University in 1902 but he did not achieve academic distinction until his final year when he was awarded the class medal in Clinical Surgery as well as the Allan Fellowship and graduated MB ChB with honours in 1907.
After holding resident posts in Edinburgh Royal Infirmary, Fraser was appointed house surgeon to Mr Harold Stiles (qv) at the Royal Hospital for Sick Children and this was the start of a long association which was to be the single most important influence upon his career. He later became Stiles’ assistant in private practice at Chalmers Hospital and in 1910 he obtained the Fellowship of the College. Also in that year the University awarded him the degree of Master of Surgery (ChM) with honours and the Lister prize for his thesis on inguinal hernia which included some original observations on the mechanism of testicular descent.
With the encouragement of Harold Stiles, Fraser then embarked on his classic study of bone and joint tuberculosis in children, which was to make his surgical reputation. He showed that, in Scotland, the bovine form of the tubercle bacillus was the causative agent in 60% of cases and this finding led to the introduction of legislation which, by ensuring the elimination of tuberculous infection from milk supplies, dramatically reduced the incidence of this form of the disease. In 1912 Fraser was appointed assistant surgeon to the Sick Children’s Hospital and, in the same year, the University awarded him the degree of Doctor of Medicine (MD) with the Gold Medal for his thesis based on his studies of bone and joint tuberculosis. A number of his papers on the same subject received international acclaim which, in 1913, resulted in him being invited to lecture in the United States and being made an Honorary Fellow of the American Medical Association.
On the outbreak of World War I, Fraser was commissioned in the RAMC and served in France from February 1915 to November 1917. For most of this time he was in a Casualty Clearing Station close to the front line and, in 1916, he was wounded and awarded the Military Cross. During this period, his surgical reputation was further enhanced by his outstanding clinical and operative skill, by his important original observations on the pathophysiology of traumatic shock, by his work on blood transfusion and on the use of plasma substitutes and by his classic report (written jointly with Hamilton Drummond) on the treatment of penetrating wounds of the abdomen.
After demobilisation he resumed his work at the Sick Childrens Hospital where he was promoted surgeon in charge of wards and, at the same time, he was appointed to the surgical staff of the Royal Infirmary. His adult practice increased rapidly but he remained best known as a paediatric surgeon and his position as an international authority in this field was consolidated by the publication of his celebrated magnum opus “The Surgery of Childhood”.
John Fraser’s worldwide reputation made him the obvious successor to his mentor Sir Harold Stiles when that redoubtable surgeon retired in 1924 from the Edinburgh University Regius Chair of Clinical Surgery and, over the next 19 years, he enhanced its fame in a manner worthy of his great predecessors.
First and foremost, he was undoubtedly one of the most inspiring clinical teachers ever produced by the Edinburgh medical school as well as being an absolute master of the art of the formal lecture. The educational impact of his teaching whether in the classroom or the outpatient clinic or on the wards was reinforced by the warmth of his personality no less than by his ability to illuminate his discourse with blackboard sketches and diagrams of real artistic quality.
As a surgical diagnostician he was unsurpassed and in the operating theatre he was a master craftsman of supreme quality. Although a rapid operator, he never seemed to be in a hurry and he remained calm and deliberate in even the most trying circumstances. Most remarkable of all, however, was the way in which he inspired the complete confidence of patients from all walks of life through his obvious compassionate concern for them as individuals.
John Fraser was a true general surgeon in the original sense of that term, but besides paediatric surgery he had other special interests amongst which were the surgery of the breast and of the autonomic nervous system. Surgical pathology was always one of his greatest enthusiasms and scattered through his publications are many original observations on the pathology of a wide variety of surgical conditions. Having as an army surgeon successfully sutured a gunshot wound of the heart, John Fraser maintained a perennial interest in the possible role of surgery in the treatment of cardiac disease at a time when medical orthodoxy held this to be virtually unthinkable. He was particularly interested in the surgical relief of anginal pain for which he carried out left cervical sympathectomy with some encouraging results but his experience with O’Shaughnessy’s operation of cardio-omentopexy was disappointing.
Real success was achieved in 1940 when he became the first surgeon in Scotland and the second in the British Isles to carry out ligation of a patent ductus arteriosus.
As Regius Professor John Fraser’s academic and professional distinction was recognised by the award of many honours. He was an Honorary Fellow of the Royal Australasian and of the American College of Surgeons and, in 1935, he was appointed Surgeon to H.M The King in Scotland. Two years later he was made a Knight Commander of the Royal Victorian Order (KCVO) and, in 1942, he was created a Baronet; only two other Fellows of the College, William Ferguson and Joseph Lister, have been honoured in this way.
Sir John Fraser throughout his life had always driven himself hard and the exigencies of World War II greatly increased his workload to the detriment of his health.
In 1944, he was invited to become Principal of Edinburgh University and although this meant giving up his life’s work and taking on a host of new and unfamiliar responsibilities, his sense of duty and his loyalty to his alma mater compelled him to accept the invitation. Sir John’s term of office as Principal was interrupted by illness and cruelly cut short by his untimely death in December 1947 but, under his guidance, the University’s transition from wartime to peacetime conditions was smoothly accomplished, a number of important academic reforms were effected and several major developments postponed by the war were successfully inaugurated.
As Principal, Sir John’s character and personality no less than his services to the University endeared him to the entire academic community from which he received the same respect and affection that he had so worthily earned from his patients, students and colleagues during his nineteen years as Regius Professor of Clinical Surgery. He was never a College office-bearer but he gave it devoted service in other capacities and throughout a career of the highest distinction, by precept and example, he enhanced its frame and prestige. His name occupies an honoured place amongst those of the College’s most illustrious Fellows.
