William Macewen
Encyclopedia
Sir William Macewen, CB, FRS, (22 June 1848 – 22 March 1924) was a Scottish
surgeon
. He was a pioneer in modern brain surgery
and contributed to the development of bone graft
surgery, the surgical treatment of hernia
and of pneumonectomy
(removal of the lung
s).
, Isle of Bute
, Scotland
in 1848 and studied at the University of Glasgow
, receiving a medical degree in 1872. He was greatly influenced by Lord Joseph Lister
(1827–1912), who revolutionized surgery by developing antisepsis, by the use of phenol
, 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
of hands and arms), sterilization
of surgical tools, use of surgical gowns, and (recently discovered) anesthesia
, 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
, being promoted to full surgeon in 1877. 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
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
.
In 1916 Macewen helped to found the Princess Louise Scottish Hospital for Limbless Sailors and Soldiers in Erskine
(now the Erskine Hospital), near Glasgow, which was urgently needed to treat the thousands of military that lost their limbs in the First World War. Macewen was its first chief surgeon and with the help of engineers and workers of the nearby Clydeside shipyard
s, he designed the Erskine artificial limb. He trained a team of pattern-makers to manufacture them for the hospital.
Macewen died in Glasgow
on 22nd 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 Chapel.
(1835–1911) and David Ferrier
(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
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 localization were found to be correct.
He performed the first successful intracranial surgery where the site of the lesion (a left frontal meningioma
) was localized solely by the preoperative focal epileptic
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
showed no trace of the tumor. He later used this many times to successfully operate on brain abscess
es (in 1876) and hematoma
s and on the spine
. 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
and nasal sinuses, in addition to his clear description of cranial anatomy, as illustrated in his Atlas of Head Sections, were especially important in developing his successful treatment of brain abscess. The X-ray
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).
, by means of the development of the first bone grafts, but also in knee
surgery using a special instrument (Macewen's osteotome
) both techniques becoming key treatments for the highly prevalent disease of rickets
(caused by a lack of Vitamin D
). Macewen was interested in the biology of bone
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 temporal bone
and has identified an anatomical structure in this bone, the foveola suprameatica
, which was named MacEwen's triangle
in his honor.
His method of surgical removal of lungs became a major medical weapon in the treatment of tuberculosis
and lung cancer
, thus saving many patients. His name was also immortalized in Medicine in two other instances: the Macewen's operation
for inguinal hernia
and the Macewen's sign
for hydrocephalus
and brain abscess
.
Another important contribution by Macewen to modern surgery was the technique of endotracheal anaesthesia with the help of orotracheal intubation
, 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.
.
Scotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...
surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
. He was a pioneer in modern brain surgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...
and contributed to the development of bone graft
Medical grafting
Grafting refers to a surgical procedure to move tissue from one site to another on the body, or from another person, without bringing its own blood supply with it. Instead, a new blood supply grows in after it is placed. A similar technique where tissue is transferred with the blood supply intact...
surgery, the surgical treatment of hernia
Hernia
A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....
and of pneumonectomy
Pneumonectomy
A pneumonectomy is a surgical procedure to remove a lung. Removal of just one lobe of the lung is specifically referred to as a lobectomy, and that of a segment of the lung as a wedge resection .-Indications:...
(removal of the lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
s).
Career
Macewen was born near Port BannatynePort Bannatyne
Port Bannatyne is a coastal village on the Isle of Bute, Scotland. It is a popular harbour for yachts.It is approximately north of Rothesay and from Rhubodach....
, Isle of Bute
Isle of Bute
Bute is an island in the Firth of Clyde in Scotland. Formerly part of the county of Buteshire, it now constitutes part of the council area of Argyll and Bute. Its resident population was 7,228 in April 2001.-Geography:...
, Scotland
Scotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...
in 1848 and studied at the University of Glasgow
University of Glasgow
The University of Glasgow is the fourth-oldest university in the English-speaking world and one of Scotland's four ancient universities. Located in Glasgow, the university was founded in 1451 and is presently one of seventeen British higher education institutions ranked amongst the top 100 of the...
, receiving a medical degree in 1872. He was greatly influenced by Lord Joseph Lister
Joseph Lister, 1st Baron Lister
Joseph Lister, 1st Baron Lister OM, FRS, PC , known as Sir Joseph Lister, Bt., between 1883 and 1897, was a British surgeon and a pioneer of antiseptic surgery, who promoted the idea of sterile surgery while working at the Glasgow Royal Infirmary...
(1827–1912), who revolutionized surgery by developing antisepsis, by the use of phenol
Phenol
Phenol, also known as carbolic acid, phenic acid, is an organic compound with the chemical formula C6H5OH. It is a white crystalline solid. The molecule consists of a phenyl , bonded to a hydroxyl group. It is produced on a large scale as a precursor to many materials and useful compounds...
, 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
Disinfection
Disinfectants are substances that are applied to non-living objects to destroy microorganisms that are living on the objects. Disinfection does not necessarily kill all microorganisms, especially nonresistant bacterial spores; it is less effective than sterilisation, which is an extreme physical...
of hands and arms), sterilization
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...
of surgical tools, use of surgical gowns, and (recently discovered) anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
, 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
Glasgow Royal Infirmary
The Glasgow Royal Infirmary is a large teaching hospital, operated by NHS Greater Glasgow and Clyde,. With a capacity of around 1000 beds, the hospital campus covers an area of around 20 acres, situated on the north-eastern edge of the city centre of Glasgow, Scotland.-History:Designed by Robert...
, being promoted to full surgeon in 1877. 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
Royal Hospital for Sick Children
The Royal Hospital for Sick Children may refer to:*Royal Hospital for Sick Children, Edinburgh*Royal Hospital for Sick Children, Glasgow...
in Glasgow. In 1892 Macewen became Regius Professor
Regius Professor
Regius Professorships are "royal" professorships at the ancient universities of the United Kingdom and Ireland - namely Oxford, Cambridge, St Andrews, Glasgow, Aberdeen, Edinburgh and Dublin. Each of the chairs was created by a monarch, and each appointment, save those at Dublin, is approved by the...
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
Western Infirmary
The Western Infirmary is a teaching hospital situated in the West End of Glasgow, Scotland. There is also a Maggie's centre at the hospital to help cancer patients, as well as the Glasgow Clinical Research Facility....
.
In 1916 Macewen helped to found the Princess Louise Scottish Hospital for Limbless Sailors and Soldiers in Erskine
Erskine
Erskine is a town in the council area of Renfrewshire, and historic county of the same name, in the west central Lowlands of Scotland.It lies on the southern bank of the River Clyde, providing the lowest crossing to the north bank of the river at Erskine Bridge connecting the town to Old Kilpatrick...
(now the Erskine Hospital), near Glasgow, which was urgently needed to treat the thousands of military that lost their limbs in the First World War. Macewen was its first chief surgeon and with the help of engineers and workers of the nearby Clydeside shipyard
Shipyard
Shipyards and dockyards are places which repair and build ships. These can be yachts, military vessels, cruise liners or other cargo or passenger ships. Dockyards are sometimes more associated with maintenance and basing activities than shipyards, which are sometimes associated more with initial...
s, he designed the Erskine artificial limb. He trained a team of pattern-makers to manufacture them for the hospital.
Macewen died in Glasgow
Glasgow
Glasgow is the largest city in Scotland and third most populous in the United Kingdom. The city is situated on the River Clyde in the country's west central lowlands...
on 22nd 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 Chapel.
Neurosurgery
Following the work of John Hughlings JacksonJohn Hughlings Jackson
John Hughlings Jackson, FRS , was an English neurologist.- Biography :He was born at Providence Green, Green Hammerton, near Harrogate, Yorkshire, the youngest son of Samuel Jackson, a yeoman who owned and farmed his land, and the former Sarah Hughlings, the daughter of a Welsh revenue collector...
(1835–1911) and David Ferrier
David Ferrier
Sir David Ferrier, FRS was a pioneering Scottish neurologist and psychologist.-Life:Ferrier was born in Woodside, Aberdeen and educated at Aberdeen Grammar School before studying for an MA at Aberdeen University...
(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
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
or lesion in the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
, 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 localization were found to be correct.
He performed the first successful intracranial surgery where the site of the lesion (a left frontal meningioma
Meningioma
The word meningioma was first used by Harvey Cushing in 1922 to describe a tumor originating from the meninges, the membranous layers surrounding the CNS ....
) was localized solely by the preoperative focal epileptic
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
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
Autopsy
An autopsy—also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present...
showed no trace of the tumor. He later used this many times to successfully operate on brain abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
es (in 1876) and hematoma
Hematoma
A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
s and on the spine
Vertebral column
In human anatomy, the vertebral column is a column usually consisting of 24 articulating vertebrae, and 9 fused vertebrae in the sacrum and the coccyx. It is situated in the dorsal aspect of the torso, separated by intervertebral discs...
. 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
Temporal bone
The temporal bones are situated at the sides and base of the skull, and lateral to the temporal lobes of the cerebrum.The temporal bone supports that part of the face known as the temple.-Parts:The temporal bone consists of four parts:* Squama temporalis...
and nasal sinuses, in addition to his clear description of cranial anatomy, as illustrated in his Atlas of Head Sections, were especially important in developing his successful treatment of brain abscess. The X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
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 orthopedicsOrthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
, by means of the development of the first bone grafts, but also in knee
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
surgery using a special instrument (Macewen's osteotome
Osteotomy
An osteotomy is a surgical operation whereby a bone is cut to shorten, lengthen, or change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum...
) both techniques becoming key treatments for the highly prevalent disease of rickets
Rickets
Rickets is a softening of bones in children due to deficiency or impaired metabolism of vitamin D, magnesium , phosphorus or calcium, potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries...
(caused by a lack of Vitamin D
Vitamin D
Vitamin D is a group of fat-soluble secosteroids. In humans, vitamin D is unique both because it functions as a prohormone and because the body can synthesize it when sun exposure is adequate ....
). Macewen was interested in the biology of bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
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 temporal bone
Temporal bone
The temporal bones are situated at the sides and base of the skull, and lateral to the temporal lobes of the cerebrum.The temporal bone supports that part of the face known as the temple.-Parts:The temporal bone consists of four parts:* Squama temporalis...
and has identified an anatomical structure in this bone, the foveola suprameatica
Suprameatal triangle
In the temporal bone, between the posterior wall of the external acoustic meatus and the posterior root of the zygomatic process is the area called the suprameatal triangle, mastoid fossa, foveola suprameatica, or Macewen's triangle, through which an instrument may be pushed into the mastoid...
, which was named MacEwen's triangle
Suprameatal triangle
In the temporal bone, between the posterior wall of the external acoustic meatus and the posterior root of the zygomatic process is the area called the suprameatal triangle, mastoid fossa, foveola suprameatica, or Macewen's triangle, through which an instrument may be pushed into the mastoid...
in his honor.
His method of surgical removal of lungs became a major medical weapon in the treatment of tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
and lung cancer
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
, thus saving many patients. His name was also immortalized in Medicine in two other instances: the Macewen's operation
Macewen's operation
Macewen's operation is an operation for the cure of inguinal hernia, developed by Scottish surgeon Sir William Macewen .It is performed by closing the internal ring with a pad made of the hernial sac....
for inguinal hernia
Inguinal hernia
An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. They are very common , and their repair is one of the most frequently performed surgical operations....
and the Macewen's sign
Macewen's sign
Macewen's sign is a sign used to help to diagnose hydrocephalus and brain abscesses. Tapping the skull near the junction of the frontal, temporal and parietal bones will produce a stronger resonant sound when either hydrocephalus or a brain abscess are present.The sign was discovered and...
for hydrocephalus
Hydrocephalus
Hydrocephalus , also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head,...
and brain abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
.
Another important contribution by Macewen to modern surgery was the technique of endotracheal anaesthesia with the help of orotracheal intubation
Intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
, 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 GlasgowRoyal College of Physicians and Surgeons of GlasgowThe 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, this institution originally existed as a regulatory authority to ensure that...
(1874) - Fellow of the Royal SocietyRoyal SocietyThe Royal Society of London for Improving Natural Knowledge, known simply as the Royal Society, is a learned society for science, and is possibly the oldest such society in existence. Founded in November 1660, it was granted a Royal Charter by King Charles II as the "Royal Society of London"...
(1895) - Honorary Fellow of the Royal College of Surgeons of EnglandRoyal College of Surgeons of EnglandThe Royal College of Surgeons of England is an independent professional body and registered charity committed to promoting and advancing the highest standards of surgical care for patients, regulating surgery, including dentistry, in England and Wales...
(1900) - President of the British Medical AssociationBritish Medical AssociationThe British Medical Association is the professional association and 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 headquarters are located in BMA House,...
(1922) - Knighted (1902)
- Companion of the Order of the BathOrder of the BathThe 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 mediæval ceremony for creating a knight, which involved bathing as one of its elements. The knights so created were known as Knights of the Bath...
(1917)
Archives
The archives of Sir William Macewen are maintained by the Archives of the University of GlasgowArchives of the University of Glasgow
The Archives of the University of Glasgow maintain the historical records of the University of Glasgow back to its foundation in 1451. Its earliest record is a charter dating from 1304 for the lands of the earliest mention of record-keeping in the University is in 1490 when it is recorded in...
.