The Growth of Bone

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Sir William Macewen (1848–1924) was a Scot, born on the island of Bute. He received his medical education in Glasgow and spent his long and illustrious career associated with the university. As a student he had the good fortune to come under the influence of Joseph Lister, the professor of surgery who was just beginning his epochal work on antiseptic surgical technique. Macewen recognized the value of Lister's innovation, and during the next decade he improved and perfected sterile technique in his operating room, progressing from antisepsis to asepsis. Macewen's control of infection allowed him to become a daring pioneer in the elective surgical treatment of a wide variety of diseases and conditions. Along with his clinical interests, Macewen had a deep-seated interest in investigation. He characterized himself as an “anxious inquirer.” Macewen made important contributions to the technique of tracheal intubation and to the treatment of aneurysms, appendicitis, and mastoiditis. In 1895 he performed the first total pneumonectomy, in a patient with tuberculosis. This patient is known to have survived at least 45 years. Macewen is also considered to be one of the founders of neurosurgery for his work on the localization of brain tumors, subdural hematomas, and abscesses on the basis of clinical findings. He successfully attacked such lesions in the operating room. Because of his international prominence as a surgeon, he was invited in 1889 to accept the chair of Professor of Surgery at Johns Hopkins University. It was only after Macewen refused to leave Glasgow that the position was offered to William Stewart Halsted of New York. Macewen was interested in normal and diseased bone throughout his career. His book On Osteotomy, published in 1880, was based on extensive experience with subcutaneous and open osteotomies performed primarily for rachitic deformities. His interest in bone grafting led him to carry out heterografts, homografts, and autografts in his patients. He introduced the use of morcellated bone grafts in place of large grafts of cortical bone. He was interested in the relative osteogenic properties of bone and periosteum. His book The Growth of Bone, Observations on Osteogenesis addressed this problem. His interest in research for its own sake is illustrated by his work The Growth and Shedding of the Antlers of the Deer, published in 1920, only four years before his death at 76 years of age. The breadth of Macewen's interests and the variety of the problems that benefited from his analytic and innovative approach make it difficult to categorize him other than as a surgeon in a very general sense, since essentially all of the surgical specialties can claim him as a founder or pioneer.