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.