FOOTNOTES:

[2] The writer is indebted for this anecdote to Dr. Paterson’s “Memorials of the Life of James Syme,” in which a number of incidents relating to Liston are given, with an interesting parallel between the careers of the two great surgeons (chapter xii., p. [210-216]). It is much to be regretted that no biography of Robert Liston has yet been written.

[CHAPTER XIII.]
BAILLIE, HALFORD, CHAMBERS, AND HOLLAND, THE FASHIONABLE AND COURTLY PHYSICIANS.

One cannot more strikingly emphasise the change which has taken place during the present century in the views and practice of medical men than by quoting from Sir Henry Halford’s biographical notice of Baillie, the nephew of William and John Hunter, and brother of Joanna Baillie. Here we have Halford acknowledging a current sentiment against physical examination of the patient. “He (Baillie) appeared to lay a great stress upon the information which he might derive from the external examination of his patient, and to be much influenced in the formation of his opinion of the nature of the complaint by this practice. He had originally adopted this habit from the peculiar turn of his early studies,—and assuredly such a method, not indiscriminately but judiciously employed, as he employed it, is a valuable auxiliary to the other ordinary means used by a physician, of obtaining the knowledge of a disease submitted to him. But it is equally true that, notwithstanding its air of mechanical precision, such examination is not to be depended upon beyond a certain point. Great disordered action may prevail in a part without having yet produced such disorganisation as may be sensibly felt; and to doubt of the existence of a disease because it is not discoverable to the touch, is not only unphilosophical, but must surely, in many instances, lead to unfounded and erroneous conclusions. One of the inevitable consequences of such a system is frequent disappointment in foretelling the issue of the malady, that most important of all points to the reputation of a physician, and though such a mode of investigation might not prove unsuccessful in the skilful hands of Dr. Baillie, it must be allowed to be an example of dangerous tendency to those who have not had his means of acquiring knowledge, nor enjoyed the advantages of his great experience, nor have learned by the previous steps of education and good discipline to reason and judge correctly.” Halford then refers to the quickness with which a good physician makes up his mind on the nature of a disease; at that time it was oftener a guess than a process of reasoning. Baillie was one of the first to study pathology, and to bring into practice physical examination.

Matthew Baillie was born on the 27th October 1761, in the manse of Shotts, Lanarkshire, his father having been Professor of Divinity in Glasgow University, his mother, Dorothea, sister of William and John Hunter. After two sessions at Glasgow, Baillie entered, in 1779, at Balliol College, Oxford, where he completed his M.D. in 1789. Residing during vacations with William Hunter, he became almost like a son to him, and assisted him much in making his anatomical preparations and superintending his dissecting-room. On the death of his uncle in 1783, he and Cruickshank continued the lectures with great success. Baillie lectured till 1799. One of his pupils said of him that his style, though not eloquent, irresistibly commanded attention; he appeared completely master of his subject, was exceedingly clear, concise, and condensed, and never at a loss for an appropriate word. He was always modest and unostentatious. When left sole heir of his uncle William, he at once transferred to John Hunter the family estate of Long Calderwood, to which he regarded him as entitled.

Baillie’s principal work is pathological. In 1793 he published “The Morbid Anatomy of some of the most Important Parts of the Human Body,” and although pathology is now very different from what it was in his day, and his classification is not now useful, his facts, when properly interpreted, are still found excellent. The work met with very great success, and was translated into many European languages, besides going through five English editions in the author’s lifetime.

Baillie gradually got into good practice, being appointed physician to St. George’s Hospital in 1787, elected Fellow of the College of Physicians in 1790, Censor in 1791 and 1796, and Fellow of the Royal Society in 1789. On the retirement of Dr. Pitcairn from practice in 1798, Baillie succeeded to a great part of it, and his practice was still further benefited by his marriage with the daughter of Dr. Denman, whose great obstetric practice enabled him to recommend Baillie very frequently. He resigned his hospital work in 1799, and from that time had perhaps the leading practice in London, making ten thousand pounds in some years. He was consulted about George III.’s case, and in 1810 was made Physician to the King and offered a baronetcy, which he declined. In 1814 he was also appointed Physician-in-Ordinary to the Princess Charlotte, and attended many members of the royal family. His manner towards his fellow-practitioners was as pleasing as his conduct to patients. To both he would carefully explain, as far as possible, his views of the nature of the case and the treatment required, and he was exceedingly successful in tranquillising the apprehensions of his patients. His modesty was transparent. He would say to his friends: “I know better perhaps than another man, from my knowledge of anatomy, how to discover a disease, but when I have done so, I do not know better how to cure it.” From this one is not surprised to learn that he was not fertile in expedients, but if the simplest means failed, he was often at a loss what to do next, and was not apt at varying his prescriptions.

Baillie was not without an irritability of temper, in which we see some resemblance to John Hunter; but his heart was at bottom most kindly. He would often say after an outbreak, “I have spoken roughly to that poor man; I must go and see him, be it ever so late;” “that patient is in better health than I am myself, but I have been too hard with him, I must make him amends.” There were many instances of his great and delicate generosity to his patients. Overwork, to the extent of devoting sixteen hours a day to practice, enfeebled his constitution, and before the age of sixty he was compelled to retire in a large measure from practice. He died at his seat, Duntisbourne House, near Cirencester, on the 23d September 1823, leaving a fortune of £80,000. He bequeathed a considerable sum to the College of Physicians, with his manuscripts and other interesting curiosities, such as the gold-headed cane used by Radcliffe, Mead, and others, whose arms are engraved on it. He was buried in Duntisbourne Church, but his memory was commemorated by his professional friends by a fine bust by Chantrey in Westminster Abbey. His excellent qualities and his strong religious principle were well set forth by Sir Henry Halford in an address to the College of Physicians.

Sir Henry Halford was long a contemporary of Baillie, but survived him more than twenty years. He was the second son of Dr. James Vaughan, a successful physician at Leicester, whose third son became a judge of the Court of Common Pleas; the fourth son was Dean of Chester and Warden of Merton College, Oxford; the fifth, Envoy-extraordinary to the United States; and the sixth was the father of Dean Vaughan, the well-known Master of the Temple. The eldest son died in his twenty-third year. The distinction which Vaughan’s sons attained shows that his judgment was admirably exercised in their education. In fact, he spent his whole professional income in providing for them the best possible educational aids. Henry, like the others, was sent from Rugby to Oxford (the youngest only going to Cambridge); and he records, in eulogising his father’s treatment of them, that not one of them asked or received further pecuniary assistance from him after he had finished his education, and commenced his own efforts to provide for himself.

Henry Vaughan was born on October 2d, 1766. Entering at Christchurch, Oxford, he graduated B.A. in 1788, M.D. 1791. He studied medicine for some months at Edinburgh, and also practised for a time with his father at Leicester. About 1792 he came to London, and having a good opening through his Oxford friends, had courage enough to borrow £1000 on his own security in order to establish himself in London practice. Here his good manners and evident learning stood him in good stead, and he was elected physician to the Middlesex Hospital in 1793, becoming a Fellow of the College of Physicians in 1794. In March 1795 he still further promoted his advancement by his marriage with the third daughter of Lord St. John, and rapidly rose into note. With all his talents, however, it looks like one of fortune’s freaks that Vaughan should have been appointed Physician-Extraordinary to the King in 1793, at the age of twenty-seven; and that his practice should have so increased that in 1800 he was compelled to give up his hospital appointment. But fortune had more favours in store for him. He inherited a large property on the death of Lady Denbigh, widow of his mother’s cousin, Sir Charles Halford; and he consequently changed his name in 1809 by Act of Parliament from Vaughan to Halford. George III. created him a baronet in the same year.

The King had indeed a strong preference for Sir Henry Halford, as he now became. He secured Sir Henry’s promise, before the onset of his last long derangement, that he would not leave him, and that if necessary he would call in also Dr. Heberden and Dr. Baillie. To recite the number of royal personages to whom Sir Henry was physician would be tedious; suffice it to mention that he attended, besides George III., George IV., William IV., and Queen Victoria, having thus been the physician of four English sovereigns.

There is no doubt that Halford possessed talents of a high order. He is said to have been inferior to Baillie in accuracy of diagnosis, but superior in the cure and alleviation of disease. He had quick perception, sound judgment, and great knowledge of the powers of medicines. For many years after Baillie’s illness and death he was undisputedly at the head of London practice. At the College of Physicians his rule continued unchecked, if not unquestioned, for more than twenty years, he having been President from 1820 till his death on the 9th of March 1844. He was largely instrumental in securing the removal of the College from Warwick Lane in the city to the present commodious building in Pall Mall East. His bust by Chantrey was presented to the College by a number of Fellows. His portrait by Sir Thomas Lawrence is at Wistow, Leicestershire, where he was buried in the parish church.

Halford’s early success was not favourable to his prosecuting original research nor to his publishing much that is important. His chief publications were first given as addresses to meetings of the College of Physicians. In these he showed skill and pleasing literary art. He wrote on the Climacteric Disease, on the Necessity of Caution in the Estimation of Symptoms in the Last Stages of some Diseases, on the Tic Douloureux, on Shakespeare’s Test of Insanity (Hamlet, Act iii. Sc. 4), on the Influence of some of the Diseases of the Body on the Mind, on Gout, on Phlegmasia Dolens, on the Treatment of Insanity, and on the Deaths of some Illustrious Persons of Antiquity—and again, on the Deaths of some Eminent Persons of Modern Times. It is to be regretted perhaps that a man of such accomplishments should have left so little behind him; but he was of use to his day and generation; and as to the knowledge he had attained, it served him only to affix the term “conjectural” to medicine, when speaking of the confidence Baillie inspired. At least he did not seem to have hidden from himself how little the medicine of his days could lay claim to being completely informed.

William Fredric Chambers, the son of an East Indian civil servant, whose family belonged to Northumberland, was born in India in 1786. Brought to England in 1793 in consequence of his father’s death, he was educated at Bath, Westminster, and Trinity College, Cambridge, where he graduated B.A. in 1808. He had hoped for a fellowship, intending to take orders; but being disappointed, he turned to medicine, and entered at the Great Windmill Street School, subsequently spending a year at Edinburgh, and returning to study at St. George’s Hospital, the Eye Infirmary at Moorfields, and at Bateman’s celebrated Dispensary. His diligence, both in practical medical study and in dissections, attracted the attention of the St. George’s physicians, and on the resignation of Dr. Pelham Warren, then one of the leaders of London practice, he was brought forward and elected physician to the Hospital in 1816 when only thirty years of age. His East Indian connection secured him, in 1819, the post of examining physician to the East India Company, after being some time assistant-physician. Notwithstanding his early prominence, his professional income rose but slowly, showing that neither ability nor patronage will avail greatly in competition with the established favourites. It was 1825 before Chambers’s practice amounted to £2000; and his pre-eminence was not marked till the death of Dr. Maton in 1835, and the great age of Sir Henry Halford (who died in 1844), left him in indisputed possession of the leading London practice. From 1836 to about 1851 he received in fees between seven and nine thousand guineas a year. In 1836 he was consulted by Queen Adelaide, and in 1837 was made Physician-in-Ordinary to William IV., declining knighthood, though made Commander of the Guelphic order. He was continued as Physician-in-Ordinary to Queen Victoria, and his successful career was uninterrupted, except by rather frequent ill-health. About 1851, owing to the failure of his health, he retired from practice, and settled near Lymington, where he died on the 17th December 1855.

Chambers did not win his success either by writing, teaching, or discovering. In addition to a tall commanding figure, and the most agreeable, yet straightforward manners, he possessed striking decision, and pursued bold and successful plans of treatment in acute diseases. He kept himself well acquainted with the advances of others, and was early distinguished by his adopting the stethoscope. Like many men of great eminence, he was at heart exceedingly diffident, and felt acutely the responsibilities which he undertook. He was continually in fear of doing something wrong or making a mistake. Thus he undoubtedly was a most conscientious physician, and it is to be feared that he gave himself much suffering by the minutely painstaking system that he adopted. Both at the hospital and in private practice, he personally recorded the particulars of every case that he saw, together with all his prescriptions—an astounding instance of laborious effort. In this way his private practice furnished sixty-seven large quarto volumes of notes, which were every day completely written up, and carefully indexed, so that he could refer with the utmost ease to any case he had ever seen. Moreover, he made in very many instances sketch maps of the diseased organs, side by side with the description. So persistent was he in this conscientious toil, that he often continued it far into the night and even till daylight, resuming work again before nine o’clock. Ill-health was a necessary consequence, but his reliability was certain to tell in practice. He could scarcely depend on a single regular meal a day, so great was the demand for his services. He literally rushed through the streets driven post-haste at ten miles an hour. After a serious illness in 1834, through having absorbed poisonous matter from a patient who had died of pleurisy, his right hand was distorted by the results of abscesses; and it was hence vulgarly reported that his fingers had become crooked from the continual habit of taking fees. The regard he won from others may be evidenced by the fact that Sir Benjamin Brodie for some weeks visited him daily during this illness at Tunbridge Wells, when this entailed much greater loss of time than now. His liberality was well known, and this, with his frequent illnesses, caused him to accumulate no great fortune.

With regard to Sir Henry Holland, it is with regret that we own how comparatively slight are his claims to a place in the gallery of great medical men. He was accomplished beyond most men, but one is compelled to ask, what did he accomplish with his great opportunities? Whom did he teach? what did he teach? what did he discover? His travelling excursions extended over almost the whole globe except Australia. He was intimate for more than half a century with many men and women of mark on both Continents. He knew well the Presidents and statesmen of the United States; prescribed for six Prime Ministers of England, as well as for its sovereigns and princes. But even in regard to information of moment which he might justifiably have given concerning them, he has been strikingly reticent in his “Recollections of Past Life.”

Henry Holland, the son of Peter Holland, a much-respected medical practitioner, was born at Knutsford in Cheshire, on October 27, 1788. His maternal grandmother was a sister of Josiah Wedgwood, the eminent potter, and grandfather of Charles Darwin. Holland was also a cousin of Mrs. Gaskell, the author of “Mary Barton,” and biographer of Charlotte Brontë. He was educated first at Newcastle-on-Tyne under the Rev. W. Turner, and early showed his predilection for travel by making long pedestrian excursions in the neighbourhood. In 1803, he went for a year to Dr. Estlin’s school, near Bristol, where he succeeded at once to the position of head boy, left vacant by John Cam Hobhouse, afterwards Lord Broughton, and where he also commenced his long friendship with Richard Bright, who has already been mentioned in this work. His classical and literary tastes here developed, and were further fostered by a vacation passed at Dr. Aikin’s at Stoke Newington, and in the society of his sister Mrs. Barbauld and his daughter Lucy Aikin. Still, young Holland leaned towards a commercial life, and entered a Liverpool merchant’s office, with the stipulation that he was to spend two sessions at Glasgow University. These saved him from being bound to a merchant’s desk; for after his second session, 1805-6, he sought and obtained release, and took up medicine. At Glasgow he had become intimate with William Hamilton (afterwards Sir William), his discussions with whom had doubtless a considerable influence on his mental development. Holland’s literary talent already began to show itself, for he was selected at the age of eighteen to draw up a Statistical Report on the Agriculture of Cheshire for Government, and received for it £200, double the sum proposed.

In October 1806, Holland entered at the Edinburgh Medical School; but he did not confine himself exclusively to one school, for he spent two succeeding winters in the Borough Schools of London, Guy’s and St. Thomas’s, and in private study. Resuming at Edinburgh, he took his degree in 1811. Travel had already found him apt; in 1810 he went to Iceland with Sir George Mackenzie and Richard Bright, and contributed considerable portions to the narrative of the expedition. Holland early became associated with the Whig section of Edinburgh society, but he saw much of its general aspects, and he knew Walter Scott, Dugald Stewart, Francis Jeffrey, Henry Erskine, and many others known to fame. He had already made the acquaintance of Maria Edgeworth during a visit to Ireland; and her letters to him would in themselves fill a volume. Everywhere the bright pleasing intelligent youth was welcomed. As he could not yet be admitted by the College of Physicians owing to his lack of years, he undertook extensive travels on the Continent, venturing into little-known regions, and published his “Travels in Portugal, Sicily, the Ionian Islands, and Greece,” in 1815, a work which yet further increased his fashionable repute. Mrs. Piozzi, writing from Bath in 1815, says, “We have had a fine Dr. Holland here. He has seen and written about the Ionian Islands, and means now to practise as a physician—exchanging the Cyclades, say we wits and wags, for the sick ladies. We made quite a lion of the man. I was invited to every house he visited at for the last three days. So I got the queue du lion, despairing of le cœur.”

Holland had spent much time in the military hospitals in Portugal during his travels, and gained valuable experience. In Turkey he came into contact with Ali Pasha, through whom he was deprived of most of his papers relating to Albania, a mortifying loss at the time. After his return home he speedily formed friendships with Lords Lansdowne, Aberdeen, and Holland, which continued uninterrupted save by death, and of course led to his intimacy with many other persons of note, traits in whose characters are recorded in the “Recollections.” We cannot here follow the incidents of the brilliant social life into which Henry Holland entered with so much zest. Suffice it to mention that he was elected to the Royal Society in 1816, and admitted on the same day as Lord Byron, who on that occasion made his only visit. Henry Holland was an almost constant guest at Holland House. In the summer of 1814 he became domestic medical attendant on the Princess (afterwards Queen) Caroline, to accompany her during her first year of travel on the Continent. This situation became one of extreme delicacy, and its importance was very manifest at her trial years afterwards, where Dr. Holland’s evidence, declaring that he had never seen anything improper or derogatory in her behaviour to Bergami or any other person, proved of extreme weight in her behalf.

A man of such connections could not fail to gain almost as much practice as he liked. His visits to Spa for four successive years, after the London season, strengthened his professional prospects, and his fourth year’s practice brought him over £1200. In a few years he was able to resolve that his professional income should never exceed £5000, and that he would give to study, recreation, or travel all his surplus time. Thus happily placed, Henry Holland became the friend of every man of note, the patron of science at the Royal Institution, of which he was long president—but not the hospital physician, the clinical teacher, the original writer, the promoter of medical reform, or the habitué of the medical societies. He dined out, and never reproved his patients for the lapses from physiological prudence which he observed at the table. The “frequent half hour of genial conversation” was what he bestowed and was most capable of bestowing on his patients. Perhaps he thereby solaced their days of tedium or hypochondria as well as others who might have sought to root up their habits or impart tone to their minds with more ruthless energy. “When Lady Palmerston was suffering from an illness that occasioned some alarm to her friends,” said the Times, in its obituary notice of Holland, “one of them, meeting the late Dr. Fergusson, asked anxiously how she was. ‘I can’t give you a better notion of her recovery,’ was the reply, ‘than by telling you that I have just received my last fee, and that she is now left entirely to Holland.’” On this being repeated to Lord Palmerston his lordship mused a little, and then said, “Ah! I see what he means. When you trust yourself to Holland, you should have a superfluous stock of health for him to work upon.” Holland himself had this superfluous stock of health. When over eighty he writes: “A frequent source of amusement to myself is my incapacity for walking slowly; and the sort of compulsion I even now feel to pass those immediately before me in the street, and to take the diagonal instead of the two sides of a square, whenever this is the alternative. When I cease to take the diagonal (often a dirty one) instead of the side pavements, I shall consider that I have gone a step downwards in the path of life.” His excursions were almost all taken alone; but he evidently seldom put himself out of the reach of general society, as good as the neighbourhood afforded. He was no recluse, yet apparently not a man of a few warm strong personal friendships. If he was we find no record of it. From his utter reticence about his medical contemporaries, we should judge that he did not at bottom appreciate them as they deserved.

To give briefly a few of the more notable dates in Holland’s life, he married first, in 1822, a Miss Caldwell, who died in 1830, leaving two sons, the present Sir Henry Holland and the Rev. F. J. Holland; and secondly, in 1834, Saba, daughter of Sydney Smith. He was made Physician-Extraordinary to the Queen in 1837; Physician-in-Ordinary to the Prince-Consort in 1840; was offered, but declined, a baronetcy by Lord Melbourne in 1841; was made Physician-in-Ordinary to the Queen in 1852, and accepted a baronetcy in 1853. In later years he withdrew altogether from practice, but continued active in society and persevering in travel. In his last journey, to Russia, he was accompanied by his son, the Rev. F. J. Holland; on his way back he attended the trial of Marshal Bazaine at Versailles on the 24th October 1873, dined the same day at the British Embassy, returned to London the next day, did not go out on Sunday the 26th, and died quietly in bed on the 27th, on the 85th anniversary of his birth.

To this extraordinary age lived the man who had been seen in all climates, in the Arctic Circle or in the Tropics, on the Prairies or the Pyramids, in the same black dress coat in which he almost ran from house to house at home. Sydney Smith said of him that he started off for two months at a time with a box of pills in one pocket and a clean shirt in the other—occasionally forgetting the shirt. Let Sir Henry tell his own tale of his enjoyment. “The Danube I have followed, with scarcely an interruption, from its assumed sources at Donau-Eschingen to the Black Sea—the Rhine, now become so familiar to common travel, from the infant stream in the Alps. The St. Lawrence I have pursued uninterruptedly for nearly two thousand miles of its lake and river course. The waters of the Upper Mississippi I have recently navigated for some hundred miles below the falls of St. Anthony. The Ohio, Susquehanna, Potomac, and Connecticut rivers I have followed far towards their sources; and the Ottawa, grand in its scenery of waterfalls, lakes, forests, and mountain gorges, for three hundred miles above Montreal. There has been pleasure to me also in touching upon some single point of a river, and watching the flow of waters which come from unknown springs or find their issue in some remote ocean or sea. I have felt this on the Nile at its time of highest inundation, in crossing the Volga when scarcely wider than the Thames at Oxford, and still more when near the sources of the streams that feed the Euphrates, south of Trebizond.” Altogether Sir Henry estimated that he had spent twelve years of his life in foreign travel.

Literary work was a pastime with Holland, and both in the Quarterly and the Edinburgh Reviews he delighted to show his extensive reading, and his enlightened yet very unrevolutionary views. His more interesting reviews have been published as “Scientific Essays,” and “Chapters on Mental Physiology;” while his “Medical Notes and Reflections” constitutes almost all his practical contribution to medical science. Interesting “Fragmentary Papers” were published posthumously. In the “Medical Notes” certain current questions were philosophically discussed in a most pleasing style, and some questions of practice treated with some originality if not with boldness. Two chapters may be especially alluded to as valuable, namely, those “On the Abuse of Purgative Medicines,” and “On Bleeding in Affections of the Brain.” Many of his chapters on Mental Physiology show wide observation and kindly insight into the relations of mind and body. But after all it is by his “Recollections of Past Life” that Holland will be most known, his sketches of the leading personages, politicians, wits, and scientific and literary men having a charming vividness and truthfulness about them, making every one regret that so many limitations were imposed by the author upon himself when he might have easily furnished so much more material for history.

Holland was of the middle height, spare in appearance, but very active; with a countenance not indicative of the highest mental power.

[CHAPTER XIV.]
SIR WILLIAM FERGUSSON AND CONSERVATIVE SURGERY.

The association of the word “conservative” with operative surgery, so strongly identified in the popular mind with the removal of portions of the body, needs some explanation to the non-professional reader. In former times inflammation with denudation of bone was commonly believed to necessitate amputation; and diseased joints, especially the elbow, knee and ankle, with ulceration of cartilages, were generally considered incurable, except by removal of the limb. As Fergusson said, the ways of surgery get grooved; they are hallowed in the estimation of some. The man who steps from the groove is held to be rash and is called to account. How much this was the case will be seen by the reception accorded to conservative surgery, which aspired to do away with many of the radical proceedings of the past.

The term “conservative surgery,” as first used by Sir W. Fergusson in 1852, meant operations for the preservation of some part of the body, which would otherwise have been unnecessarily sacrificed. A smaller and more limited operation was undertaken to remove simply the incurably disorganised portion of the body, such as a diseased joint, and not an entire limb. Thus Fergusson said, “a compromise may be made, whereby the original constitution and frame, as from the Maker’s hand, may be kept as nearly as possible in its normal state of integrity.” “No one can more thoroughly appreciate a well-performed amputation than I do, but I certainly appreciate more highly the operation which sets aside the necessity for that mutilation.”

Two great surgeons thus bear testimony to Fergusson: “The improvements which he introduced in lithotrity and in the cure of cleft-palate may almost be considered typical,” says Sir Spencer Wells,[3] “of the school of modern conservative surgery, and will long be acknowledged as triumphs of British surgery in the reign of Victoria.” He was, in the words of Sir James Paget, “the greatest master of the art, the greatest practical surgeon of our time.”

William Fergusson was born on March 20th, 1808, at Prestonpans, East Lothian, and was educated first at Lochmaben in Dumfriesshire and afterwards at the High School of Edinburgh. At fifteen he entered a lawyer’s office, by his own desire, but soon found that law did not suit him, and at seventeen exchanged law for medicine, which profession his father had wished him to adopt. He was early attracted by the teaching of Robert Knox, the celebrated anatomist, who quickly discerned the stuff his pupil was made of. Fergusson would often spend from twelve to sixteen hours a day in the dissecting-room. One of his dissections of the nerves of the face, preserved in the museum of the Edinburgh College of Surgeons, remains an admirable example of manipulative skill and dexterity, and the stand on which it is placed is also a specimen of his work. At twenty Knox made him demonstrator to his class, which then numbered four hundred. He had previously assisted John Turner, Professor of Surgery at the College of Surgeons. At the early age of twenty-one Fergusson became Fellow of the College of Surgeons by examination. Knox then promoted him to a share in his lectures on general anatomy, and the young lecturer also gave demonstrations on surgical anatomy, which proved highly valuable. He soon began to manifest his skill in operative surgery, and in 1831 he was elected surgeon to the Edinburgh Royal Dispensary, and showed his boldness by performing the important operation of tying the subclavian artery, which as yet had only been twice done in Scotland. In 1833 he married Miss Ranken, heiress of the estate of Spittlehaugh in Peeblesshire. This marriage, while it placed him beyond pecuniary difficulty, had no effect in diminishing his industry. In 1839 he became surgeon to the Royal Infirmary, and Fellow of the Royal Society of Edinburgh, and already shared the highest surgical practice with Syme. In fact there was hardly room for two such men in Edinburgh. Liston had betaken himself to London. In 1840 Fergusson followed his example, accepting an invitation to King’s College, which was now establishing its hospital. At a farewell presentation, Lizars said that he had seen no one, not even Liston himself, surpass Fergusson in the most trying and critical operations. The man of whom this could be said at the age of thirty-two had every chance of success in London, even though he came thither with scarcely any personal friends to back him. Professor Partridge, his old friend, gave him a cordial introduction, and he established himself in Dover Street, Piccadilly, only to find that his first year’s private practice did not exceed £100. Yet it cannot be denied that Fergusson came to London at a fortunate period. Within a few years death or retirement withdrew from practice many of the most capable operators, such as Liston, Aston Key, and Astley Cooper. Thus his success was really rapid, for his third year brought him £1000, and in 1847 he removed to a large house in George Street, Hanover Square. His style of operating soon attracted general attention both among students and practitioners, and King’s College operating theatre became the resort of all the medical students and practitioners who could cram into it.

As an operator Fergusson was most peculiarly skilled, and he appears to have had a natural manipulative dexterity, which he assiduously cultivated. Like Sir Charles Bell and other eminent surgeons, he was a splendid fly-fisher; and his manipulation served him in good stead in acquiring skill on that most difficult of instruments, the violin. Carpentering and metal-working came easily to him, and gave him great readiness in improvising splints or other apparatus desirable for his patients’ special circumstances. Yet having such power and dexterity, he did not choose to display it on all possible occasions, but rather was conspicuous for his frequent abstinence from operative interference, counting it a greater glory to save a limb than to cut one off, and taking endless trouble to preserve a portion when amputation would have been much easier.

Although the rivalry between Fergusson and Syme frequently led to open dissensions, yet no man more freely, fully, and repeatedly acknowledged Syme’s great services than Fergusson. Thus he always ascribed the chief merit of the revival of the “conservative” operation of excision of the elbow-joint to Syme. Originally suggested by Park, and first performed by Moreau, it was not until the operation was taken up by Syme that it attracted serious attention. Fergusson followed in his wake, and extended the same principles till there was scarcely a part which could be conserved which he had not laid hands on with that object. To take an instance from parts of small size. A gentleman of active habits, in charge of a large establishment, to whom the use of a pen was of vast importance, had a bad whitlow at the end of his right thumb. An abscess was opened in due time, and the bone was found bare. Amputation was urged, but the patient objected, and on consulting Fergusson, he was advised to wait, and then a few weeks afterwards the portion of bone that died was removed through the original opening for the abscess. Before long, the thumb, apparently entire, was as useful as ever. “Opinions may differ,” says Fergusson, “but for my own part, I deem it a grand thing when by prescience even the tip of a thumb can be saved.”

To Liston’s boldness and rapidity Fergusson added greater caution and self-control. In lithotomy both were equally distinguished, and attained their end with the simplest instruments. An anecdote recorded in the Medical Times and Gazette (Feb. 17, 1877) illustrates this. Some practitioners were discussing the relative merits of some leading hospital surgeons, and introduced the subject of lithotomy. “I saw Mr. —— perform lithotomy to-day in half a minute.” “Oh,” replied B, “I saw —— once extract the stone in twenty seconds.” “Have you ever seen Fergusson perform lithotomy?” “No.” “Well then, go; and, look out sharp, for if you only even wink, you’ll miss the operation altogether.”

In 1845 Fergusson revived the plan of excising the head of the femur for incurable disease of the hip-joint, and it became established as a valuable operation, in spite of Syme’s violent opposition. In 1847 Mr. Fergusson excised the entire scapula, where the whole arm would otherwise have been sacrificed. In 1850 his attention became concentrated on diseases of the knee-joint, and before long he excised the joint for severe disease. Although the result was unfavourable, Fergusson, undismayed, repeated the operation successfully, and in spite of strong criticism and opposition, continued for at least fifteen years, it has become established. The strength of the feeling aroused on this subject was so great that once when Fergusson was about to excise a knee-joint at King’s College Hospital, a surgeon, once a colleague, publicly protested against the performance of the operation. Fergusson’s earlier cases were not always well selected for the operation, and he had many disheartening failures. But he persevered and improved in his selection of cases, and achieved what he regarded as the greatest triumph of conservative surgery.

Some of Fergusson’s greatest triumphs were in connection with hare-lip and cleft-palate. His first formal operation in surgery was for hare-lip in 1828. Up to 1864 he had operated on nearly four hundred cases with only three deaths. The adoption in 1850 of a spring or truss to push the sides of the lips forwards, invented by Jem Hainsby (the old dissecting-room attendant at Guy’s), and the father of a child-patient, was of great value in preserving the mobile parts of children from undesirable movements. In regard to cleft-palate Fergusson’s labours were of even greater value, for he discovered by careful dissection the reason why the edges of the wound were so often prevented from uniting, and by dividing the muscles concerned, in addition to other valuable improvements in practice, he enabled many patients to gain an excellent undivided palate. Up to 1864 he had operated on 134 cases, of which 129 were successful, and only two failed entirely. It is unnecessary to go through the long list of successes won by Fergusson; but it is well to mention that when he found the existing instruments unsuitable for his purpose, he never rested till he had invented better ones. The bull-dog forceps, the mouth-gag for operations on the palate, various bent knives, and many other instruments and apparatus bear the stamp of his inventive skill.

With all his operative brilliancy, that did not constitute Fergusson’s chief claim to admiration, nor was it the principal cause of his success. The perfect planning of the operation beforehand from beginning to end, down to the smallest detail, and being ready for every possible emergency with the precise method for meeting it, distinguished him most. Consequently he neither hurried, wearied, nor hesitated when he began. Things were so perfectly planned, his assistants so well drilled, that not a word needed to be spoken, and this produced a curious appearance at times, so that it was often remarked that he must be on bad terms with his assistants. He left no detail unsupervised, and completed the operation entirely himself, even applying bandages and plasters. His coolness under difficulty was probably connected with his forethought; he could often cover his own or others’ mistakes in the coolest manner, and this put him in the best position for remedying them. It was his pride never to be late. He hated unnecessary waste of time, and once when a friend intending to tie a large artery had laid it bare by a fine dissection, and was showing it with natural gratification, Fergusson called him to the point by remarking, “Jist put a thread round it.” So when a large artery had been wounded, and an assistant eagerly tried to stop the bleeding with his finger, Fergusson said: “Jist get your finger out of the way, mon, and let’s see what it is,” and satisfactorily tied the vessel.[4] He was remarkably neat too in his completion of an operation, and could not bear to leave any traces behind, either in hospital or private house.

In the subjects which he had thoroughly studied and on which he had practical experience Fergusson was a master. This is seen in his “Practical Surgery,” which reached a fifth edition in 1870, and in his lectures on the Progress of Anatomy and Surgery delivered at the College of Surgeons in 1864 and 1865. But as a systematic lecturer he did not achieve great success, nor was he conspicuous as a bedside teacher owing to his reticent manner. It was in operating that he shone most, and in his remarks on operations; to see him operate was for the student or practitioner already instructed what to observe a lesson full of practical value. On some important questions he was imperfectly informed, and this was proved when he opposed the movement for securing a pure water supply to large towns, and favoured the anti-vivisectionists in some remarks and evidence which showed considerable ignorance of physiological discovery and progress. Again, his attitude towards homœopathic practitioners largely compromised his influence at one time.

Fergusson’s social instincts as well as his personal sympathies won him favour from all classes, and his male as well as his female patients felt deeply his kindly attentions, while children simply worshipped him. His practice was always to treat a hospital patient with exactly the same consideration as one in private. Mr. Henry Smith records the profound impression made upon him as a young student by his remarkable kindness and gentleness towards a little lame boy. It is not to be wondered at that he inspired his patients with the utmost confidence, an art that many equally clever have lacked. A gentleman who came to London to have an enormous tumour of the lower jaw removed, saw several eminent surgeons, but chose Fergusson as the operator without hesitation. “Directly he put his hands upon me,” said this gentleman, “to examine my jaw, I felt that he was the man who should do the operation for me; the contrast between his examination and that of others was so great.” As Mr. Henry Smith says, “Fergusson not only shone pre-eminently as an operator, but he possessed a profound knowledge of his art, and wielded all its resources with consummate skill. His powers of observation were remarkable; his memory was most tenacious; his shrewdness, sound common-sense, tact and knowledge of men, and how to deal with them, were acknowledged by all; and conspicuous amongst them was that facility of resource in all trying emergencies, which, added to his extraordinary mechanical skill, made him what he was, and brought about a success which has seldom been vouchsafed to any surgeon.”

Fergusson became M.R.C.S., Eng., in 1840, and Fellow in 1844. He was appointed Surgeon to the Prince-Consort in 1849, and Surgeon-Extraordinary to the Queen in 1855, and Sergeant-Surgeon in 1867. In 1861 and again in 1868 he was elected to the Council of the College of Surgeons, notwithstanding the strong opposition of the existing council on the first occasion. In 1867 he became an examiner in surgery, and in 1870 President of the College. His lectures as Professor have already been mentioned. We may add that he was President of the Pathological Society in 1859 and ’60, and of the British Medical Association at its brilliant London meeting in 1873. His many other appointments and distinctions must be passed over, with the exception of the baronetcy, which he received in 1866.

Fergusson never tired of work. His fine energies kept him ever fresh. He could sing, or dance a Highland reel, with energy long after middle age, and when just returned from a prolonged and tiring journey. He was a munificent patron of literature and the drama; attended many an author without fee, and would not unfrequently pay for their lodging near him in cases where that was desirable. His spirit of hospitality was lavish, whether in London or at his seat at Spittlehaugh in Peeblesshire. He was ever ready to show kindly feeling towards even those who censured him most severely, and his forgiving nature was many times most conspicuously evident. Whenever he had any consciousness of having done or said anything calculated to wound another’s feelings, old or young, he never rested until he had made reparation in some way. He held a truly modest estimate of himself, was unspoiled by popularity, and never became at all overbearing. He was a staunch friend, to old pupils especially, and a liberal helper of members of the profession generally. Many a surgeon who has risen has owed to him essential help. Indeed, he displayed the best Christian characteristics, and was, in Mr. Henry Smith’s words, “the true type of a Christian gentleman.” He died in London, after an exhausting illness, of Bright’s disease, on February 10th, 1877, and was buried at West Linton, Peeblesshire, where his wife had already, in 1860, been buried. A portrait of him by Lehmann was presented by subscription to the London College of Surgeons in 1874, and a replica is in the Edinburgh College of Surgeons. His best monument is in the life and work of the multitude of his pupils, whom he influenced and stimulated as few have ever done.