William Cheselden, father of modern British surgery

William Cheselden was the most eminent English surgeon of the first half of the eighteenth century.1,2 Born in Leicestershire in 1688 just two weeks before William of Orange landed in England, he learned Greek and Latin at school, then was apprenticed to a local barber-surgeon. At fifteen he went to London and was again apprenticed, this time for seven years to a young surgeon at St. Thomas’ Hospital. After qualifying to practice medicine he began to give regular lectures at the Barber-Surgeons company, of which he became a member. In 1712 he read a paper before the Royal Society on bones discovered in an old Roman site, and a year later was elected member of the Royal Society.1

At the end of his apprenticeship he applied for a position at St. Thomas’s Hospital, then “a hotbed of corruption and dissent.”2 Rejected twice, he was appointed in 1719 upon the death of one of the senior surgeons. He began his career by focusing on the surgical removal of urinary bladder stones and in 1723 he published a treatise on that subject. Dissatisfied with the current suprapubic approach, he developed his own particular surgical method of lateral lithotomy. This consisted of reaching the bladder by making an incision in the perineum between the urethra and the anus, and then extracting the stone. As speed was essential, there not yet being any anesthesia at that time, he was able to get the job done in less than one minute. He had no deaths in the first 27 patients operated on in 1727, and overall mortality was under ten percent in his total series of 213 patients. He became famous throughout England and even had patients sent to him from the Continent.

He then expanded his interest to eye surgery, operating on cataracts and becoming one of the first to perform an iridectomy in order to construct an artificial pupil. In 1728 he received much publicity for restoring the sight of a young man who had been blind since birth. His fame spreading, he was appointed surgeon to Queen Caroline, wife of King George II, but later fell out of favor at court and was not consulted when the Queen died of a strangulated umbilical hernia in 1733.2 Among his patients was the famous poet Alexander Pope.

For seventeen years Cheselden operated at St. Thomas’s, and as his practice expanded, he also took up appointments at several other hospitals, including the new St. George’s Hospital founded in 1733. As early as 1713 he had published a textbook of anatomy written in English so that students could receive instruction in anatomy without having to first learn Latin.1,2

In 1733 he published Osteographia, a beautifully illustrated atlas of the bones of the human body, celebrated as “one of the most important and beautiful books in the British anatomical tradition.”3,4 It contained the most accurate and artistic depiction of the human skeleton, full of beautiful illustrations, some obtained by using a camera obscura. It cost one thousand pounds to produce, and was at first a failure in that only ninety-eight volumes were sold. But in time it achieved great popularity, becoming an essential study source for students, lasting through thirteen editions.1

Cheselden had many other interests. He liked poetry and music. He was a patron of boxing and in his younger days had practiced the art himself. In 1717 he had lost one thousand pounds by investing in the ill-fated South Sea company, but later became wealthy. He shifted his interest from designing books to architecture and became a member of a committee of five to propose and approve the design for a new Fulham-Putney bridge across the Thames.1 He is remembered as a friendly broad-minded man, kind to his patients and a good family man, lively and fond of society, friendly but somewhat ostentatious.1,2

In retirement Cheselden dedicated himself to reforming surgical education, then largely controlled by the barber-surgeons. He would have remembered how as a young man he had been brought before a committee of the barber-surgeons for dissecting a corpse without permission—which was rarely granted.1,2 What role he himself played in separating the surgeons from the barbers is unclear, and he may have worked behind the scenes, but in 1744 the surgeons petitioned the House of Commons to separate the surgeons from the barbers. This request was referred to a special committee consisting of twenty members that included such distinguished persons as Pitt the Elder (the Earl of Chatham), and Horace Walpole.1 The separation from the barbers was approved and resulted in the creation of the Royal College of Surgeons. Within the newly formed body, Cheselden was instrumental in improving the practice of surgery and care of the patients in hospitals by measures such as segregating the surgical sick, hiring more nurses, effecting economies, and designating special rooms for carrying out autopsies.1 Teaching, throughout his life, was his passion. By teaching many famous surgeons such as John Hunter, he contributed to the later rise of a generation of notable surgeons.

Cheselden suffered a stroke in 1751 and subsequently visited Bath several times. It was there that after drinking some ale and eating hot buns he “became very uneasy.” A physician was sent for and advised the immediate administration of an emetic, “which advice had he taken may have saved his life . . . a sad ending to such a distinguished life.”5 He died in 1752, the year when the calendar was changed from the Julian to the Gregorian style, and is remembered as a pioneer of scientific surgical education.1

Portrait of William Cheselden Frontispiece of book by William Cheselden
Portrait of William Cheselden. Credit: Wellcome Collection. CC BY 4.0 Osteographia, or The anatomy of the bones. William Cheselden. NLM.

 

References

  1. Cope, Sir William Cheselden and the separation of the barbers from the surgeons. Ann R Coll Surg Engl. 1953; 12(1): 1–13.
  2. William Chesterton, anatomist and surgeon. British medical Journal 1898; 2: 815-817.
  3. Russell, FK. The Osteographia of William Cheselden. Bulletin of the History of Medicine 1954; 28:32-49 (January-February)
  4. Neher, The Truth about our bones: William Cheselden’s Osteographia. Medical history 2010; 54:517 – 528
  5. Copeman WSC. William Cheselden. British Medical Journal 1953; 2:1088 (Nov14)

 


 

GEORGE DUNEA, MD, Editor-in-Chief

 

Winter 2020  |  Sections  |  Surgery