Victor Negus
Sir Victor Ewings Negus, MS, FRCS was a British surgeon who specialised in laryngology and also made fundamental contributions to comparative anatomy with his work on the structure and evolution of the larynx. He was born and educated in London, studying at King's College School, then King's College London, followed by King's College Hospital. The final years of his medical training were interrupted by the First World War, during which he served with the Royal Army Medical Corps. After the war, he qualified as a surgeon and studied with laryngologists in France and the USA before resuming his career at King's College Hospital where he became a junior surgeon in 1924.
In the 1920s, Negus worked on aspects of both throat surgery and the anatomy of the larynx, the latter work contributing to his degree of Master of Surgery. His surgical innovations included designs for laryngoscopes, bronchoscopes, oesophagoscopes, an operating table, and tracheotomy equipment. His major publications were The Mechanism of the Larynx and his work on the clinical text Diseases of the Nose and Throat, starting with the fourth edition of 1937. Negus was also awarded several lectureships and published many medical papers and other works on comparative anatomy and laryngology. He became a senior surgeon at King's College Hospital in 1940 and a consulting surgeon in 1946.
Negus was one of the founders of the British Association of Otorhinolaryngologists, helping to establish his speciality as a discipline within the newly formed National Health Service. He was a member of numerous international and national otolaryngology organisations, and presided over the Fourth International Congress of Otolaryngology in London in 1949. In this period of his career following the Second World War he also worked on the anatomy of the paranasal sinuses, and played a key role in rebuilding and establishing collections of animal dissections used by comparative anatomists.
Negus, who married in 1929 and had two sons, retired in 1952, though he continued to publish on comparative anatomy and the history of medicine. His honours before and after retirement included the Fellowship of King's College, London, an honorary degree, the Lister Medal, a knighthood, honorary fellowships of the Royal College of Surgeons of Edinburgh and the Royal College of Surgeons in Ireland, and the Honorary Gold Medal of the Royal College of Surgeons of England. He died in Hindhead, Surrey, aged 87 in 1974.
Early life and education
Victor Ewings Negus was born on 6 February 1887 in Tooting, London, the youngest of three sons of William and Emily Negus. His father was a solicitor, Justice of the Peace, and Deputy Lieutenant for the County of Surrey. Victor's pre-university education took place at King's College School. In 1906, he was awarded a Sambrooke scholarship to King's College London, on the Strand, where his studies for the next three years included premedical and preclinical subjects.After passing the required examinations, Negus proceeded in 1909 to the next stage of his basic medical education at the nearby King's College Hospital, at that time located on Portugal Street between the Strand and Lincoln's Inn Fields. Three more years of study led to the attainment in 1912 of the MRCS and LRCP, marking his formal qualification to practice medicine. In the final year of these studies, Negus was an usher at the funeral service for Lord Lister at Westminster Abbey. Another connection with Lister's generation came when Negus worked as surgical dresser and house surgeon under Sir William Watson Cheyne, who had himself been house surgeon to Lister. The postgraduate stages of Negus's training involved specialisation in diseases of the ear, nose and throat, a direction influenced and guided by the otorhinolaryngologist St Clair Thomson. In the years following his qualification in 1912, Negus worked at King's College Hospital, and had started further clinical training at the Hospital for Diseases of the Throat in Golden Square, Soho, but this was interrupted by the outbreak of the First World War.
Negus served in the Royal Army Medical Corps with the British Expeditionary Force for the first 18 months of the war. He initially deployed with the 1st General Hospital, then saw action in the trenches on the front line with a machine-gun battalion at the First Battle of Ypres. The effects of explosives during this period left him with tinnitus. This was followed by a period serving on hospital barges. In 1916, Negus, still with the RAMC, was posted to the 3rd Division and took part in the Mesopotamia Campaign. As one of those who had deployed to the Western Front in the opening months of the war, he was later awarded the Mons Star. His service in the RAMC ended in 1919.
Surgical career and family
Following his discharge from the army, Negus, again with the advice and guidance of St Clair Thomson, resumed his studies and preparations for a career in throat surgery. By 1921 he had graduated MB BS and by 1922 he had taken the surgical exams for the FRCS qualification. To gain further experience, he spent periods of time abroad studying with renowned laryngologists: firstly with Emil Moure and Georges Portmann in Bordeaux, France; and secondly with Chevalier Jackson in Philadelphia, USA. On his return to London, he became clinical assistant to St Clair Thomson at King's College Hospital.At this point, still early in his surgical career, Negus took a different approach to that which was common at the time. Rather than be apprenticed to a leading surgeon in his ENT speciality, he undertook basic research on the structure of the larynx that led to a higher degree in 1924 and the publication of books and papers on the topic in later years. While engaged in this research, Negus continued his work at King's College Hospital, being appointed junior surgeon in 1924. It was during this period, following his return from the USA, that Negus both promoted the methods and tools he had seen used in Philadelphia by Jackson, and worked to improve the designs of the endoscopes and other equipment used in ENT surgery. These instruments, developed in collaboration with the Genito-Urinary Company of London, included laryngoscopes, bronchoscopes and oesophagoscopes. Other surgical innovations developed by Negus included an operating table, and a speaking valve for use in tracheotomy tubes. He also helped develop strategies for treatments of throat cancer to aid the choice between surgery and radiotherapy.
In 1929, Negus married Winifred Adelaide Gladys Rennie with whom he had two sons, David and Richard. Negus's surgical and medical teaching career continued to progress, and he was appointed surgeon in 1931. It was in 1937 that his major work in clinical medicine, the fourth edition of Diseases of the Nose and Throat, was published. This work, "still used for reference", was described as "for many years the standard textbook in English on this subject", and as Negus's "major literary contribution to clinical medicine". The 1937 edition continued work on earlier editions by St Clair Thomson, who worked jointly with Negus on the new edition. A fifth edition worked on by both men was published in 1948 following Thomson's death, and the sixth edition by Negus alone appeared in 1955.
In 1939, the Negus family moved to Haslemere, Surrey. During the Second World War, Negus again served in a medical capacity, this time with the Emergency Medical Service at Horton Hospital, Epsom, from 1939 to 1946. In 1940, on the retirement of his colleague Charles Hope, he had been appointed senior surgeon at King's College Hospital, and in 1946 he reached the peak of his profession as a consulting surgeon. During this post-war period one of Negus's patients was the former prime minister Winston Churchill, who in 1950 was diagnosed by Negus with high-frequency sensorineural hearing loss. Negus retired from clinical and teaching work in 1952 at the age of 65.
Comparative anatomy
In parallel with his career as a throat surgeon at a teaching hospital, Negus become a leading expert on the comparative anatomy of first the larynx and then the nose and the paranasal sinuses. This strand of his professional life started with the research he carried out in his thirties in the 1920s that eventually led to his degree of Master of Surgery, awarded by the University of London. This work started as early as 1921 in the laboratories of the Royal College of Surgeons of England, whose museum housed the collections of animal specimens gathered by the anatomist John Hunter. Working on these specimens, and adding to them with others supplied by the Zoological Society of London, Negus carried out meticulous dissections that enabled him to trace the stages of evolution and development of the larynx across a wide variety of animals. Part of this research was submitted as his thesis, and the excellence of the work was recognised by the award of a Gold Medal with his MS degree in 1924. In addition to this, Negus gave the Arris and Gale Lecture on 28 April 1924 at the Royal College of Surgeons, with his talk titled "On the Mechanism of the Larynx".Further recognition of his work came when Negus was made Hunterian Professor at the Royal College of Surgeons in 1925, followed three years later in 1928 by the awarding of the triennial John Hunter Medal from the Royal College of Surgeons, which came with a prize of £50. The following year Negus published his observations and conclusions in The Mechanism of the Larynx, a "classic piece of research" still referred to forty-five years later in 1974 as "the standard reference book" on this topic. Negus's work had shown that the main function of the larynx is as a valve that only allows air into the lower respiratory tract. In humans, the voice is only a byproduct of this more vital function. Another lecture resulting from this work was given under the auspices of the University of London's Semon Lectureship, named after the German-born British laryngologist Felix Semon. This talk was delivered on 6 November 1930 at the Royal Society of Medicine under the title "Observations on Semon's Law".
These earlier works were followed after the Second World War by the publication of Comparative Anatomy and Physiology of the Larynx. This work was a condensed and updated version of Negus's original 1929 work on the larynx. It was in this post-war period that Negus increasingly studied the function of the nose, both as the organ for the sense of smell and the role of the nose in respiration. This was prompted by wartime damage in 1941 to the Royal College of Surgeons' Hunterian Museum, which included the loss of parts of the Onodi Collection. This collection had contained specimens of the accessory sinuses prepared by the Hungarian laryngologist Adolf Onodi and demonstrated by him in 1900. Negus undertook to replace the destroyed and damaged specimens and to extend the collection with animal specimens. This work was covered in Negus's Hunterian Lecture, delivered on 20 May 1954 at the Royal College of Surgeons under the title "Introduction to the Comparative Anatomy of the Nose and Paranasal Sinuses". This was followed four years later by the publication of Comparative Anatomy and Physiology of the Nose and Paranasal Sinuses. Much of this later work was carried out after retirement in 1952, both at the laboratories of the Royal College of Surgeons and at the Ferens Institute of Otolaryngology at the Middlesex Hospital. Negus's research over many years on these topics and their relation to nose and throat surgery led to the awarding of the 1954 Lister Medal. This was presented the following year when Negus delivered the Lister Oration on 5 April 1955 at the Royal College of Surgeons. The oration was titled "The Comparative Anatomy and Physiology of the Respiratory Tract in Relation to Clinical Problems". Ten years later, towards the end of his life, Negus published The Biology of Respiration.
Negus's legacy in this field was assessed in 1986 by the British surgeon and comparative anatomist Sir Donald Frederick Norris Harrison, himself an expert on the mammalian larynx. Writing further on the subject in 1995, Harrison states that Negus's "pioneer research into the mechanism of the animal larynx established him as a unique comparative anatomist." Harrison quotes from the Scottish anatomist Sir Arthur Keith's preface to The Mechanism of the Larynx. In this preface, Negus's 1929 work is described as showing "the same patient power of assembling observation after observation as Darwin had and some of the hot pursuit of function as urged by Hunter".