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diff --git a/34128.txt b/34128.txt new file mode 100644 index 0000000..7e720a9 --- /dev/null +++ b/34128.txt @@ -0,0 +1,6647 @@ +The Project Gutenberg EBook of Sir James Young Simpson and Chloroform +(1811-1870), by Henry Laing Gordon + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Sir James Young Simpson and Chloroform (1811-1870) + Masters of Medicine + +Author: Henry Laing Gordon + +Editor: Ernest Hart + +Release Date: October 24, 2010 [EBook #34128] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK CHLOROFORM *** + + + + +Produced by Bryan Ness and the Online Distributed +Proofreading Team at http://www.pgdp.net (This file was +produced from images generously made available by The +Internet Archive/American Libraries.) + + + + + +Sir James Young Simpson and Chloroform + +(1811-1870) + +BY H. LAING GORDON + + LONDON + T. FISHER UNWIN + PATERNOSTER SQUARE + MDCCCXCVII + + +Copyright by T. Fisher Unwin, 1897, for Great Britain and Longmans +Green & Co. for the United States of America + + +MASTERS OF MEDICINE + +EDITED BY ERNEST HART, D.C.L + + + "HOMINES AD DEOS NULLA IN RE + PROPIUS ACCEDUNT QUAM + SALUTEM HOMINIBUS DANDO." + + CICERO. + + Title. Author. + + JOHN HUNTER _Stephen Paget_ + WILLIAM HARVEY _D'arcy Power_ + SIR JAMES SIMPSON _H. Laing Gordon_ + EDWARD JENNER _Ernest Hart_ + HERMANN VON HELMHOLTZ _John G. McKendrick_ + WILLIAM STOKES _Sir William Stokes_ + CLAUDE BERNARD _Michael Foster_ + SIR BENJAMIN BRODIE _Timothy Holmes_ + THOMAS SYDENHAM _J. F. Payne_ + VESALIUS _C. Louis Taylor_ + + +[Illustration: J. Simpson] + + +To PROFESSOR ALEXANDER RUSSELL SIMPSON + + + "Him by the hand dear Nature took, + Dearest Nature, strong and kind." + + RALPH WALDO EMERSON. + + + "When Nature has work to be done, she creates a genius to do it." + + _Id._ + + + + +PREFACE + + +I have endeavoured to condense the vast amount of matter which has +been written concerning this Master of Medicine and his work into the +form of a readable narrative, and to represent him in his social and +intellectual environment in accordance with the object of this Series. +The selections from his own writings illustrate as far as possible his +versatility and many-sided character. I have chosen for quotation out +of the numerous sketches and memoirs of him those written from +undoubted knowledge of the man. + +I am indebted especially to Professor A. R. Simpson for kind advice, +to Mr. Cuthbertson of the Edinburgh University Library for useful +help, to Mr. C. Louis Taylor for valuable criticism, and to my wife +for assistance in research and compilation. I have also to thank those +friends who from time to time have favoured me with personal +reminiscences of Sir James. + +The following are the chief works, in addition to Simpson's own +writings, from which my information has been drawn:--(1) "The Jubilee +of Anaesthetic Midwifery"; (2) "Keiller and Crede"; (3) "History of the +Chair of Midwifery in the University of Edinburgh," being addresses by +Professor A. R. Simpson; (4) Miss Eve B. Simpson's "Sir James +Simpson"; and her (5) "Dogs of other Days;" (6) "Twenty Years and +their Lesson; a Retrospect and Review" (_Scots Observer_, 1891); (7) +Dr. Duns's "Memoir of Sir J. Y. Simpson"; (8) Professor Gusserow's +"Zur Erinnerung an Sir J. Y. Simpson"; (9) Mr. Cuthbertson's +"Student's Pilgrimage"; (10) "The Story of Edinburgh University," by +Sir A. Grant; (11) "The Life of Sir Robert Christison"; (12) "The Life +of Robert Knox"; and numerous back numbers of the _Century Magazine_, +the _Lancet_, the _British Medical Journal_, the _Medical Times and +Gazette_, the _Edinburgh Medical Journal_, &c., &c. + +FOREST HILL, _October, 1897_. + + + + +CONTENTS + + + CHAP. PAGE. + I. Birth and Childhood. (1811-1825) 1 + II. Student Days. (1825-1830) 17 + III Further Studies. (1830-1835) 36 + IV. Early Practice and Professorship. (1835-1840) 52 + V. Professor and Physician. (1840-1847) 66 + VI. The Discovery of Anaesthetics. (1844-1847) 88 + VII. The Fight for Anaesthesia. 1847 onwards 111 + VIII. Home Life--Controversies 133 + IX. Archaeology--Practice 152 + X. Personal--Professorial--Professional 164 + XI. Further Reforms--Honours 186 + XII. Failing Health--Death 202 + Appendix 223 + Index 227 + + + + +SIR JAMES SIMPSON + +CHAPTER I + +BIRTH AND CHILDHOOD. 1811-1825 + + The state of the healing art at Simpson's birth--Birthplace--Family + superstitions--His father's bakery--His mother's Huguenot + descent--Commencement of schooldays--Natural and antiquarian + features of Bathgate district--The village hand-loom weavers as + antiquarians and naturalists--His interest in Nature and craving + for knowledge--Brothers' and sister's care for him--Size of his + head--Village doctor's record of his birth--Schooldays cease at age + of fourteen--Influence of his environment in developing his + character. + + +James Young Simpson, who will ever be remembered as the discoverer of +the pain-annulling power of chloroform, was born in the year 1811, at +a period when there was room for a hero in the practice of the healing +art in the British Islands. + +It is true that in the seventeenth century Harvey had laid bare the +great fact of the circulation of the blood and the practical Thomas +Sydenham had swept aside the highly empirical systems and theories of +medicine which had successively supplanted each other since +Hippocrates first taught, and urged men to found their knowledge upon +what they actually saw--on observation and experiment; and that in the +eighteenth century men like Cheyne, Heberden, Cullen, and the +wonderful Jenner had appreciably assisted in developing medicine at +the same time that Hunter was raising surgery nearer to the level of a +science. But even while Simpson was growing out of childhood all the +powers of such professional giants as Bright, Addison, Abernethy, +Astley Cooper, and Charles Bell, were insufficient to dispel the +massive cloud of mystery and superstition which enveloped the practice +of both medicine and surgery in this country and obscured whatever +there was of truth in the teaching of these men. + +In the first decade or two of this century the medical profession had +not yet entirely abandoned the use of the golden-headed cane, nor had +what Oliver Wendell Holmes calls the solemn farce of overdrugging yet +ceased. "Humours," "impostumes," "iliac passions," and such like were +still spoken of--terms now heard only amongst country-folks in remote +districts and that rarely, or encountered in curious old medical +publications. Messes and abominations, prepared by the apothecaries +according to more or less secret recipes handed down through the +Middle Ages, were swallowed in good faith; blood-letting was still a +panacea; and such remedies as that of holding a live puppy to the +body for the relief of colic still had their professional advocates, +but happily a decreasing number; whilst those pains + + "... In the hour, + When the veil of the body we feel + Rent round us--while torments reveal + The motherhood's advent in power" + +--pains which Simpson was the first truly to relieve by his +application of anaesthetics, were gravely said to be alleviated by +the swallowing of a concoction of white onions and oil. Surgery +was no doubt ahead of medicine; but the early surgical records of +this century have little more than a curious interest to modern +practitioners. Operations entirely unknown to our professional +forefathers less than a century ago are now performed in safety +daily. Such mysterious diseases as "icteric irritative fever" and +"acute sinking" after operations, dreaded then with the fear that is +always inspired by unseen or ill-understood dangers, have vanished +before the progress of modern science in which the introduction of +anaesthesia was the first great step. + +The practice of the branch of medicine which Simpson made so +peculiarly his own--that of obstetrics--originally in the hands of +women only, had been fiercely contested for by the two sexes during +two centuries, and such was the feeling against man-midwives in +Scotland that the dispute had scarcely ceased at Simpson's birth. The +stronger sex, however, was then at last asserting its superiority, +and to be an accoucheur was beginning to be considered after all as +worthy of a gentleman. The despised art was preparing for its +renaissance. + +Simpson grew to manhood whilst science, aided by precise methods of +accurate observation, was shedding new light upon physic, surgery, +and obstetrics. In fulfilling his great part in establishing the +healing art on a firm scientific basis, Simpson encountered the full +force of the ignorance and prejudice of his day both within and +without his profession. It was, perhaps, fortunate that he was brought +up in a small village and in a rank of life where he would meet from +his earliest days with many superstitious beliefs and practices, +strange and utterly irrational. A mind such as his would meet, +reason, and experiment these out of existence. Probably through +these circumstances he conceived the taste for archaeology and +antiquarian research which were his recreation in later years; but, +what was more important, he gained also some training for the +struggle with ignorance, untruth, and irrationalism, into which he +threw with his eager vigour the whole strength of his manhood. + +Simpson was born in the village of Bathgate, in Linlithgowshire, where +his father, David Simpson, was the local baker. David's father, who +died at the ripe age of ninety-one a few years after James's birth, +was the descendant of a line of small hard-working farmers, who added +to his work and his profit the practice of farriery. Although modern +science has, by the aid of bacteriology, proved such practitioners of +the rough veterinary medicine of the day to have been right in +ascribing to unseen influences many of the diseases of animals which +they found themselves powerless to check, the methods they employed +for treatment when what they called witchcraft was at work scarcely +have the support of present-day practitioners. In one of his addresses +upon archaeology Simpson records how his grandfather ordered and his +own father took part in the burial alive of a cow in order to appease +the evil spirit which was spreading the plague of murrain with fatal +effect. And the older gentleman was known to have had more than one +serious encounter with a witch. On one occasion an old beggar woman, +who plied her calling in quite an original method--that of being +wheeled in a barrow from farm to farm--hurled curses at old Simpson +for ordering a servant to wheel her from his house on to her next +calling-place, and vowed an awful vengeance on his family if he did +not replace the servant with one of his stalwart sons. The farmer +recollected that an ill event had followed the old woman's last visit, +and quickly drew a sharp flint from his pocket and made a gash across +her forehead with it. "Ah," he exclaimed, "I see what ye're noo, ye +auld witch; but I've scored ye aboon the braith and my house is +safe." + +Simpson noted these and many other curious practices and beliefs, and +afterwards pointed out in one of his addresses that they were +probably, for the most part, relics of the pagan creeds and customs of +our ancestors. He urged the making of a collection of the folk-lore of +Scotland, ere it utterly disappeared before the march of modern +civilisation, and suggested that, perhaps, some archaeological Cuvier +might one day be able to re-construct from these mythological +fragments distinct pictures of the heathen practices, rites, and +faiths of our forefathers. + +In his early boyhood he listened to many stories of local and family +superstitions told to him with all the earnestness of a firm believer +by his father. He himself was the object of superstitious admiration +to the simple villagers all through his boyhood, and they freely +foretold great deeds from him in later years; for he was a seventh +son, and the good luck which seventh sons were supposed to bring had +appeared in the family soon after his birth. Up to the day on which +James first saw the light, June 7, 1811, the baker's business had been +going steadily from bad to worse, and the shop books showed that on +that very day the lowest depths were reached. The baker, David +Simpson, seems to have been curiously lacking in business method, +although he was a hard-working man. But after James's birth he wisely +interested his wife in his affairs, with the result that she +energetically and successfully bestirred herself to recoup their +fallen fortunes. Mrs. Simpson was directly descended from a fugitive +Huguenot family, settled for many years on a farm near Bathgate, and +intermarried with well-known families. Through her, indeed, Simpson +claimed a distant relationship with the national hero, Sir William +Wallace. The cares of her family and the strain of managing the +increasing baker's business proved too much for her always delicate +constitution, and she died when James was only nine years old. There +is no doubt that the youngest child and favourite son had an unusually +large share of his mother's society during those years; he was a +peculiarly attractive child, "a rosy bairn wi' laughin' mou' and +dimpled cheeks," and his manner, even when he was little more than an +infant, was quiet and affectionate. When physical sufferings overtook +the mother, the child's quiet sympathy and engaging manner helped and +comforted her. Her own nature was bright, vivacious, and energetic, +quick to think and prompt to act; and she was full of love, sympathy, +and piety. These maternal traits influenced the youth, and added a +soft, refined--delicately refined--tone to the paternal influence, +whence he received self-reliance and habits of persevering industry. + +The boy's school-life began at the age of four years. The orthodox +learning came very easily to him; he entered into both work and play +so whole-heartedly that he at once became known as the "wise wean," +and was at the same time ever sought after by his school-mates as a +companion in out-door sports. The parish schoolmaster was one James +Taylor, who had considerable ability for the post, and encouraged his +pupils by kindly personal interest to develop affection for learning. +But for Simpson there were other teachers and greater subjects for +study in the countryside around Bathgate. The district was full of +rich treasures for the field naturalist and for the antiquarian. +Bathgate lies between the Firth of Forth and the Pentland Hills, in a +geologically varied district, with a varied and abundant flora and +fauna--more so in those days when Bathgate was a small village of +hand-loom weavers than latterly, when it was a thriving little town, +the centre of a coal, shale, and ironstone mining industry. The +archaeological features of the neighbourhood were full of interest. +There was the famous "Catstane," of Kirkliston, which had puzzled +antiquarians even before the establishment of the Scots Society in +1780, and at Kipps was one of the few remaining cromlechs--and that a +ruined one--in Scotland; whilst the line of the Roman wall between the +Firth of Forth and the Clyde was not far distant. There were traces of +a Cistercian monastery founded by David I., and various hills and +fields and caves were associated with the names of Sir William +Wallace, Robert Bruce, and King Edward I. + +Simpson thoroughly familiarised himself in boyhood with the natural +features, as well as with the antiquarian objects in the district. +He continued to investigate them during his vacations when a student +at Edinburgh University, and rendered the neighbourhood famous +archaeologically by masterly monographs written when he was at the +height of his fame. Amongst the village hand-loom weavers, a race +of peculiarly observant and intelligent men, there were some who +studied both the antiquarian objects and the natural history of +Linlithgowshire. Simpson used to speak of one man, a daily labourer +at the loom, who was able to write, in correct Latin, an accurate +description of any plant or animal brought before him, although +his earnings at the loom never amounted to fifty pounds a year. +These men thoroughly enjoyed the evident interest of the "young +philosopher" in their discussions and demonstrations, at the same +time kindly directing his mind towards the simple, painstaking, true +methods of observing and reflecting upon nature. There was no lack +of change in his environment for him; his interest in natural +phenomena was roused and kept alive during his drives round the +countryside delivering bread to the farmers and cottagers, or in +occasional visits to his parents' relations. He daily took his turn +behind the shop counter, reading, writing, or drawing in the +interval of waiting for customers. He trained himself to read or +do his school lessons as readily in a roomful of romping children +as in the quiet of the bedroom. It has been said that he never knew +an idle moment from the day of his birth onwards, and his was such +an indomitable and persevering energy that the remark is no +exaggeration. But the pathway to greatness was made specially smooth +for James Simpson. He was set upon it, and protected in his +childhood, and guided in his youth, with the one definite object +always in view. The Simpson family as well as the whole Bathgate +community, took it for granted that eminence was to be his in +whatever walk of life he entered seriously upon. His sister Mary and +his brother Alexander looked upon him as a special care; the former +watched over him as a mother, and the latter helped him in the ups +and downs of boyhood, just as he constantly stood by him throughout +the difficult days of his later career. It had always been a +custom in Scots families of humble rank that one child, either from +the exhibition of a natural aptitude, or through the ambition of +the parents, was singled out to receive the advantages of a fuller +education such as is within the reach of every able lad in Scotland. +Honour and glory would thus be brought to the family, greatest of +all if from the pulpit, while the less favoured members of the family +would plod on in the same sphere of life as their parents. The world +owes a great deal to the Simpsons, and particularly to Alexander, who +cheerfully seconded their father's efforts to help forward their +young brother, without a suspicion of jealousy. They knew he would +be great some day, and therein they looked for their reward. + +Happily there were ample means for all their requirements derived from +the now prosperous bakery. The money was kept in one drawer, the till +where the shop earnings were placed. All the household were free to +draw thence supplies for their ordinary wants, James without stint; +and he alone was exempted from the condition that he who profited must +also contribute by the sweat of his brow. The boy took very full +advantage of his fortunate circumstances and drank deeply of all the +knowledge that came near and ever hunted for more. With each +succeeding year the craving to know, and to know thoroughly, became +more and more his ruling passion; by the time his schooldays were over +it had gained complete mastery over him; happily for the human race +Providence had so endowed him that when knowledge had come wisdom did +not linger. + +He was never in any way led away by the temptations that no doubt +beset every boy in a village of hard-drinkers such as Bathgate was in +his youth. Alexander took pains to warn him--"Others may do this, +Jamie, but it would break all our hearts and blast all your prospects +were you to do it," he said. It was not necessary to make appeals to +James to work and fulfil the family predictions; he was as firmly +determined to be great as they were sure he would be: He never forgot +how much he owed to the loving help of his family, and to the fact +that he was the youngest son growing up at a time when the family +struggles were fairly over; when instead of its being an effort for +the parents to provide the necessary funds for his education, the +shop-till was well filled and the elder brothers and the loving sister +were at hand eagerly willing to help. In student days when struggles +came and the path seemed dark and beset with dangers, the knowledge of +the firm faith in his powers of the family at home and of the scarcely +smaller faith of the weavers, was a powerful incentive in the moments +when he required any other than that of the spirit within him. + +We cannot feel otherwise than thankful that up to the age of fourteen, +when his schooldays ended, he had access to but a limited stock of +literature wherewith to gratify his hunger for knowledge. To satisfy +his appetite he was driven into the fields and the forests; every +sense was stimulated, and became developed through repeated use. Thus +he laid the foundation of his phenomenal faculty of rapid and accurate +observation, and of his no less phenomenal memory. + +His imagination was fed with the legends of the district and tales of +his remote moss-trooper ancestors told to him of an evening by his +father. Though happily saved from being a bookworm to the exclusion of +sounder means for acquiring knowledge, he devoured and digested every +scrap of literature which came in his way. Like all Scots children of +his class he learnt his Bible thoroughly from end to end--a knowledge +which served him well in later years. Shakespeare followed the Bible +in his own review of his favourite reading as a boy; but a gazetteer +or an almanac was quite as acceptable. His taste was for solid +fact--fact which he could learn and put to the test; thus the great +open book of Nature was the attraction he most readily yielded to. But +nothing in book form ever came amiss to him; if between the covers +there was useful information to be had, Simpson extracted it and +stored it away in his capacious brain. + +The unusually large size of his head, a source of admiration in +manhood, was in childhood an object of wonder to observers. In manhood +he wore his hair in long locks, and this was apparently his habit in +boyhood. Once a strange barber cut his hair so close that his brother +took upon himself to go and rebuke the man. "The callant had suck a +muckle head," was the retort, "I was doin' my best to mak' it look +respectable." A close-cropped head gave altogether a too sportive +appearance to the "young philosopher" in the eyes of the watchful +elder brother. + +There is no evidence that Simpson displayed in his schooldays any +special leaning towards the medical profession; it cannot be +reasonably urged that his grandfather's rough skill in the treatment +of animals fostered any medical tendency in him, for James was but +five years old when the old man died. Even had he been of an age to +understand them, the methods employed would have scarcely recommended +themselves to a youth of Simpson's nature, sufficiently to raise a +spirit of emulation within him. It is also not recorded that the +village doctor took any special interest in the boy or brought any +influence to bear upon him; although his note-book thus gives the +earliest record of the future prince of obstetricians:-- + + 275.--June 7. Simpson, David, baker, Bathgate. Wife, Mary Jarvie. + AE. 40. 8th child, son. _Natus_ 8 o'clock. _Uti veniebam natus._ + Paid 10s. 6d. + +James displayed his superiority so decidedly in the village school +that when he reached the age of fourteen it was decided to send him to +Edinburgh University without further waste of time. It was no unusual +age for boys to commence their University career in Scotland. There +was no secondary education in the Scots provinces, but instruction +intermediate between that of the parish school and what is ordinarily +known as University education was given within the walls of the +University itself. Boys of humble rank who aspired to a profession +were sent up, as indeed many still are, at the age of fourteen or +fifteen, to attend these junior Arts classes in which this instruction +was, and still is, imparted. The University was crowded with +schoolboys of all ranks of life gathered together from town and +country, and consisted of nothing more than a collection of +class-rooms devoted to the giving of instruction in lecture form. This +stepping-stone of junior classes threw open the higher education to +hundreds of youths whose equals in England had no such advantage at +that time. Scots University education besides being thorough was +decidedly cheap, so that the church, law, and medicine received many +recruits from the class out of which Simpson was drawn. + +His environment up to the age of fourteen was well calculated to train +him for the great work that lay before him. The legends of the +district, and the sight of the objects of archaeological interest which +he came across in his rambles out of school hours, were powerful +stimuli to his sensations; whilst the accurate observation of natural +phenomena in field and hedge which the kindly interested weavers +helped him to, was also a valuable educative influence. It is probable +that his senses received much of the training which was to lead to his +ultimately being the greatest physician of his day by these means, +rather than from the instruction imparted to him in the village +school, or derived by him independently from the books that came in +his way. It was undoubtedly a fortunate circumstance that he was born +and bred in an out-of-the-way country district, where he drew his +lessons from Nature and the phenomena which lay round him, rather than +in a great city where he would have been educated on the stereotyped +orthodox system. When we look further back, asking why he saw sermons +in stones and books in the running brooks, to which the bulk of his +schoolfellows were entirely blind, we are bound to confess that we +find no satisfactory answer in his family history, to which it is +customary to look for an explanation of such tendencies. Heredity +played no great part in making Simpson great; from the paternal side +there was imparted to him a vigorous physique; from his mother he +received the bright, happy, sympathetic, and alert disposition, which +descended through her from his French ancestors. He was provided with +a brain of marvellous quality and phenomenal size. But it was the +environment which acted upon this brain and brought out the capacities +born in him without any apparent hereditary bias, and which might have +remained entirely latent under less favourable circumstances. No small +part of the development was due to the people among whom he lived; a +race of men accustomed to rely upon their senses which were always +with them, rather than upon books which they seldom saw, even if they +were able to read them; and to observe not only all that lay around +them, but also the characteristics of their fellowmen with whom they +were brought into contact--the close contact of different classes +which obtains in village and rural life. Simpson was taught to study +Nature whether in field or fellow-creature first, and the knowledge +and opinions of men as expressed in books afterwards. + + + + +CHAPTER II. + +STUDENT DAYS. 1825-1830. + + Visit to Edinburgh--Sent to the University--Takes the Arts + classes--Gains a bursary--Influence of MacArthur and Reid--Robert + Knox the anatomist--The Burke and Hare murders--Superiority of the + extra-mural teachers of the day--Edinburgh an intellectual + centre--University life--His mode of living as a student--Apprenticed + to a chemist--Studies surgery under Liston--Regularly falls asleep + in the obstetric class--Influence of his teachers--Verse + writing--Description of the medical student of the day--Vacation + work--Death of his father--Obtains qualification to practice at + the age of eighteen. + + +Although Edinburgh was only eighteen miles from Bathgate, Simpson +visited it only once as a schoolboy; probably he walked all the way, +for railroads were as yet unknown and it was not a long walk for a +country-bred vigorous youth. He exercised his already formed habit of +noting objects of interest during this great event in his boyhood, and +in his journal there are copies of old inscriptions from tombs in the +famous Greyfriars' Churchyard to which he made his pilgrimage. + +The boy's nearest and dearest ambition was to become a student at "the +College," as Edinburgh University was familiarly termed. It received +encouragement in the periodical return to the village of elder boys +who had gone up before him. He was specially struck, and afterwards +stimulated, by the appearance of one John Reid, his senior by two +years, and his former companion in many a country ramble, who came +back for the vacations smartened up both physically and mentally by +the new life. + +Although the collegiate life characteristic of Oxford was unknown in +Scots Universities, there was social intercourse amongst the boys very +different from that of the village. The ancient Edinburgh University +attracted students from all parts of the world, mostly for the medical +curriculum, but many preceded the professional course with a year or +two's attendance on the Arts classes; and it was usual for young +Englishmen of good family to spend a session at Edinburgh before going +to Oxford or Cambridge. Probably before he entered the medical +classes, Simpson rubbed shoulders with lads of all ranks from home and +abroad. Pillans was at this time the Professor of Humanity, Wallace +held the chair of Mathematics, John Wilson--better known as +Christopher North--that of Moral Philosophy, and Dunbar was Professor +of Greek. Wallace had begun life as a bookbinder's apprentice, and +Dunbar had risen from being a gardener; the example of these men under +whose influence he was brought encouraged the baker's son to go and +do likewise. + +The family had sent him off to the College with the mission to be +famous, and he was beginning only in an orthodox fashion when he +entered himself for the curriculum in Arts. It had been easy for him, +with his magnificent brain power, to stand _dux_ of the village school +over the ordinary village youth; but here, in Edinburgh, he was +brought into competition with the picked boys from other country +schools, and intellectually eager youths from town schools where the +course of instruction was such as more easily to lead to early +University success than that of the Bathgate parish school. At first +he found difficulty and desponded. The keen observer with senses all +alert was dashed to find so much of the College life to which he had +so eagerly looked forward only a magnified repetition of the dull +school routine. But he was too intent on ultimate success to be +repulsed by his initial disappointment, and soon brought his mind into +adjustment with the circumstances he found himself in, reserving +leisure time and vacations for the exercise of his faculties as he +most loved to exercise them. He did not persevere in the Arts course +after he found his tastes led him to other studies; he did not trouble +to obtain the Master of Arts degree, which was then conferred in a +very lax manner; probably he saw its worthlessness, for it was not +until the passing of the Scots Universities Act in 1858 that this +degree became really valuable. He recognised, however, the value of +laying a good foundation of general knowledge; without straining after +any distinction he acquitted himself creditably in all his classes. In +the second year of the curriculum he won one of the numerous small +bursaries of the value of L10 a year, for which logic was one of the +chief subjects of examination; but as candidates were restricted to +those who possessed either the name of the founder, Stewart, or that +of his wife, Simpson, the competition was not particularly severe. His +individuality and natural straightforwardness attracted the attention +of some of his professors. The boldness of his original essays +provided them with food for comment in a manner dear to the +professorial heart. + +The Arts curriculum served him usefully in helping to develop a +literary style and in teaching him how best to express his vigorous +thoughts, as well as in strengthening his knowledge of Latin and +Greek. According to the record preserved on his class certificates he +worked attentively and diligently; but the mere fact that he did not +excel is sufficient proof that he did not make an attempt. + +During his Arts course Simpson lodged at No. 1, Adam Street, along +with the John Reid already mentioned, who was now a medical student, +and with a Mr. MacArthur, who had been a junior master at the Bathgate +school, but had now also commenced to study medicine. MacArthur was a +man of dogged determination; he urged Simpson to persist with his +Arts course when his spirit seemed to rebel against it, and so long as +they were together seems to have maintained some of the authority of +the usher over both of the youths. The spirit of work was strong +within him. Soon after Simpson joined him he related that he could +then do with four hours' sleep, John Reid with six, but he had not +been able to break in James yet. What MacArthur and the Arts course +could not do, however, the attraction of medicine accomplished without +effort, and Simpson soon formed the habit of early rising. + +It seems remarkable that so much study should have been required when, +compared with to-day, the science of the healing art was in but a +rudimentary condition. The teachers of the day had, in spite of +Sydenham, a great regard for authority, and burdened their students +with much that is utterly unknown to the present generation, and, if +known, would be regarded as worthless. A very large part of the +curriculum consisted of practical and bedside work, so that book study +was necessarily left to the evening or early morning. All three +students, moreover, were fired with ambition, and thirsted for +something more than mere professional knowledge. MacArthur constantly +urged on his two young friends, and foretold great things for them if +only they would work. When he afterwards heard of their successes he +used to say, "Yes, but _how_ they worked." Simpson became the +greatest living obstetrician, and Reid rose to be Professor of +Physiology in St. Andrew's University. MacArthur never became famous; +his name is known only because of the initial impetus which his +influence gave to the professional careers of his two young friends. + +In his close association with two such men as MacArthur and Reid, +Simpson was again fortunate in his environment. The art of medicine +was also fortunate inasmuch as at the right moment the right +influences were at work to direct his mind towards it. While occupied +in mastering the laws of hexameter and iambic or in assimilating the +prescribed portion of Virgil and Tacitus, he happily now and then, +living with two such enthusiastic medical students, got a taste of the +more stimulating study of things scientific--food which was more +agreeable to his mental palate, more suited to his mental digestion. +By peeps into anatomical books, by little demonstrations of specimens +in their lodgings, and by occasional visits to some of the lecture +rooms or the wards of the Infirmary, his appetite was whetted for that +great study of nature which his youthful training at Bathgate had +prepared him for, and for which his mental constitution was specially +adapted. One can picture the eagerness with which he would cast aside +the finished Greek or Latin essay and urge the not unwilling embryo +professor to demonstrate a bone or lecture on an anatomical +preparation. + +Sometimes as a special favour he was taken by Reid to hear one of the +lectures of the notorious Robert Knox, the extra-academical teacher of +anatomy, whose strong personality and unrivalled powers as a lecturer +were at that time attracting to Surgeon's Square hundreds of students, +while Munro (Tertius) was mechanically repeating his grandfather's +lectures from the University chair. + +It was towards the end of 1828, when Simpson was just about commencing +his medical studies that Edinburgh, and in fact the whole of civilised +Europe, was horrified by the revelation of the doings of Burke and +Hare, when they were at last brought to justice for the long series of +crimes perpetrated for the purpose of selling the bodies of their +victims to the anatomical schools. Knox having a class of some four +hundred students had special difficulty in meeting the demand for +"subjects," and it was brought to light at the trial of Burke that the +majority of the bodies were disposed of to Knox. As was only natural, +a fierce indignation against Knox sprang up in the city. His residence +was assailed and his effigy burnt. His life was in danger at the hands +of the mob on more than one occasion. + +Lord Cockburn in his "Memorials of His Time" says that all the +Edinburgh anatomists incurred an unjust and very alarming though not +an unnatural odium--Dr. Knox in particular, against whom not only the +anger of the populace but the condemnation of more intelligent +persons was directed. "But," he says, "tried in reference to the +invariable and the necessary practice of the profession our anatomists +were spotlessly correct and Knox the most correct of them all." + +These were stirring times in Edinburgh medical circles. The strong, +cool demeanour of Knox under the persecutions to which he was +subjected, must have made an indelible impression on Simpson's mind, +and the memory of it may have served to strengthen him in later years +when himself subjected to the unjust accusations of thoughtless and +ignorant people. + +One night when Knox had attracted a large class to hear him on a +favourite subject, the crowd in the street mustered in unusual force; +the yells and howls from outside were heard distinctly in the +class-room. The students got alarmed, and kept looking to the doors of +egress. Knox perceiving the restlessness and alarm of his audience +paused, and then addressed to them reassuring words, expressing his +contempt for the cowardly mob, and reminding them of the great men who +at different times had suffered persecution for the cause of their +science. His statement was received with such cheers as resounded +beyond the class-room walls and actually cowed the uproarious mob, so +loudly did the students applaud the words of the man who, they knew, +daily placed his life in danger in order to lecture to them, and whose +last hour seemed to have come, so great and threatening was the crowd +on this particular evening. + +If Simpson did not actually witness such a scene as the foregoing--he +was not a member of Knox's class until the session 1830-31--he must at +least have known full well about it at the time, and shared with the +whole body of students the worship of the man as a hero. His fellow +lodger, Reid, was not only a distinguished pupil in Knox's class, but +became one of Knox's demonstrators in 1833, and was always a prominent +Knoxite. We know also that Knox went down to Bathgate to visit Reid's +relations there, so that it is justifiable to conclude that Simpson +came closely in contact with this remarkable teacher. That the +relationship between Reid and Simpson was most intimate we have the +former's own words for. At a public dinner given to him when appointed +to his professorship in 1841, he said, "In the croupier (Simpson) I +recognise my earliest friend, a native of the same village. We were +rivals at school and at college. We stood to each other from boyhood +upwards in every possible relation, whether of an educational, +warlike, delicate, or social character, which the warm and fitful +feelings peculiar to boyhood and youth can produce." + +In the end Knox and Reid quarrelled over a scientific matter. Knox +never recovered from the effect of the Burke and Hare incident; in +spite of the favourable report of an influential committee appointed +to inquire into his share in the proceedings, and his own explicit +statements, the public never acquitted him of at least a wilful +shutting of his eyes to much that ought to have aroused his +suspicions. His crowded class-room gradually became empty during the +next few years, and the once brilliant, talented, and determined man +became demoralised and left Edinburgh. Christison says that Knox +finally died almost destitute in London, and that one of his last +occupations was that of showman to a party of travelling Ojibbeway +Indians. + +However the strong personality and attractive lecturing of Knox may +have influenced him, it is undoubted that to the personal influence of +MacArthur and Reid, acting upon his constant hunger to know nature and +truth, stimulated as it was by what he saw of anatomy and physiology, +we owe the fact that Simpson decided to enter the medical profession. + +Although the number of medical students in Edinburgh University +reached one of its highest points during the years that Simpson was a +student, it is remarkable that with one, or perhaps two, exceptions, +the University professors were men of no marked eminence in their +various subjects. On the other hand, the extra-mural teachers included +men of such wide reputation as Knox, Lizars, and Liston. Syme, who +reached the height of his fame as a surgeon about the same time that +Simpson became renowned, had just resigned the teaching of anatomy to +take up surgery; shut out at first from the wards of the Royal +Infirmary by jealous colleagues, he was boldly establishing for +himself the little Minto House Hospital, which became the successful +nursery of his own unsurpassed system of clinical teaching, and +remains in the recollection to this day as the principal scene of Dr. +John Brown's pathetic story, "Rab and his Friends." It was chiefly +these extra-academical teachers who at that time made the medical +school famous, and were raising for it a reputation in surgery such as +it had acquired in physic in the days of Cullen. In certain subjects +the students would, according to the regulations for the degree, take +out their tickets of attendance on the professor's course of lectures, +but would put in only a sufficient number of appearances to entitle +them to the necessary certificates; the real study of the subject +being made under the more accomplished teacher outside the University +walls. + +Edinburgh was at this period much more than the scene of the foremost +medical and surgical teaching of the day in the world. It was a +striking centre of intellectual activity. Sir Walter Scott, +Cockburn, and Jeffrey were famous in literature and politics; Chalmers +and Moncrieff in Church affairs; and Aytoun, John Wilson, Sir +William Hamilton, and Sir David Brewster were names that attracted +men from far and wide to the modern Athens. English and foreign +advocates, scholars, artists, squires, and noblemen mingled together +to hear or see some of these men. Lord John Russell, Henry +Temple--subsequently Lord Palmerston--and Lord Melbourne were +amongst the young Englishmen who attended university classes for a +session or two; and H.R.H. the Prince of Wales, and his brother the +Duke of Edinburgh, each matriculated in later days. When Simpson began +his studies Knox was the great lion, without a visit to whose +class-room no sojourn in Edinburgh was complete; just as in later +years Simpson's house in Queen Street was the resort of all sorts +and conditions of distinguished people. + +The University had little control over her students once they were +outside the gates of the quadrangle. There were no residential +colleges; each youth found lodgings for himself suitable to his means, +and led a perfectly independent life. So long as he conducted himself +with propriety within her walls his Alma Mater cared little how he +conducted himself or how he fared outside. Before 1858, when the Town +Council controlled University affairs, there were sometimes attempts +to order the comings and goings of students. It is recorded that in +1635 the Town Council discovered that the scholars of the College were +much withdrawn from their studies by "invitations to burials," which +"prejudiced their advancement in learning," and they enacted that no +student was to be permitted to attend burials except those of +University or city worthies. This was at a time when some of the +students were provided with residences inside the University, but by +the beginning of the eighteenth century College residence had ceased. +From time to time attempts have been made to render the students +conspicuous in the city by the wearing of red gowns, but without +success; and those of all faculties continue to be their own masters, +in marked contrast to the mode of government in force at Oxford and +Cambridge. Recently, in the eighties, a batch of students who had +figured in the police-court after a riot in the gallery of a theatre +were surprised to find themselves summoned before the Senatus +Academicus and rusticated for varying periods; this, however, was but +a spasmodic exercise of power. The chief advantage claimed for this +custom of leaving the student to his own devices is that it encourages +independence and develops each man's individuality better than a +system of discipline and control. In men of Simpson's calibre it +certainly has had a good effect. + +Although the family in Bathgate strained every nerve to keep James +well supplied with the necessary funds as a student, they were not +able to place him in such a pecuniary position as to make it +unnecessary for him to exercise economy: He appears to have been very +careful indeed of the money which he had; much more careful than when +he reckoned his income by thousands. He kept methodical accounts of +his expenses down to the most trivial items, and regularly submitted +them to his family. His cash-book opened with the following quotation +from a small book called the "Economy of Life," which figures at a +cost of ninepence:--"Let not thy recreations be expensive lest the +pain of purchasing them exceed the pleasure thou hast in their +enjoyment"; and to this he added:-- + + "No trivial gain nor trivial loss despise; + Mole-hills, if often heaped, to mountains rise. + Weigh every small expense and nothing waste; + Farthings long saved amount to pounds at last." + +It is easy to see here the imprint of a well-known national +characteristic, from which, however, he completely shook himself free +when prosperity came to him. + +His share of the rent of the Adam Street lodging amounted to only +three shillings a week. The entries in the cash-book show how frugally +he lived and how every spare sum was devoted to the purchase of books. +His library, the foundation of much of his encyclopedic knowledge, was +a curious mixture. Adam's "Antiquities," Milton's Poems, Byron's +"Giaour" and "Childe Harold," a Church Bible, Paley's "Natural +Theology," Fife's "Anatomy," and "The Fortunes of Nigel," were amongst +those entered as purchased. The daily entries were such as the +following:--"Subject (anatomical), L2; spoon, 6d.; bread and tart, 1s. +8d. Duncan's Therapeutics, 9d.; snuff; 1-1/2d.; Early Rising, +9-1/2d." + +He followed out the usual student's custom of the day of learning +dispensing by serving for a time in a chemist's shop. The late Dr. +Keiller, of Edinburgh, used to relate how, while he himself was so +employed in a chemist's shop in Dundas Street, one day "a little +fellow with a big head" was brought in and entered as a pupil by a +relative. The little fellow was Simpson, and no sooner was he left in +the shop than he sat down with a book upon drugs, and turning to the +shelves took down drug after drug to read up. The prompt industry of +the big-headed fellow deeply impressed Keiller. + +James attended most of the University classes, but studied surgery +under the great Robert Liston, the foremost extra-mural surgeon, +daring and skilful as an operator and of great repute as a lecturer, +who afterwards filled the post of Professor of Clinical Surgery in +University College Hospital, London. Liston was an abrupt-mannered but +sincere man, and a keen lover of truth. He was a warm advocate of +hospital reform, and was successful in introducing several needed +improvements into the Royal Infirmary after a fierce fight. Here again +Simpson was brought under the influence of a strong, self-reliant man +with a distinct tendency towards controversy; to whom he was also +attracted by the fact that Liston was a native of Linlithgowshire. +Liston and Syme, after being close colleagues, quarrelled most +fiercely, and were bitter rivals until Liston removed to London in +1835. Simpson attended Liston's lectures during three sessions. + +There is no record of his having obtained great distinction in any of +the medical classes, but his certificates show that he worked with +pre-eminent diligence in them all, and obtained a characteristic +mastery of each subject. If any exception occurred it was in the very +subject in which he afterwards earned his greatest scientific +fame--that of obstetrics. He attended Professor James Hamilton's +course of lectures on that subject early in his career, and apparently +felt so little interest--the subject only became a compulsory one for +examination for qualification in 1830--that he regularly went to sleep +during the lecture. The excuse urged was that the lecture being a late +one, three to four in the afternoon, it found him tired out after a +long morning of study, lectures, and practical work. But had he been +keenly interested he would have been wide awake, for Hamilton was a +forcible, if plain, lecturer. + +Hamilton was another of Simpson's teachers who exhibited the same +uncompromising fighting characteristics--eager and strenuous in his +efforts to obtain some object--which Simpson himself afterwards +displayed. He fought hard for fifteen years to gain recognition for +the subject which he taught, and to have it included in those +necessary for qualification. He succeeded in the end, but in the +course of the struggle had to bring two actions at law against +professional brethren. In one the defendant was Dr. Gregory, whose +teaching was mainly responsible for the British system of medical +practice in the early part of this century, viz., free purging, +free bleeding, and frequent blistering, and who was the inventor of +that well known household remedy, Gregory's powder. Gregory was also +a pugnacious man and could not abide the pretensions of the +representative of the despised art of midwifery; he administered a +public caning to him, and had to pay L100 in damages which, it is +said, he offered to pay over again for another opportunity of +thrashing the little obstetrician. This encounter occurred before +Simpson became a student, but the memory of it was frequently +revived in the subsequent disputes which Hamilton carried on. + +The notes which Simpson took of the curriculum lectures were concisely +made and full of comments, criticisms, and queries. He by no means +bowed down to authority; he allowed nothing to pass which he did not +understand at the time, and specially noted points which it seemed to +him his teachers themselves did not understand. + +Like most young men of his abilities and temperament, Simpson took +pleasure in rhyming, and some of his verses are preserved. They +indicate something of the rollicking spirit of the medical student's +life seventy years ago. The medical student at that date has been +described in a recent interesting sketch of Edinburgh student life as +wearing a white great-coat and talking loud; his hat was inclined +knowingly to one side of his head, and the bright hues of an Oriental +handkerchief decorated his neck. There was a great deal of acting in +his motions. He was first at the door of the theatre on a Saturday +night, and regardless of the damages sustained by the skirts of his +coat, secured the very middle seat of the fifth row of benches in the +pit. Simpson, however, hardly conformed to this description. He +enjoyed recreation as much as any man, and had a keen sense of humour +which made him popular among his fellow students, but he was saturated +with the love of study and was not led into extravagances of the Bob +Sawyer type, or the harmless inanities of Albert Smith's immortal +Medical Student. + +During the long summer vacation he noted carefully his observations on +the botany, zoology, geology, and even the meteorology of the Bathgate +district. Dr. Duns, in his memoir, points out that he was much more at +home with the phenomena of organic than with those of inorganic forms. +His highest powers came into play when he had to do with the presence +of life and its varied manifestations. Even his antiquarian notes +illustrated this. He passed at once from the things to the thoughts +and feelings of the men associated with them. + +In the holidays he also assisted the village doctor in visiting and +dispensing, and lent a willing hand in his father's shop when he was +wanted, often enough driving the baker's cart on the daily round of +bread delivery. + +In January of the year 1830 his father was taken seriously ill, and +James hastily left Edinburgh and tended him till his death. On his +return he presented himself for the final examination at the College +of Surgeons. This he passed with ease and credit in April, and found +himself a fully qualified medical practitioner at the age of +eighteen. + + + + +CHAPTER III + +FURTHER STUDIES. 1830-1835 + + Applies for a village appointment--Disappointment--Brother's help + to further studies--Dispensary assistant--Obtains University M.D., + 1832--Thesis--Assistant to the Professor of Pathology--Turns to + obstetrics--Attends Professor Hamilton's lectures again--Royal + Medical and Royal Physical Societies--Edward Forbes--The + Oineromathic Society--Foreign tour--Visits Liverpool and meets + Miss Jessie Grindlay--His characteristics, principles, and + methods, with extracts from addresses. + + +There now came the first crisis in Simpson's medical career. After +his father's death he felt that having obtained his qualification +to practise it was his duty to relieve his family of the burden of +supporting him through more extended studies. After due deliberation +he applied for a small appointment which would have served as a +nucleus for private practice, that of parish surgeon to a small +village on the banks of the Clyde. Those in whose hands the +appointment lay were not impressed with his fitness for the post, +and he was not elected, "I felt," he afterwards said, "a deeper +amount of chagrin and disappointment than I have ever experienced +since that date. If chosen, I would probably have been working there +as a village doctor still." Although such a commencement might have +delayed his ultimate rise to eminence, it cannot be agreed that it +could possibly have prevented it. It was at this crisis that what he +tenderly referred to as "the ceaseless love and kindness of a dear +elder brother" came to his rescue, and by Alexander's or, as he +affectionately called him, "Sandy's" help, he returned to Edinburgh +to resume his studies in the winter session, 1830-31. His other +brother, David, had started in business as a baker at Stockbridge, +close to Edinburgh, and James boarded with him there for a time. +His qualification enabled him to become assistant to a Dr. Gairdner +in dispensary practice, a class of work he had had some experience of +in the previous year while staying with Dr. Girdwood at Falkirk during +the summer. Dr. Gairdner was much struck with Simpson's abilities, +which he stated, "promised the most flattering expectations." In the +course of his first experiences of actual practice he became +impressed with the necessity for a knowledge of obstetrics, and +therefore attended lectures on the subject by Dr. Thatcher, an +extra-mural teacher of repute, who subsequently applied for the +University chair of midwifery when Simpson was the successful +candidate. + +His chief object, however, was to qualify for the degree of Doctor +of Medicine of the University, and this he succeeded in doing in +1832. The regulations for this coveted degree were, for the times, +wonderfully complete; it was held in such high estimation and such +large numbers qualified annually--in 1827 there were one hundred and +sixty graduates--that the authorities felt justified in being +stringent. The length of the course of study necessary for graduation +had been fixed at four years, and required the candidate to have +attended classes in Anatomy, Surgery, Materia Medica, and Pharmacy, +the Theory and Practice of Medicine, Clinical Medicine, Midwifery, +Chemistry, and Botany, as well as a three months' course in any two +of the following:--Practical Anatomy, Natural History, Medical +Jurisprudence, Clinical Surgery, and Military Surgery. The first +step in examination took place at the house of one of the professors +where the candidate was questioned in literary subjects, chiefly +Latin, and in the different branches of Medicine and Surgery. If he +passed this satisfactorily he was examined more minutely by two +professors in the presence of the others, and was subsequently given +two Aphorisms of Hippocrates to explain and illustrate in writing and +to defend before the faculty, as well as two cases with questions +attached. The last step was the presenting of a thesis which was +read by one of the faculty and was publicly defended by the +candidate on the day of graduation. All this examination was +conducted in Latin. Simpson's thesis was entitled: "_De causa +mortis in quibusdam inflammationibus proxima_." He was amongst the +last graduates who were examined through the medium of Latin, for +after 1833 the language was optional, and English soon became the +only one used; at the same time the examinations were differently +arranged, and made to consist of more thorough and prolonged written +and oral stages. Being on a pathological subject, Simpson's thesis +was allotted to Thomson, the professor of Pathology, to examine, +who not only recommended the author for the degree, but was so +impressed by the ability displayed in the dissertation that he sought +him out and promptly offered him the post of assistant, which +Simpson as promptly accepted. This appointment was most welcome. Not +only did it give him a much desired opportunity for pathological work, +but the salary of L50 a year enabled him to free his family from +the immediate necessity of supporting him. + +If to MacArthur and John Reid was due the credit of first directing +Simpson's thoughts to the study of medicine, to Professor John Thomson +belongs the credit of having made him an obstetrician. "At Dr. +Thomson's earnest suggestion and advice," says Simpson, "I first +turned more especially to the study of midwifery with the view of +becoming a teacher of this department of medical science." He lost no +time in throwing himself heartily into the work that was nearest to +him, and became almost indispensable to his chief. Most of his time +was spent in the Pathological Museum, busily engaged in arranging, +classifying, and describing the preparations, but he also assisted in +preparing the professor's lectures. He took up more readily than +Thomson the then new mode of study by the microscope, and it is +related that once he composed a lecture for his chief on this subject +which Thomson delivered without previous perusal. Several times as +Thompson read the lecture to the class he looked up to glare at his +assistant, and when they returned to the side room he shook his fist +in his face, saying, "I don't believe one d--d word of it." + +Although Simpson was now earning enough by his salary as assistant to +meet his expenses at the time, his family maintained their loving +interest in his welfare. His sister told him he was working too hard +and hurting his health. "Well," he replied, "I am sure it is just to +please you all." + +Sandy, who had married in 1832, watched his career carefully, and when +the cholera made its appearance in Scotland he made a will with a +provision for "my dear James" in the event of his death. "I daresay," +he addressed his family therein, "every one of you has a pleasure in +doing him good by stealth as I have had myself." + +By Thomson's advice Simpson attended Hamilton's lectures in the winter +session 1833-4, and this time with awakened interest. With the +definite object of devoting himself to Midwifery clearly in view +Simpson worked with all his phenomenal energy during the years from +1832 to 1835, studying the subject while he was helping Thomson. He +entered the front rank of the young graduates of his day, and was +elected a member of the Royal Medical and Royal Physical Societies in +the same year, 1833. Both these societies were for the encouragement +of scientific study and discussion among students and young graduates, +and to obtain the Presidential chair of either was a high honour. The +Royal Medical Society was the oldest Society in the University, having +been established in 1737 by the great Cullen and others; it had always +been of great account in the University, and the originality of the +utterances on professional matters which emanated from it made it then +a power to be reckoned with not only in Edinburgh, but throughout +European professional circles. For membership of the Royal Physical +Society he was proposed by Edward Forbes, a brilliant youth, who +subsequently distinguished himself in Natural History, and held the +University Chair in that subject for a brief period until cut down +prematurely at the age of thirty-nine. Forbes was the leader of a set +of able young students who have left a distinct mark in the history of +the University. John Reid was an intimate friend of Forbes, and +Simpson was probably as intimate with him. Forbes was the founder and +editor of the best of all the shortlived literary ventures of +Edinburgh undergraduates--_The University Maga_, which was issued +weekly in 1834; and he was also one of the founders of the +Oineromathic Society, "The brotherhood of the friends of Truth." +Forbes thus described the nature of this Society in song:-- + + "Some love to stray through lands far away, + Some love to roam on the sea, + But an antique cell and a college bell, + And a student's life for me. + For palace or cot, for mead or grot + I never would care or pine, + But spend my days in twining lays + To Learning, Love, and Wine." + +"Wine, Love, and Learning" was the motto of this curious brotherhood, +and it numbered in its membership many men of the day, who afterwards +became eminent, such as Forbes himself, Reid, George Wilson, Goodsir, +and Bennet. Simpson must have been quite cognisant of this Society's +doings; he was closely associated with its leaders, but his name does +not appear in any of the lists of members still preserved. His +whole-hearted devotion to the ~MATHESIS~ probably prevented his +uniting with the brotherhood to worship the ~EROS~ and ~OINOS~. The +brotherhood was conspicuously united. In the great snowball riot of +1837, which was quelled only by the reading of the Riot Act and the +marching down at the double from the Castle of the Cameron Highlanders +into the University gates, they fought shoulder to shoulder. + +In 1835 Simpson felt that the time had come to enter into serious +practice and turn his acquired knowledge to account. Fifty pounds a +year was no large income on which to satisfy his craving for +learning, and there was no surplus from which by any means to repay +his family for their assistance. Before taking any decided step, +however, he desired to pay a visit to the Continental centres of +medical science and teaching. The funds for the proposed tour were +promptly found by his brothers Alexander and John; by their assistance +he was enabled to visit Paris, Liege, and Brussels, as well as London +and Oxford. He was accompanied by Dr. (now Sir Douglas) Maclagan, and +kept a journal of the tour, which is an interesting example of his +lively powers of observation. In London he visited the leading +hospitals, and made the acquaintance of the leading physicians and +surgeons, amongst whom were many _alumni_ of his own _alma mater_. In +the journal he freely and concisely criticised the men, their methods, +and their hospitals. In Paris he followed the same plan, going the +round of all the hospitals, and searching for and grasping the +principle which guided each distinguished man's thought and teaching. +He took more than a medical interest in all that he saw, and noted the +appearance and habits of the people of each place that he visited. At +the end of his coach ride from London to Southampton, on the way to +Paris, he sat down to write:--"The ride as far as Windsor Park was +delightful, and from the top of the coach we had two or three most +lovely glimpses of English scenery. After passing Windsor the soil was +rather inferior in many parts, and we passed every now and then large +tracts of heath.... The neatness and cleanliness of the English +cottages is greatly superior to all that we have in Scotland; the +little patches of garden ground before, behind, and around them set +them off amazingly. I wish the Scottish peasantry could by some means +or other be excited to a little more love of cleanliness and +horticulture. I did not see above two or three dirty windows, men or +women along the whole line of road. The snow-white smock-frocks of the +Hampshire peasantry do actually look well in my opinion." + +At Liege on June 13th he wrote:--"And is it possible that I here begin +a second volume of a journal?... I began my journal chiefly with some +distant prospect of teaching myself the important lesson of daily +notation. I am vain enough to flatter myself now that I have partly at +least succeeded. At all events that which was at first a sort of task, +at times rather an annoying task, has now become to me a pleasure. If +I had my first volume to write over again I think I would now write it +twenty times better. In writing a journal 'tis needless to think of +making no blunders in the way of blots and bad grammar or of crooked +sentences. We, or at least I, have occasionally felt so confoundedly +tired at night that if I had been obliged to attend to such minutiae I +certainly would not have been able to advance above two sentences. + +"This morning rose by half-past seven--dressed and breakfasted on +coffee and rolls, read the _Liege Courier_, and by nine o'clock called +on Professor Fohman with a copy of Dr. Reid's paper on the glands of +the whale, which I had promised him yesterday. The Professor kept us +until five minutes to ten, lecturing us on his discoveries upon the +original elementary tubular structure of animal tissues. Somebody has +remarked that no person ever entered into or at least came out of the +study of the Book of Revelation without being either mad before or mad +after it. I would not choose to say that Dr. F.'s case is perfectly +analogous, but has it not some analogy? He seems to run wild on +elementary tubular texture; ... he hates Lippi and his researches with +a perfect hatred. Lippi has been preferred to him by the Parisian +Academy. Is he not working against Lippi, and it may be against truth, +if they happen to go together, which I do not believe? + +"We have taken our seats in the diligence to-morrow for Louvain, and +on leaving Liege I must confess that I leave one of the most lovely +places I have seen on the Continent. 'Tis rich, populous, busy; the +town in itself is old and good, though not so neat and clean as Mons; +its environs wild and romantic. Besides it seems full of good-natured +_gash_ old wives, and sonsy, laughing-faced, good-looking, nay, some +of them very good-looking girls." + +The homeward journey was made _via_ Birmingham, Liverpool, and +Glasgow. In Liverpool he called upon a distant relative named +Grindlay, established there as a shipper, and laid the foundation of a +life-long friendship with the family. He also then for the first time +met Miss Jessie Grindlay who afterwards became his wife. + +With the end of this tour, Simpson brought to a close the more +strictly student part of his career, although it remained true of +him, as of all eminent scientific men, that he was a student to the +end of his days. He felt himself now fully equipped to enter into +the professional battle, and he stepped into the arena, not only +full of vigorous life and hope, but possessed of highly trained +faculties, keen senses, and lofty ideals. It was his strong, +personal characteristics, apart from his accomplishments, which at +once placed him head and shoulders above his fellows. "He had a great +heart," says a recent writer, "and a marvellous personal influence, +calling forth, not only the sympathy and love of his fellowmen, +but capable of kindling enthusiasm in others almost at first +sight." It is impossible to overestimate this personal influence in +analysing the elements of his ultimate success, and it is more +impossible for those who did not feel it to realise its nature; but +that he became the beloved as well as the trusted physician is due to +this influence. "He had no acquaintances," says the writer already +quoted; "none could come into contact with him and stop short of +friendship." This was a powerful trait to possess; it cannot be +denied that he was fully aware of it and its value; and used it with +good effect in establishing himself as the greatest physician of his +day. + +As a scientist he started with an eager desire for knowledge and +reverence for truth, to which was added the highly developed power of +mental concentration born of early self-training. When most men would +be waiting in what they would term enforced idleness, Simpson would be +busy with book or pen, deeply attentive to his occupation despite +surrounding distractions or temptations to frivolous idleness. He took +the full measure of the value of Time and handled his moments as +another would a precious metal. "At all times," he said himself, "on +all occasions, and amidst the numerous disturbing influences to which +the medical man is so constantly subjected, he should be able to +control and command his undivided mental attention to the case or +object that he may have before him.... In the power of concentrating +and keeping concentrated all the energies of attention and thought +upon any given subject, consists the power of thinking strongly and +successfully upon that subject. The possession or the want of this +quality of the mind constitutes the main distinction between the +possession or the want of what the world designates 'mental abilities +and talents.'" + +His high ideals, his conception of the functions of the physician, +and the strivings of the scientist are best shown in his own +words:--"Other pursuits become insignificant in their objects when +placed in contrast with ours. The agriculturist bestows all his +professional care and study on the rearing of crops and cattle; the +merchant spends his energies and attention on his goods and his +commissions; the engineer upon his iron-wheels and rails; the sailor +upon his ships and freights; the banker upon his bills and his +bonds; and the manufacturer upon his spindles and their products. But +what after all are machinery and merchandise, shares and stocks, +consols and prices-current, or the rates of cargoes and cattle, of +corns and cottons, in comparison with the inestimable value and +importance of the very lives of these fellowmen who everywhere move +and breath and speak and act around us? What are any, or what are all +these objects when contrasted with the most precious and valued gift +of God--human life? And what would not the greatest and most +successful followers of such varied callings give out of their own +professional stores for the restoration of health and for the +prolongation of life--if the first were once lost to them, or if +the other were merely menaced by the dreaded and blighting finger of +disease?" + +In one of his addresses of later years he urged upon his students the +objects and motives which had been his in early professional +life:--"The objects and powers of your art are alike great and +elevated," he said. "Your aim is as far as possible to alleviate +human suffering and lengthen out human existence. Your ambition is to +gladden as well as to prolong the course of human life by warding off +disease as the greatest of mortal evils; and restoring health, and +even at times reason itself, as the greatest of mortal blessings.... +If you follow these, the noble objects of your profession, in a proper +spirit of love and kindness to your race, the pure light of +benevolence will shed around the path of your toils and labours the +brightness and beauty that will ever cheer you onwards and keep your +steps from being weary in well-doing; ... while if you practise the +art that you profess with a cold-hearted view to its results, merely +as a matter of lucre and trade, your course will be as dark and +miserable as that low and grovelling love that dictates it." + +Simpson's method of study was simple, at the same time that it +involved immense labour. In entering upon a new work his first +proceeding was to ascertain conscientiously all that had already been +said or written by others upon the subject. He traced knowledge from +its earliest sources and was able, as he followed the mental workings +of those who had preceded him, to estimate the value of every vaunted +addition to the sum of knowledge; and to weigh the theories and new +opinions of men which had been evolved with the progress of time, and +which had sometimes obscured, instead of casting greater light upon +the truth. His antiquarian tastes added to his knowledge of Latin +helped him in this work and turned a tedious task into a real +pleasure. This preliminary accomplished, he plunged into the work of +adding to the knowledge of the subject by thought, research, +experiment, or invention. + +In writing upon an abstract subject he would disentangle the confused +thoughts of his predecessors and restate their opinions in direct and +simplified language. But matters of opinion never had such an +attraction for him as matters of fact; in dealing with these latter he +would test by experiment the statements of authorities and correct or +add to them by his own researches. Most of his professional writings, +as well as his archaeological works, are valuable for the historical +_resume_ of the knowledge on the subject as well as for his additions. +His later writings show as careful an attention to the inductive +method with which he started, as those produced in the days of his +more youthful enthusiasm; when fame was attained and fortune secured, +when excessive work was sapping his physical strength, he never sank +into lazy or slovenly methods in scientific work, but ever threw his +whole vigour into the self-imposed task. + +When studying Nature directly he was constantly asking her "why?"--just +as in his notes of his teacher's lectures the query was ever recurring. +He never felt himself beaten by an initial failure, but returned again +and again with his questions with renewed energy each time. He was not +to be denied, and in this manner he wrested from Nature some of +those precious secrets the knowledge of which has relieved suffering and +prolonged human life in every corner of the globe. "He never kept +anything secret," says his nephew and successor, Professor A. R. +Simpson, "that he thought could help his fellows, and it is hard to +say whether his delight was greater in finding some new means to cure +disease, or in demonstrating to others his methods of treatment." + +He was indeed clothed in well-nigh impenetrable armour, and provided +with powerful weapons, when in the autumn of 1835 he returned from his +foreign tour to commence the serious fight in which his avowed object +was not only to obtain professional eminence, but to stand forth a +proud benefactor of the human race. Although he appealed always +directly to Nature and used his own well-trained eyes and ears in +preference to those of others, he did not completely brush aside +authority as Sydenham had done; he hesitated neither to extract all +that was valuable, nor to discard what appeared worthless from the +writings of past masters. + + + + +CHAPTER IV + +EARLY PRACTICE AND PROFESSORSHIP. 1835-1840 + + President of Royal Medical Society--Personal appearance--Practice + among the poor--Corresponds with Miss Grindlay--Lecturer on + obstetrics--Resignation of Professor Hamilton--Applies for + vacancy--Active candidature--Strong opposition--Marriage--Account + of the midwifery Chair--The medical professors at the time--Their + opposition--Cost of candidature--Triumphant election. + + +In November, 1835, Simpson was elected one of the annual Presidents of +the Royal Medical Society; a position which has been occupied by many +young Edinburgh graduates, who have subsequently risen to fame. He +took pains to make his inaugural address worthy of the occasion, and +chose a subject connected with the pathology of obstetrics. It was a +great success, and contributed largely towards giving him a recognised +position as an authority in that branch of study. After appearing in +the _Edinburgh Medical and Surgical Journal_ for January, 1836, it was +translated into French, Italian, and German. It also obtained for him +his first foreign honour--one of a long list that was made up through +his lifetime--that of corresponding member of the Ghent Medical +Society; indeed, his early works received more attention and +appreciation abroad than at home. In 1836, in order to widen his +experience in his chosen subject, he filled the post of house-surgeon +to the Lying-in Hospital, and held it for twelve months. He was also +elected a Fellow of the Edinburgh College of Physicians. From this +time he became a profuse writer on professional subjects, and +developed an easy and convincing style; he carried on this work _pari +passu_ with practice amongst the poorer classes of the city and in +addition to his work in connection with the Pathology Chair, always +keeping in view his great object of becoming an obstetrician. It was +not until 1838 that he became an independent lecturer on Midwifery. He +had intended to do so earlier, but owing to Professor Thomson's +ill-health, he had been called upon to act as Deputy-Professor of +Pathology, a most valuable and useful employment. + +Simpson's personal appearance at this time has been described by one +who visited a meeting of the Royal Medical Society on an evening when +he was in the chair:--"The chair was occupied," says the narrator, "by +a young man whose appearance was striking and peculiar. As we entered +the room his head was bent down, and little was seen but a mass of +long tangled hair, partially concealing what appeared to be a head of +very large size. He raised his head, and his countenance at once +impressed us. A pale, rather flattish face, massive brent brows, from +under which shone eyes now piercing as it were to your inmost soul, +now melting into almost feminine tenderness; a coarsish nose with +dilated nostrils, finely chiselled mouth which seemed the most +expressive feature of the face ... Then his peculiar rounded soft body +and limbs, as if he had retained the infantine form in adolescence, +presented a _tout ensemble_, which even if we had never seen it again +would have remained indelibly impressed on our memory." + +In Simpson's youth physicians and surgeons made a habit of cultivating +peculiarities of appearances and behaviour, but he was so shaped by +nature as to attract attention without artificial aid. The growth of +long hair seemed a natural accompaniment to his massive head and broad +expressive countenance. + +His practice at this time was scattered over the city, and he took +long tramps in the course of the day. In one of his letters to his +brothers, who were still loyally supporting him in his increasingly +successful endeavours to establish himself after his heart's desire, +he says:--"The patients are mostly poor it is true, but still they are +patients; ... if my health is spared me, I do hope I may get into +practice sufficient to keep me respectable after the lapse of years; +but I know years must pass before that. At present I enjoy the best +possible spirits and health, and with all my toils was never happier +or healthier." + +_Tout vient a point a qui sait attendre._ Simpson knew how to wait; he +knew that waiting did not mean inactivity. Every opportunity that +arose for advancement found him prepared to take full advantage of +it. + +That his lectures on pathology were acceptable was made manifest by +the address presented to him by the students of the class at the end +of his temporary term of office, testifying to his zeal, fidelity, and +success, their admiration of his high talents, of the varied and +extensive research which he displayed, and of his uniform and kind +affability which, while it exalted him in the eyes of all as a +teacher, endeared him to each as a friend. + +During this period he kept up a correspondence with the Miss Grindlay, +of Liverpool, whose appearance he had been struck with when he visited +the family, and towards the end of 1837 he found time to visit there +again accompanied by Dr. John Reid. + +The way for his appearance as an extra-academical lecturer on +midwifery was made clear at the end of 1837 by the death of Dr. +Macintosh, a successful teacher of that subject. He had been in +negotiation, without success, with this Dr. Macintosh for the taking +over of the part or whole of his lectures, and found it easy to step +at once into his place at his death. He was firmly determined to +succeed ultimately to the University Chair of Midwifery. On one +occasion he pointed out to some friends the then holder of the Chair, +Professor Hamilton, thus:--"Do you see that old gentleman? Well, +that's my gown!" + +The good luck which had been his during his boyhood did not desert him +when he began his course of lectures; for not only did he speedily +attain a reputation for teaching, science, and practical skill, +wonderful for one so young, but he had not two years to wait after +thus establishing himself before the chair of his ambition fell vacant +owing to the resignation in 1839 of Professor Hamilton, who died soon +afterwards at the age of seventy-two. + +It was a bold step for so young a man--for Simpson was only +twenty-eight--to apply for the professorship. He was, however, not +without his precedent. The second Monro obtained the Anatomy Chair at +twenty-five, Alison filled that of Physic at thirty, and Thomas Hope +and Alexander Christison were Professors of Chemistry and Medical +Jurisprudence respectively each at the age of twenty-four. But this +subject was one which was popularly thought to require a man of +experience and especially a married man. Simpson had devoted his +energies but partially to midwifery for only four or five years, and +except for his short hospital appointment and recent experience as a +lecturer on the subject had in the eyes of many no greater claim to +the post than any other general practitioner, except in the fact that +he had obtained a wide reputation in the science of the subject by +his contribution to its literature and his researches. This last was +the point on which he himself most relied; for his age he had done +more scientifically than any of his opponents. Those who had watched +his career knew that he possessed in addition to zeal and ability, +brilliant teaching and practical powers. The objection of his youth +was less easily got over than that of his unmarried state. With +characteristic promptness, as soon as he had determined to apply for +the Chair and found that as a bachelor his chances would be small, he +disappeared for a time from Edinburgh, and returned triumphantly with +Miss Jessie Grindlay, of Liverpool, as his wife. It was a bold stroke +which delighted his supporters, discomfited his opponents, who saw +therein the removal of a barrier to his success and a weapon from +their hands, and astonished the worthy town councillors in whose gift +the appointment lay. + +The Edinburgh Chair of Midwifery was established in 1726, and was +indisputably the first Chair of its kind in the British Islands, and +probably in the world. It was in that year that the Town Council first +established the medical faculty, by appointing two Professors of the +Theory and Practice of Medicine and two of Medicine and Chemistry. A +Chair of Anatomy had been instituted six years earlier through the +instrumentality of the first Monro who became its first occupant. +These five chairs were considered sufficient wherewith to teach all +the medical knowledge of the day, and although appointed _ad vitam +aut culpam_ the professors received no remuneration out of the city +revenues. The Chair was not reckoned at first as a faculty Chair, but +was termed a city professorship. The newly created medical faculty +would have no midwifery within the precincts of the University; and +this is scarcely surprising when we remember that at first the only +persons lectured to by the city professor were women of an inferior +class in whose hands the practice of the art almost entirely lay. + +Along with this appointment the Town Council established a system of +regulation for midwifery practice within the city. It ordered that all +midwives already in practice should at once be registered, and that no +persons should thereafter enter on the practice within the city until +they had presented to the magistrate a certificate under the hands of +at least one doctor and one surgeon who were at the same time members +of the College of Physicians or of the Incorporation of Chirurgeons, +bearing that they had so much of the knowledge and principles of this +art as warranted their entering on the practice of it; whereupon a +licence should be given them signed by four magistrates at least +entitling them to practise. It was further enacted that certain pains +and penalties were to be inflicted upon ignorant persons for +practising without this licence whereby their "want of skill might be +of such dangerous consequences to the lives of so many people." It is +to be presumed that as qualified medical men granted them these +certificates and that these women had extensive practices, they +possessed also a fair amount of skill. But slowly and gradually they +had to give way and retire to the rank of nurses before the rise and +growing public tolerance of the qualified male practitioner of +obstetrics. + +The second occupant of the chair, appointed in 1739, was elevated to a +place in the medical faculty, but Professor Thomas Young, who occupied +it in 1756, was the first to teach the subject to medical students by +means of lectures and clinical instruction. As already noted, it was +left for James Hamilton to obtain the recognition of midwifery as a +subject, a knowledge of which was necessary for the obtaining of the +University medical degree. + +At the time when Simpson was straining every nerve to gain the post he +coveted, the medical faculty of the University comprised the following +professors of the following subjects:--Botany, Robert Graham, who +established the Edinburgh and Glasgow Botanical Gardens; Anatomy, +Monro the third; Chemistry, Hope, who discovered strontium in the lead +mines of Argyleshire; Institutes of Medicine, Alison, an eminent +physician and philanthropist who first pointed out the connection +between destitution and epidemics of disease, and secured improved +Poor Laws for his country; Practice of Physic, James Home; Materia +Medica, Christison, the world-reputed toxicologist; Natural History, +Robert Jameson; Clinical Surgery, James Syme, the wonderful operator +and teacher, and inventor of the "macintosh" waterproof; Military +Surgery, Ballingall; Medical Jurisprudence, Traill; Pathology, +Thomson; and Surgery, Charles Bell, the discoverer of the double +function of the nerves, who was ranked in his day on the Continent as +greater than Harvey. It was thus not an undistinguished body that +Simpson strove to enter; several of the best-known members were +comparatively young men, recently appointed to their posts, and full +of the rising scientific spirit. It is little to their credit that +they were practically unanimous in opposing the candidature of this +young and enthusiastic scientist, who afterwards shed such lustre on +the University from the chair which they would have denied him for no +reasons other than his youth and his humble origin. + +Fortunately for Simpson and for the University, the appointment did +not lie in the gift of the professors, but was entirely in the hands +of the Town Council, comprising thirty-three citizens. + +Such an election was always a matter of keen interest to the +inhabitants of Edinburgh, and each candidate brought all the direct +and indirect influence within his power to bear on every councillor +whom he could reach. The Professors in the various faculties had no +doubt great influence; they openly canvassed for the candidate they +favoured, and did not hesitate to decry those they did not approve of. +Shortsighted as this professorial opposition was, it proved no small +difficulty in Simpson's way. Foremost amongst his opponents was Syme, +who commenced a long feud with him by supporting his chief rival, Dr. +Kennedy; "I feel no hesitation in stating," he wrote purposely for +publication, "that of all the candidates in the field, he (Kennedy) is +out of all question, according to my judgment, the one that ought to +be elected." Sir Charles Bell was equally emphatic, and characterised +Simpson's testimonials, in a note which Kennedy circulated, as given +by "good-natured people merely to do a civil thing to a friend"--which +was his mode of describing the declarations of some of the most +eminent men of the day. + +Each candidate also brought political influence to bear, and Whig and +Tory grew agitated as the contest became keener. Simpson seems to have +thought that both political parties were in opposition to him, but he +certainly had the strong support of Ritchie of _Scotsman_ fame, and +the no less important influence of Mr. Duncan Maclaren. + +When writing to ask Mr. Grindlay for his daughter's hand, Simpson +candidly confessed his pecuniary position at the time. He referred to +a debt of L200 already owing to his brother Sandy, and added:--"Again +he gave me a bill for L120 to assist me in furnishing my house. This +has been renewed and becomes due in January. He hopes to be able to +pay it, and I fondly imagined I would have paid the half, but this +canvass has involved me in new difficulties, and besides, I have +endeavoured to assist my sister to go out to Van Diemen's Land. As it +is now I am self-sufficient enough to think that I am as well off as +regards station in my profession as any who started here in the race +of life with me. They have all, I believe, been aided by friends or by +private wealth. They have almost all been fortunate enough to have the +protection of a father's roof during the first years of practice. I +have had no such advantages, but have worked and stood alone. I have +accumulated for myself a library and museum, worth L200 at least, +amidst these difficulties. These I have won by my pen and my lancet, +and these are my only fortune. And now could you trust her future +happiness to me under such circumstances? I did not intend to ask her +hand at present. I fondly hoped I might have _first_ cleared myself of +my debts." + +Grindlay did not hesitate, but willingly gave his daughter, as she was +willingly given, for better or worse. + +The expenses of the canvass amounted to about L500, an amazingly large +sum; he spared no expense in printing and posting his testimonials and +letters to every one who had any influence with the Council, however +small; but taking into consideration the cost of printing and postage +in 1839, it is difficult to realise how the money was expended. His +aim was to make known his scientific attainments, powers as a +teacher, and personal qualifications which he felt, if duly realised, +would outweigh the disadvantages of his youth and comparative +inexperience. His testimonials spoke in strong terms of his abilities +and characteristics; they were a good deal more numerous and elaborate +than is customary to-day, but Kennedy's also made a fat volume of 150 +octavo pages. + +As the day of election drew near the excitement amongst citizens, +professors, and students grew intense. Of the five candidates in the +field, three, including his former teacher Thatcher, speedily fell out +of the running. Dr. Evory Kennedy, of Dublin, and Simpson stood face +to face as rivals. Kennedy was no mean opponent, and his supporters +honestly considered him the better man of the two; his attainments +certainly merited warm support. The prophets foretold a close +struggle, and the event proved them correct. So keen was public +interest that when a report was circulated that Kennedy was a bad +lecturer, his friends brought him over from Dublin a few days before +the election, hired a public room, and made him lecture to a crowded +and enthusiastic audience to dispel that illusion. In spite of this +the popular vote was decidedly in Simpson's favour; if the citizens +had had votes Simpson would have been returned at the head of the poll +by a large majority. + +On Tuesday, February 4, 1840, at a Council meeting, at which all +thirty-three members were present, the Provost himself proposed +Kennedy, while Baillie Ramsay proposed Simpson. The result was +awaited with breathless suspense, the chamber being crowded by anxious +spectators. Simpson's enthusiasm had infected his supporters; he had +kindled the first sparks of that enthusiastic affection with which the +citizens of Edinburgh ever after regarded him; when his triumph, by +the narrowest majority, was announced, the cheers resounded loud and +long. + +The same evening he was able to write to Liverpool:-- + + "1, DEAN TERRACE. + + "I was this day elected Professor. My opponent had sixteen and I + had seventeen votes. All the political influence of both the + leading Whigs and Tories here was employed against me; but never + mind, I have got the chair in despite of them, Professors and all. + Jessie's honeymoon and mine is to commence to-morrow." + +It was the man's strong individuality which carried the day. The town +councillors threw aside the political and academic bias of those who +endeavoured to lead them, and elected the man who had boldly said, +"Did I not feel I am the best man for the Chair I would not go in for +it"; and had more boldly gone on showing them how thoroughly he felt +what he said until they themselves came to believe it. + +The gift of this Chair, as of many others in the University, has now +passed from the hands of the Town Council into those of a body of +curators, seven in number, three nominated by the University Court +and four by the Town Council; such a body might have made a more +cautious choice, but never a more fortunate one both for the city +and the University than this of their long-headed and far-sighted +predecessors. + + + + +CHAPTER V + +PROFESSOR AND PHYSICIAN. 1840-1847 + + Success as a lecturer--Increased practice--Generosity--Fashionable + patients--Memoir on Leprosy--Controversy concerning the Pathology + Chair--Address to the Graduates, 1842--Squabbles--Purchases 52, + Queen Street--A great and good physician--Called to London--Visit + to Erskine House--The daily scene at 52, Queen Street--Rangoon + petroleum and Christison--The disruption--His family--Appointed + Physician-Accoucheur to the Queen for Scotland. + + +Simpson had not long been engaged upon his new duties before the town +councillors gladly saw, and his brother professors were obliged to +admit, that the baker's son was bringing a mighty genius to bear upon +the subject of his choice from the chair of his ambition. He cherished +no ill-feeling against those _confreres_ who had actively opposed his +candidature, but set to work amidst his new surroundings conscious +that the best way to obliterate bitter feelings was by gradually +creating a stronger feeling--that of respect for him as a man and a +worker. He had dealt heavy blows himself during the conflict--blows +not easily forgotten. The position demanded tact and patience, and he +was not found wanting in either. He converted many who had worked +against him into adherents, admirers, and even friends. + +His lectures speedily attracted students. Besides those who were +entering the profession, grey-headed and grey-bearded men, whose +student days had long since passed away, came to sit at the feet of +this remarkable young man and hear the so recently despised subject +dealt with in his own masterly, scientific manner. Conciseness, +clearness, and directness characterised his delivery; while with +illustration and anecdote he made his dull subject fascinatingly +interesting. It was his custom to write out on a black-board notes of +the subject on which he was about to speak--concise, pithy headings, +which were hung up in the theatre and which he proceeded methodically +to explain and enlarge upon. So successful were his efforts that even +in the first session he was able to make the proud boast that his +class was for the first time in its history the largest in the +University, and this in spite of the fact that one of the leading +professors altered his lecture hour to the same hour as Simpson's, +with the purpose of injuring the attendance at Simpson's class. + +A direct result of the reputation obtained through his course of +lectures and improved professional position was the rapid increase of +his practice and the improvement of the class of his patients, so that +pecuniary profit came within his reach. He continued to be a general +practitioner, however, attending to all classes of cases that came to +him; but his zeal for midwifery and the diseases of women, together +with his renown in those subjects, brought mostly patients of the +female sex to his consulting-room. With the improved position there +came necessarily increased expenditure, which at first exceeded the +income; he never stopped to consider the patients' circumstances or +whether he was likely to be paid for his services. "I prefer to have +my reward in the gratitude of my patients," he said. He treated all +that came to him, and his generous nature was oftentimes taken +advantage of by persons very well able to remunerate him; moreover, at +this time, when his pecuniary profit did not equal his professional +reputation, he cheerfully helped many who appealed to him with amounts +he could ill spare. + +His father-in-law generously and willingly stood by him until the fees +began to come in more freely--his brother Sandy, who had supported him +hitherto, having now other claims upon his purse. He found two +ordinary but costly steps advisable--first, to move into a better and +more centrally situated house; and, secondly, to obtain a carriage, +"both to support my rank among my wealthier compeers and to save my +body from excess of work." The outlay was justified in the result; the +fees from students and from his private practice very soon enabled him +to repay the debts to his brothers and his father-in-law without +inconvenience and with grateful pleasure. Once and for ever within +the first few years of his professorship he placed himself in a safe +position, free from all pecuniary anxiety. + +If he had laboured hard to fit himself for the front rank of his +profession, his work on attaining that position showed increase rather +than abatement. His private practice alone was the work of more than +one ordinary individual, and his professorial duties took up some of +the best hours of his day. In the evenings and at all odd times he +busied himself with absorbing current or ancient literature, or in +preparing his own contributions to both professional and general +knowledge either with the pen or by experiment. "Oh that there were +double twenty-four hours in the day," he sighed at a time when he was +working at highest pressure, practising amongst peers, commoners, and +cottagers alike, who all flocked to his residence or sent long +distances for him. When Princess Marie of Baden, wife of the Duke of +Hamilton, came under his special care in 1843 he felt that he was +placed at the top of his profession in Scotland, and must have +smilingly recalled the words of old Dr. Dawson, of Bathgate, when he +heard of the successful contest for the Chair. "It's all very well," +he had said, "to have got the Chair! But he can never have such a +practice as Professor Hamilton. Why, ladies have been known to come +from England to consult him!" + +They came from the furthest parts of Greater Britain to consult +Hamilton's successor, in spite of the old doctor's prognostication! + +The energy as well as the versatility of the man is well shown in the +works which he found time to carry on while he was thus establishing +himself as a teacher and as a practitioner, during the years from 1840 +to 1845. One of his first literary efforts, not wholly professional, +the Memoir on "Leprosy and Leper-Houses," was produced at that time. +It was a work of relaxation and pleasure, for it carried him deeply +into his favourite archaeology. The fascination which this subject +always had for him sprang from his love of nature, and of the greatest +work of nature--man. "The leading object and intent of all the +antiquarian's pursuit is MAN," he said, "and man's ways and works, his +habits and thoughts, from the earliest dates at which we can find his +traces and tracks upon the earth, onwards and forwards along the +journey of past time. During this long journey he has everywhere left +scattered behind him and around him innumerable relics forming so many +permanent impressions and evidences of his march and progress." + +The quantity and quality of the information concerning leper hospitals +which he collected and embodied in his memoir, contributed to the +Edinburgh Medico-Chirurgical Society in March, 1841, was phenomenal. +He had consulted old manuscripts and registers, monastic chronicles, +burgh records, and Acts of Parliament, as well as works of antiquity, +travel, and history. He gave close upon five hundred references, as +well as a list of one hundred and nineteen leper-houses, whose +existence in Britain and whose history he had traced. The work +illustrates the objects and proper methods of antiquarian research, +which twenty years afterwards he dilated upon in his address from the +Chair of the Scottish Society of Antiquaries. In the course of it he +pointed out how vigorously our ancestors had set to work to stamp out +the disease when it spread through Europe during the period from the +tenth to the sixteenth century. The method adopted was that still +employed--segregation; about the twelfth century scarcely a town or +burgh in France and Britain was without its leper-hospital. Although +we in Britain are happily now freed from its ravages, other parts of +the world are not so fortunate. It is still regarded popularly as an +incurable disease, as it was in 1597, when one Catherine Livingstone +was gravely brought to trial for witchcraft, one instance of which had +been that she dared to state her ability to cure "leprosie, which the +maist expert men in medicine are not abil to do." The indictment set +forth that she "took a reid cock, slew it, baked a bannock with the +blude of it, and gaf the samyn to the leper to eat." The witch's +remedy is scarcely more curious and certainly no less useful than +those recommended two centuries later by John Wesley in his "Primitive +Physic," where, moreover, he cheerfully, if somewhat too briefly to +satisfy the modern inquirer, reports the cure "of a most desperate +case" by the drinking of a half-pint of celery-whey morning and +evening. + +Scotland was severely smitten by leprosy in the centuries when it +overspread Europe; Robert Bruce fell a victim to it in 1339, and the +disease seems to have lingered in the North after it had almost +vanished from England. + +Simpson's paper was published in the _Edinburgh Medical and Surgical +Journal_ in three parts in 1841 and 1842, and to this day is the most +valuable contribution to the interesting and important history of the +disease. Some of the information had been collected in his student +days. In his antiquarian researches he had frequently met with +references to the dirty and unwholesome habits and surroundings of +Scots towns in early days. The thought that dirt and disease were +directly connected--a new thought even so recently as fifty years +ago--led to his investigations. He found that leprosy was most +prevalent at the time when his country was most dirty; but he was not +able to establish his supposition that the cause of the disease lay in +the insanitary surroundings of the people; indeed his researches +proved that, on the contrary, leprosy had declined and practically +disappeared from the country long before any material improvement in +sanitary conditions took place. + +Simpson's conduct when Professor Thomson resigned the Chair of +Pathology illustrates the vigour with which he entered into quite +casually arising incidents where he saw that strength and a fight were +necessary to conquer an evil or prevent an abuse. Thomson resigned in +1841 owing to ill-health. The Chair had been established by William +IV. in 1831 on the representations of Thomson himself, who succeeded +in satisfying Lord Melbourne that the subject was worthy of the +dignity of a separate Chair, in spite of the protests of the Senatus +Academicus, who throughout the history of the medical faculty +generally appear to have been actuated more by personal considerations +and professional jealousies, where new developments were in process, +than by zeal for their _Alma Mater_. Professors Syme and Alison +actively led an agitation that with Thomson's resignation the separate +teaching of pathology should be brought to an end. Without a moment's +hesitation, in the midst of his hard work, and suffering from +indifferent health, Simpson plunged into a controversy with these +colleagues, in which he silenced at once and for ever the detractors +who had sneered at him as an ignorant, uncultured man-midwife. The +controversy as usual was followed with intense interest by Edinburgh +folks, and Simpson received a first taste of that popular approval +which undoubtedly was one of the enjoyments of his life. The Crown +avoided the difficulty of deciding between the rival petitioners for +and against the Chair by transferring its patronage to the Town +Council, who showed the same foresight which had led them to appoint +Simpson, in deciding to maintain its existence. Unfortunately their +wisdom failed when they elected as Thomson's successor a man who, +although of brilliant attainments, subsequently brought discredit upon +his University and himself by becoming a convert to homoeopathy. +Simpson, who was indirectly instrumental in securing the Chair of +Pathology for this man became his bitterest opponent when he declared +himself a follower of Hahnemann's unorthodox and mistaken doctrines. + +In 1842 it fell to Simpson's lot to deliver the customary address to +the medical graduates after they had received their degrees at the +annual ceremonial on the 1st of August. He treated his listeners to a +discourse on the duties of young physicians. When we remember that he +had attained to his then high professional position while he was no +more than a young physician himself, we recognise that he was but +setting forth the ideals and principles which had been and still were +his guides in life and conduct. + +After warning his audience against regarding the gaining of the +coveted degree as the end of their student career, instead of as in +reality the opening up of a lifetime of observation and study, he +pointed out that self-patronage was the best of all patronage. "Place +from the first," he said, "all your hopes of advancement upon the +breadth and extent of your medical abilities alone.... Rather walk by +the steady light of your own lamp than by the more dazzling, but to +you more uncertain, lustre borrowed from that of others ... Young +physicians often dream that by extending the circle of their private +acquaintances they thus afford themselves the best chance of extending +the circle of their private patients.... No man will in any case of +doubt and danger entrust to your professional care the guardianship of +his own life or of the life of those who are near and dear to his +heart, merely because you happen to be on terms of intimacy with him. +The self-interest of human nature forbids it.... The accomplishments +which render you acceptable in the drawing-room are not always those +that would make your visits longed for or valued in the chamber of +sickness and sorrow.... Give therefore your whole energies to +medicine; and in its multiplied departments you will find 'ample room +and verge enough' for the most energetic as well as the most +comprehensive mind. Place your faith in no extrinsic influences. Let +your own professional character be the one great patron to whom you +ever look for your professional advancement." He exhorted the young +practitioners above all to save and economise their time, and to +regard it as a property to be avaricious of and of every item of which +they were to render a proper account to themselves. "It is by +carefully preserving, confirming, and making diligent use of these +broken and disjointed portions of it, which others thoughtlessly waste +and destroy, that almost all the highest reputations in the medical +profession have been formed." He strongly urged the value of a "proper +covetousness of time." "Look around, and you will find that those who +have the most to do in the way of business as practitioners have also +apparently the most time to spare as observers and writers.... And +why? Because they have all their daily duties perfectly assorted and +arrayed; they save from loss and destruction every possible fragment +of time and this very industry and precision procures them more true +leisure than indolence can boast of." + +In referring to the relation of practitioner to patient, he +spoke on a subject which has been much discussed in recent years +without altering the principle originally laid down in the oath of +Hippocrates:--"Whatever," said Simpson, "is communicated to you +as a matter of professional confidence, must ever remain buried +within your own breasts in all the silence and secrecy of the +grave." He concluded his address with well-judged remarks on the +relation of the physician to his professional brethren, counselling +his hearers to observe the Golden Rule, and, moreover, "if it be +possible, as much as lieth in you, live peaceably with all men; +never allow the darker part of your nature to persuade you to +the attempt of over-taking him who has distanced you in the race +of life by any unjust efforts to lame the character, and thus +diminish the speed, of your adversary. And if such attempts are +made upon you by others, have no dread of them--if you are armed +strong in honesty, if you have pursued a line of irreproachable +truth and unbending rectitude of conduct. 'Be thou as pure as +snow thou shalt not escape calumny.'... Your future career is a +matter of your own selection, and will be regulated by the conduct +which you choose to follow. That career may be one of happiness or +self-regret, one of honour or of obscurity, one of wealth or of +poverty. The one or other result is not a matter of _chance_, but +a matter of choice on your part. Your diligence and industry for +the next few years will almost inevitably secure for you the one; +your apathy and indolence will almost inevitably entail upon you +the other. May God, in His infinite goodness, enable you to +select the wiser and the better path." + +In this address, as in that previously quoted, we hear him exhorting +his young listeners to a line of conduct which we know to have been +broadly his own in practice as well as in ideal. During these early +years as professor, Simpson had to ward off many ill-disposed +adversaries, and he met their attack with the determination and +powerful preparedness that characterised his attitude in later years, +when he experienced the hostility so constantly opposed to genuine +reformers, and men who have lived ahead of their times. He sometimes +regarded these encounters regretfully himself; but none the less +remembered to + + "Bear't that the opposed may beware." + +The correspondence pertaining to some of these disputes was filed and +ticketed, with brief contempt, "Squabbles." His controversy with +Professor Syme over a personal matter in 1845 was not to the credit of +either of these great men, and, as Simpson himself confessed, was +equally discreditable to their profession. Simpson had seen, as has +been pointed out, several of his teachers fighting long and strongly +for their own cherished objects; and he doubtless then, in his student +days, learnt the lesson that vigorous persistence had the power to +gain much that at first seemed hopeless; he fought with such energy, +that he accomplished in his own lifetime what the example of others +might have led him to think would have been accomplished only by his +successors. + +The growth of his practice up to 1847 was little short of phenomenal. +In 1845 he purchased No. 52, Queen-street, the house which he +inhabited up to his death, and which became the Mecca of hundreds upon +hundreds of pilgrims from all quarters of the globe. Here, in those +years, he was sought and consulted by unceasing crowds; in the public +mind he was undoubtedly endowed with more than human powers, and +regarded as a magician, at the wave of whose wand pain and disease +would vanish. This caused him much embarrassment, and brought upon him +the abuse of ignorant persons, irritated to find that, after all, even +in Simpson's person, there was a limit to human powers; or of others +with unimportant ailments who were disappointed to find that, once +having made his diagnosis of their condition, he would have no more of +them, preferring to place his time at the disposal of those whose +sufferings were real and capable of relief, or whose cases were +complicated and interesting. The question of remuneration was always +secondary, and so careless was he in pecuniary matters that it is +related that he would wrap up interesting specimens, professional or +antiquarian, in bank notes; and his trusted valet was in the habit of +emptying his pockets at night of the money earned in the day, to +prevent its being lost, mislaid, or given away to undeserving persons. +With him work was first and fee second. Like a great modern teacher he +was able to say, "Work first--you are God's servant; fee first--you +are the fiend's." To Simpson "work was master and the Lord of Work, +who is God." + +The personal power and attractiveness of the man were large factors in +gaining the practice which he now enjoyed. But he did not depend for +success on these alone, by any means. His professional reputation was +fully won by great work in obstetrics and gynaecology, and by the +introduction of methods and instruments which contributed to the +saving of countless lives. It has been said that he gave a new life to +the obstetric art, and presided at the birth of gynaecology. He had +done this before the great deed was dreamt of which hands his name +down to posterity, before his discovery of the anaesthetic power of +chloroform. Simpson was a great physician, the leading practitioner +of the art and exponent of the science with which his name will always +be connected. But many great physicians have failed to fulfil as +Simpson did, Robert Louis Stevenson's description of the physician:-- + +"Generosity he has such as is possible to those who practise an art, +never to those who drive a trade; discretion tested by a hundred +secrets; tact tried in a thousand embarrassments; and what are more +Heraclean cheerfulness and courage. So it is that he brings air and +cheer into the sick room, and often enough, though not so often as he +wishes, brings healing." + +Great as a man and great as a physician, Simpson was actually run after +by the greatest in the land. In 1845 he was summoned professionally +to London, and gave an interesting description of his kindly reception +by the Duchess of Sutherland and her family in a letter written from +Stafford House. His advent to London was a matter of notoriety, and +he noted that he bought in the street a life of himself which +mightily diverted him and made him laugh until he was sore. A year or +more later he was invited for rest and change to Erskine House by +Lord Blantyre, where he says, "the Duchess of Sutherland, the Marquis +and Marchioness of Lorne, and two Ladies Gower have made up with myself +all the strangers." "Tell Janet," he wrote to his brother, "I think now +artificial flowers very ungenteel. The ladies here wear nothing but +real flowers in their hair, and every day they come down with +something new and for us males to guess at. Often the Duchess wears a +simple chaplet of ivy leaves, sometimes a bracken leaf is all she sports +in her head ornaments, and beautiful it looks. Rowans and 'haws' are +often worn beaded into crowns or flowers or chaplets. Heather is also +a favourite. On Thursday Lady Lorne came down with a most beautiful +chaplet tying round and keeping down her braided hair. It was a long +bunch of bramble leaves and half-ripe bramble berries--actual true +brambles. They have been all exceedingly kind to me, and I really +feel quite at home among them though the only untitled personage at +table." + +The daily scene at 52, Queen Street was now unique. Those who had the +fortune to lunch or breakfast in that hospitable house never forgot +it. Statesmen, noblemen, artists, scientists, clergymen, and +politicians from various countries sat down together and entertained +each other or attempted to do so in their different languages. The +host guided the conversation while he still glanced over the newspaper +or some newly published book, and never failed by skilful leading to +entice out of every one the best knowledge that they possessed. With +his quick insight he rarely failed in his estimate of character, but +rapidly perceived even in a stranger where the conventional ceased and +the real man began. + +No stranger to Edinburgh omitted to bring or obtain an introduction +to the genial professor; all were welcome, and an open table was kept. +The scene has been described from intimate knowledge in the columns of +the _Scots Observer_ as follows:--"Luncheon is set on the table, and +some ten, twenty, or even fifty people wait the appearance of their +host, who is on his rounds maybe, or in another room ministers to an +urgent case. A stranger who has not learnt that the great Simpson was +only in the broadest sense a punctual man--of minutes, hours, he knew +nothing, but none more reliably punctual, few so unsparingly regular +in working while 'tis called to-day--might be prompted by hungry +discontent to suggest that none but the wealthiest can keep the doctor +from his guests. The mere suggestion would be infamous, for rich and +ragged alike pay fees or not exactly as it pleases them. Whatever the +cause, the host still lingers, and the impatient stranger has time to +wonder how it is that so odd an assortment of human beings should be +met together in one room. Lords and Commons rub shoulders at his +table; the salt of the earth sit down side by side with the +savourless; tweed jostles broadcloth; the town-bred Briton looks +askance at his country-bred compatriot, and both unconsciously shudder +at the Briton with no breeding at all. In one room are assembled +together the American of bluest blood; the Yankee bagman; the +slave-owning Southerner, and even the man of colour hateful to both +alike. The atmosphere is chill like the grave, each guest, eyeing his +neighbour suspiciously, shrinks into his own social shell; on each +face the meanness and snobbery of humankind is, if not aggressively +expressed, at least clearly legible; when all at once Simpson bustles +in. In a few minutes, under the genial influence of his presence, all +tongues are set a-wagging, and well may you ask whether the men who +leave his house after luncheon are those who half-an-hour ago regarded +each other with cold disdain. For now they are cordial, kindly, +sympathetic; each has been induced to show whatever was attractive in +his nature, or to give the fruits of his experience. If in one short +hour Simpson could thus transform a crowd of frigid, haughty strangers +into an assemblage of decent, amiable human beings, what could he not +achieve in a day, a year, or a life?" + +His reception of members of his own profession was specially cordial, +and if those from any one country were more welcome than others, it +was the many who crossed the Atlantic to see and hear him. America had +the greatest share in the birth of anaesthetics, and Simpson's intimacy +with so many of the profession in the United States made it easy for +them to welcome his assistance in that great event. Gynaecology, too, +was eagerly taken up in America, and many were Simpson's admirers from +that country who returned home fired by his influence to work out for +themselves valuable additions to that science. + +Simpson paid close attention to current events in other branches of +science, in politics, and in religion. Sir Robert Christison and he +were at one time associated in an enterprise which narrowly escaped +being the source of a fortune to him. Rangoon petroleum which was +obtained from pits dug on the banks of the Irawaddy had been +chemically investigated by Christison, and he had isolated from it a +substance which he named petroline; unfortunately, unknown to him, a +German chemist had independently made the same discovery a few months +earlier, and christened the substance paraffin. When, a few years +later, it occurred to Simpson that the crude Rangoon petroleum might +serve as a lubricant for machinery and prove cheaper than those in +general use, he applied to Christison. He met with willing assistance, +but a refusal on principle to have anything to do with a patent, which +Christison laughingly suggested, might be called "Simpson's +incomparable antifriction lubricant!" + +"When I called for Simpson," says Christison, in his Recollections, +"his two reception rooms were as usual full of patients, more were +seated in the lobby, female faces stared from all the windows in +vacant expectancy, and a lady was ringing the door bell. But the +doctor brushed through the crowd to join me, and left them all kicking +their heels for the next two hours." + +Their experiments proved that petroleum was vastly superior to sperm +oil, the best known and most commonly used lubricant. Simpson +proceeded to take out a patent, having no such scruples as Christison; +but to his chagrin found that he had been forestalled by others, and +had to abandon the subject. + +About the period now referred to Scotland was stirred from end to end +by the ecclesiastical movement which culminated in the crisis known as +the Disruption, when, for reasons connected with the jurisdiction of +the National Church, a majority of its members severed their +connection therewith in a public and dramatic fashion, and "came out" +to found the now strong and vigorous Free Kirk. Simpson at first +steered clear of all the squabbles and discussions which the movement +gave rise to, but when affairs approached a crisis he threw his lot in +with the leaders of the new movement, and became a staunch Free +Churchman. + +Busy as he was, Simpson fully enjoyed his home and all the inner +domestic life. He was a cheery and hearty host to his intimate +friends, and took a pleasure in impromptu entertainments got up by +himself in his own house, when he found time at his disposal for such +amusement. His first child--a daughter--of whom he was mightily proud, +was born in 1840; his first son, David, in 1842; and the second, +Walter, in 1843. In 1844 the young couple, in the midst of their +rising prosperity, suffered the loss of their daughter, who died after +a brief illness. Simpson felt the loss keenly, and wrote pathetically +on the subject to his relations; long afterwards he loved to talk of +her and her winning ways. + +By 1846 the vast majority of his work lay in obstetrics and +gynaecology, although he himself would no doubt have indignantly +repelled the suggestion that he was a specialist; his mind recognised +the interdependence of all the great branches of the healing art, and +the necessity for any who wished to excel or be useful practitioners +to be _au courant_ with each and every branch. He had early shown that +as a pathologist alone he was worthy of a niche in the temple of fame; +and in later days he was urged to apply for the vacant chair of Physic +in his own University; while Professor A. R. Simpson tells us that +foreigners working in the sphere of surgery sometimes spoke of him as +a surgeon. + +Early in 1847 his good friend, the Duchess of Sutherland, wrote to +inform him that the Queen had much pleasure in conferring upon him the +vacant post of Physician to Her Majesty. In the Queen's own words, +"His high character and abilities made him very fit for the post." He +held this post until his death, under the title of Physician +Accoucheur to the Queen for Scotland. + +Thus in his thirty-sixth year, to the pride of his family and of the +whole village community in which he had been born and received his +early training, to the admiration of patients and friends, as well as +to his own conscious satisfaction, the Bathgate baker's son had risen +by his own efforts to the highest attainable position in his native +land. But the work which was to make him one of the most conspicuous +figures in the history of medicine, and raise him to a place of honour +in the grateful estimation of humanity, was scarcely begun. + + + + +CHAPTER VI + +THE DISCOVERY OF ANAESTHETICS. 1844-1847 + + His early sympathy for suffering--Surgical methods before the + discovery of anaesthetics--His mental struggle caused by the + sickening sights of the operating theatre--His researches into the + history of anaesthesia--Indian hemp--Mandrake--Alcohol--Hypnotism and + other methods--Inhalation of drugs--Sir Humphry Davy--Anaesthetics + discovered in America--Horace Wells and laughing-gas--Morton and + ether--Ether in Great Britain--He uses it in midwifery + practice--Search for a better-anaesthetic--Discovery of anaesthetic + power of chloroform. + + +From his earliest student days the desire had ever been present in +Simpson's mind to see some means devised for preventing the sufferings +endured by patients on the operating table, without, as he put it, +"interfering with the free and healthy play of the natural functions." +It is difficult for us at the close of the nineteenth century to +understand, without an effort of the imagination, the strong +incentives which he had for such a wish. Even to-day, when operations +are conducted without the infliction of pain, young students are not +unfrequently overcome by the sight and the thought of what is in front +of them. At the commencement of a winter session the theatre is +crowded with those students who are entering upon surgical study, and +with others, not so far advanced, who have come to get a preliminary +peep at the practice of this fascinatingly interesting art. Many of +these at first succumb and faint even before the surgeon has begun his +work, and sometimes are only persuaded to pursue their studies by the +encouragement of kindly teachers. + +Simpson also went through this trying experience, but it must have +been a greater struggle to him to persist. The surroundings of the +surgeon at the commencement of the century were vastly more repugnant +to a youth of sensitive nature than to-day. The operating theatre then +has been compared to a butcher's shambles; cleanliness was not +considered necessary, and little attention was paid to the feelings of +the patient. He was held down by three or four pairs of powerful arms +as the surgeon boldly and rapidly did his work, despite the screams, +stopping, perhaps, only to roughly abuse the patient for some agonised +movement which had interfered with the course of action. The poor +wretch saw the instruments handed one by one by the assistant, and +heard the surgeon's calm directions and his remarks on the case. The +barbarous practice of arresting bleeding by the application of red-hot +irons to the surface of the wound had indeed ceased three centuries +before, when that humane reformer, Pare, displaced it with the method +of tying the open blood-vessel, but the patient's blood gushed forth +before him until arrested, into the sawdust spread to receive it, and +the sight and the hot odour of it oftentimes mercifully caused him to +faint. The spirit of Pare who, when relating a successful operation, +would humbly add at the end, "I dressed him; God healed him," had not +descended to those who practised in Simpson's day the art for which +Pare did so much. It had grown to be necessary for a surgeon to be +rough and callous; it was expected of him by the public; he was a man +to be pointed at in the street, and shuddered at when he passed, by +all who devoutly prayed they might escape his clutches. Much of this +conduct was mere mannerism; it had become the custom, and had to be +maintained in order to preserve the dignity and stamp the identity of +the surgeon. Much of it arose from the haste with which the surgeon +had to work; the quicker the operation the better chance had the +patient; it was no uncommon thing to see a bystander timing the +surgeon's work, as the professional time-keeper carefully times a +race; and the rapidity of each surgeon's performances was a subject of +comparison and admiration amongst the students of his day. Much of it +also arose from the effect of the hideous scenes in the operating room +upon the surgeon himself; his nerve had to become of iron if he +desired to succeed, and with the nerve the face and the manner, but +not necessarily always the heart hardened also. Tennyson possibly +recollected these days, when he wrote of the surgeon who + + "Sent a chill to my heart when I saw him come in at the door, + Fresh from the surgery schools of France, and of other lands; + Harsh red hair, big voice, big chest, big merciless hands." + +When Simpson first saw Liston raise his knife to operate on a poor +Highland woman, he actually felt so repelled that he contemplated +abandoning his studies, and made a serious attempt to enter upon legal +work instead. But the mental struggle with which medical men of all +countries, and in all times, can sympathise out of their own +knowledge, ended in a victory for medicine, and a triumphant return to +his studies with the question permanently engraved on the tablets of +his mind, "Can nothing be done to prevent this suffering?" + +It is necessary and it is certainly beneficial that we should thus +remind ourselves of the horrors which surrounded the surgeon so +recently as sixty years ago. "Before the days of anaesthetics," wrote +an old patient to Simpson, in a letter which he treasured with +pride--the writer was himself a medical man--"a patient preparing for +an operation was like a condemned criminal preparing for execution. He +counted the days till the appointed day came. He counted the hours of +that day till the appointed hour came. He listened for the echo in the +street of the surgeon's carriage. He watched for his pull at the door +bell; for his foot on the stair; for his step in the room; for the +production of his dreaded instruments; for his few grave words, and +his last preparations before beginning. And then he surrendered his +liberty and, revolting at the necessity, submitted to be held or +bound, and helplessly gave himself up to the cruel knife.". + +It was, indeed, a monstrous ogre this giant Pain, holding the poor +weak human creature in its merciless clutches, which Simpson even in +his youthful days bethought himself to attack. It is well that we who +are the heirs, should know how Simpson and those others whose names +are ever associated with his, slew the monster, won the victory, and +championed the human race forward into a land where further victories +undreamt of by themselves are now being daily won. + +Simpson searched into ancient history in order to ascertain the +methods, if any, by which in remote and mediaeval times surgeons sought +to prevent the pain of operations. The most time-honoured method seems +to have been by the internal administration of drugs, the chief one +used being Indian hemp, which was well known in the East, and under +one of its names _haschish_ gave origin to the term assassin (strictly +eater of haschish). A certain Arab Sheikh got together a band of +followers to whom he administered haschish, which produced in them its +usual effect--beautiful dreams of a delightful paradise. He induced +them to believe so thoroughly in his power to gain for them at death +permanent entrance to this paradise that they obeyed all his ferocious +and bloodthirsty behests. Thus these assassins became known as men +obedient to their leader in any murderous enterprise. Indian hemp was, +and still is, used as a luxury all over the East, as well as to annul +pain, and was used by criminals doomed to torture or execution. +Simpson thought the _nepenthe_ of Homer was a preparation of this +drug; he also refers to the fact that Herodotus relates that the +Massagetae inhaled the vapour of burning hemp to produce intoxication +and pleasurable excitement. + +Mandrake was used in a similar manner and for similar purposes as +Indian hemp in the Middle Ages, but it fell into disuse on account of +the fatal results that often followed. It is frequently referred to by +Shakspeare both for its narcotic properties and for its fabulous power +of uttering a scream when torn up by the roots, to hear which meant +death or madness. Simpson cited also well-known passages from +Shakspeare to prove that the practice of "locking up the spirits a +time" was known to that poet. + +In later days the intoxication produced by alcohol was taken advantage +of, and instances of its use have been known in quite recent years in +the Colonies, where both a surgeon and chloroform were out of reach. + +No drug, however, was known to be of such value in producing +anaesthesia as to be constantly used, and many trials were made of +other means, notably that of compressing the nerves supplying the part +to be operated upon, but this was found to be too painful in itself. +The stupor produced by compressing the carotid arteries--a method +taken advantage of by the ruffians known as garotters--was also put in +practice for a time during the sixteenth and seventeenth centuries, +but it was found too barbarous a method even for those days. + +Hypnotism was known to the Indians, Egyptians, and Persians at a very +remote period, and may possibly have been used by them sometimes to +produce anaesthesia for surgical purposes. Simpson was attracted by the +words of the poet Middleton in his tragedy "Women, beware Women" +(1617) where he says-- + + "I'll imitate the pities of old surgeons + To this lost limb--who ere they show their art + Cast me asleep, then cut the diseased part." + +When hypnotism made one of its periodic re-appearances in 1837, this +time under the name of mesmerism, after that extraordinary exponent of +its powers Mesmer, Simpson recognised in it a possible method for +"casting the patient asleep" before operation and set to work to +investigate its phenomena. A Frenchman named Du Potet, disheartened by +the prejudice against mesmerism in his own country, came to London in +1837, and was fortunate enough to receive the support of Dr. John +Elliotson, physician to University College Hospital. Elliotson's +advocacy of the new practice was received with ridicule by the +profession, and was treated with such scathing contempt by the +_Lancet_ and other journals, that he was completely ruined. + +Simpson was very successful in his experiments with mesmerism, +conducted on the lines suggested by Elliotson, but he recognised that, +after all, it was not the agent for which he was seeking, and dropped +his researches. + +He did not resume them even when Liston, a few years later, stimulated +by the advocacy of the Manchester surgeon Braid, who met with a better +reception than Elliotson, and by the relation of a long series of +successful cases by a surgeon named Esdaile, in Calcutta, actually +performed operations with success on patients brought under its +influence. + +The first suggestion to produce anaesthesia by the _inhalation_ of +drugs was made by Sir Humphry Davy in 1800. He discovered by +experiment upon himself that the inhalation of _nitrous oxide_ +gas--commonly known as a _laughing gas_--had the power of relieving +toothache and other pains; he described the effect as that of +"uneasiness being swallowed up for a few minutes by pleasures." +Although he stopped short at this stage, and does not seem to have +used the inhalation to produce actual loss of consciousness, he, +nevertheless, forecast the future by suggesting that nitrous oxide +might be used as an inhalation in the performance of surgical +operations, in which "no great effusion of blood" took place. + +Some thirty years later Faraday pointed out that _ether_ had +effects upon the nervous system when inhaled, similar to those of +laughing-gas. These two drugs came to be inhaled more in jest than +in earnest; more as an amusing scientific experiment for the sake of +the pleasure-giving excitement they set up, than for the purpose +Davy had suggested. Ether, it is true, was recommended even before +Davy's day for the relief of the suffering in asthma, but until the +fifth decade of the century no one had attempted to prevent +suffering as inflicted by the surgeon or the dentist, by producing +the state of unconsciousness brought about by the inhalation of such +drugs as ether--a process now known to the world as anaesthesia. + +The persons who first made the bold experiments which resulted in the +discovery of how to produce anaesthesia were Americans; and two men +were prominently concerned in the discovery. Several others made +isolated and successful efforts with both ether and nitrous oxide, but +they lacked the confidence and the courage to make their success +public and to persist in their experiments. Of these, Dr. Long, of +Athens, Georgia, was one of the earliest; he is said to have +successfully removed a tumour from a patient under the influence of +ether in 1842, and in the Southern States he is regarded as the +discoverer of anaesthesia. Dr. Jackson, of Boston--a scientific +chemist--laid claim to the honour of the discovery after others had +fought the fight and established the practice of anaesthesia. Neither +of these men, for the reason already given, deserves the honour which +is now universally attributed to their fellow-countrymen, Wells and +Morton. + +Horace Wells was born at Hartford, Connecticut, in 1815, and was +educated to the profession of dental surgeon. He gave much attention +to the desire present in the minds of many men at that time to render +dental operations painless. On December 10, 1844, he witnessed at a +popular lecture the experiment of administering laughing-gas, and +noticed that a Mr. Cooley, while still under the influence of the gas, +struck and injured his limb against a bench without suffering pain. +The idea at once occurred to Wells that here was the agent he was in +search of, and the very next day he experimented upon himself. If it +has ever been fortunate to have toothache it was so for Wells that +day; he was troubled by an aching molar which was removed by a +colleague named Rigg, whilst he was fully under the influence of +nitrous oxide; and thus he began what he himself at once called on +recovering consciousness, "a new era in tooth-pulling." He proceeded +promptly to test the experiment upon others and with complete success; +and then making his success known, he proceeded with his former pupil +Morton to Boston, and gave a public demonstration of his method which +unfortunately was so imperfectly carried out that he was laughed at +for his pains and stigmatised an impostor. Wells himself stated that +the failure was due to the premature withdrawal of the bag containing +the gas, so that the patient was but partially under its influence +when the tooth was extracted. Wells and Morton were ignominiously +hissed by the crowd of practitioners and students gathered to see the +operation. Wells never recovered from the disappointment and the +illness which resulted, and although he was able to explain his +discovery to the French Academy of Science in 1846, he unfortunately +died insane in New York two years later. Undoubtedly he was the first +to discover the practicability of nitrous oxide anaesthesia, and to +proclaim the discovery with a discoverer's zeal. Although his career +ended so sadly, his efforts had, nevertheless, inspired to greater +endeavour his colleague Morton, who had not only been associated in +his experiments, but had been deeply interested in the subject for +many years. + +William Thomas Green Morton was born in 1819; his father was a farmer +at Charlton, Massachusetts. He qualified as a dentist at Baltimore, +and entered into successful practice at Boston. Fired with the same +ambition as Wells, he made attempts to extract teeth painlessly with +the assistance of drugs administered, or sometimes of hypnotism. In +December, 1844, after Wells's failure with nitrous oxide gas, he +wisely abandoned that agent and investigated another which promised +better results. He experimented first with a drug known as _chloric +ether_, but failing to get the desired effect, and at the suggestion +of the aforementioned Dr. Jackson, he proceeded to investigate the +effect of ordinary ether. The first experiments were made on animals, +and were so encouraging that he believed he had at last found the +desired agent, provided the effect on human beings corresponded with +that upon dumb creatures. Boldly and heroically he made the necessary +experiment upon himself, and on September 30, 1846, inhaled ether from +a handkerchief while shut up in his room and seated in his own +operating-chair. He speedily lost consciousness, and in seven or eight +minutes awoke in possession of the greatest discovery that had ever +been revealed to suffering humanity. We can picture the man gradually +awakening in his chair first, to the consciousness of his surroundings +and then to the consciousness of his great achievement; sitting with +his physical frame excited by the influence of the drug which he had +inhaled, and his soul stirred to its deepest depth by the expanding +thought of the far-reaching effects of what he had done. + +"Twilight came on," he said, in subsequently relating the event. "The +hour had long passed when it was usual for patients to call. I had +just resolved to inhale the ether again and have a tooth extracted +under its influence, when a feeble ring was heard at the door. Making +a motion to one of my assistants who started to answer the bell, I +hastened myself to the door, where I found a man with his face bound +up, who seemed to be suffering extremely. 'Doctor,' said he, 'I have a +dreadful tooth, but it is so sore I cannot summon courage to have it +pulled; can't you mesmerise me?' I need not say that my heart bounded +at this question, and that I found it difficult to control my +feelings, but putting a great constraint upon myself I expressed my +sympathy, and invited him to walk into the office. I examined the +tooth, and in the most encouraging manner told the poor sufferer that +I had something better than mesmerism, by means of which I could take +out his tooth, without giving him pain. He gladly consented, and +saturating my handkerchief with ether I gave it to him to inhale. He +became unconscious almost immediately. It was dark. Dr. Haydon held +the lamp. My assistants were trembling with excitement, apprehending +the usual prolonged scream from the patient, while I extracted the +firmly-rooted bicuspid tooth. I was so much agitated that I came near +throwing the instrument out of the window. But now came a terrible +reaction. The wrenching of the tooth had failed to rouse him in the +slightest degree; he remained still and motionless as if already in +the embrace of death. The terrible thought flashed through my mind +that he might be dead--that in my zeal to test my new theory, I might +have gone too far, and sacrificed a human life. I trembled under the +sense of my responsibility to my Maker, and to my fellowmen. I seized +a glass of water and dashed it in the man's face. The result proved +most happy. He recovered in a minute, and knew nothing of what had +occurred. Seeing us all stand around he appeared bewildered. I +instantly, in as calm a tone as I could command, asked, 'Are you ready +to have your tooth extracted?' 'Yes,' he answered, in a hesitating +voice. 'It is all over,' I said, pointing to a decayed tooth on the +floor. 'No,' he shouted, leaping from his chair. The name of the man +who thus for the first time underwent an operation under anaesthesia +induced by ether was Eben Frost." + +The nature of the agent used by Morton was kept secret only a short +period; the steps he took to bring his discovery before the medical +profession would have rendered it difficult if not impossible, even if +ether had not a penetrating tell-tale odour. Morton laid his method +before one of the surgical staff of the Massachusetts General +Hospital, Boston, the same institution where Wells's ill-managed +demonstration had taken place two years before; he requested, with +complete confidence, to be allowed to exhibit the powers of his agent. +The surgeon was sceptical, but wisely consented, after having +satisfied himself that there was no risk to life. A patient suffering +from a tumour was chosen, and readily consented to act as a subject +for demonstration. A large crowd of professional men and students +assembled in the surgical theatre on the morning of October 16, 1846, +the day chosen for the trial. The senior hospital surgeon, Dr. J. +Collins Warren, was to perform the operation. The spectators, many of +whom no doubt recollected the failure with laughing-gas, were disposed +to deride when the appointed hour passed and Morton did not appear; +but the delay was due only to the desire of the dentist to bring a +proper inhaler, and although the crowd received him with a chilling +reserve, and the occasion was one fit to try the nerve of the +strongest, Morton did not lose his presence of mind. He promptly +anaesthetised the patient, and as unconcernedly as does the modern +administrator, nodded to the surgeon that the patient was ready. From +the first moment that the knife touched the patient, until the +operation was concluded, no sound, no movement indicated that he was +suffering. The men who had scoffed once and had come, even the surgeon +himself, prepared to scoff again, realised the success and the wonder +of it, and remained to admire. "Gentlemen, this is no humbug," +exclaimed Dr. Warren, as he finished his handiwork. When the patient +recovered he was questioned again and again, but stoutly maintained +that he had felt no pain--absolutely none. "Gilbert Abbott, aged +twenty, painter, single," was the description of the man on whom was +performed the first surgical operation under the influence of ether. + +News of the great success rapidly spread, and the experiment was +repeated by Morton and others in America, and similar work was taken +up throughout Europe. It cannot be said that Morton derived much +benefit from his discovery. Although the greatness of it was +recognised in his lifetime, and he received several honours and +presents, he entered into prolonged squabbles concerning the discovery +which worried him into a state of ill-health, ending in his death in +1868. A monument was erected over his grave by the citizens of Boston, +bearing the following concise description of his achievement:-- + + "WILLIAM T. G. MORTON, + + "Inventor and revealer of anaesthetic inhalation, + By whom pain in surgery was averted and annulled; + Before whom in all time surgery was agony, + Since whom Science has control of Pain." + +Whilst the discoverer of nitrous-oxide anaesthesia was dying from +chagrin and inaction, and the revealer of anaesthetic inhalation by +ether was wasting time in unworthy disputes concerning priority, and +fruitless endeavours to gain pecuniary reward, a bolder than either +had taken up the work where they had left it, with the high object of +pursuing it until he had for ever established the benefit to humanity +which he recognised in it. He went straight forwards and onwards, +strong in his endeavour; undeterred by the jeers of the ignorant, the +opposition of the prejudiced or the attacks of the jealous, with no +thought of or wish for reward except that which was to come daily from +the depth of sufferers' hearts. + +During the Christmas holidays of 1846 Simpson was in London, and +discussed the new discovery with Liston, who was one of the first to +operate under ether in Great Britain at University College Hospital. +The great surgeon thought that the chief application of the process +would be in the practice of rapidly operating surgeons; it was at +first generally believed that the inhalation could be borne for only a +brief period. Simpson speedily showed that no evil resulted if the +patient remained under the influence of the vapour for hours. In the +month of January, 1847, he gained for the Edinburgh Medical School the +proud honour of being the scene of the first use of anaesthetics in +obstetric practice. In March of the same year he published a record of +cases of parturition in which he had used ether with success; and had +a large number of copies of his paper printed and distributed far and +wide at home and abroad, so eager was he to popularise amongst the +members of his profession the revolutionary practice which he +introduced. From the day on which he first used ether in midwifery +until the end of his career he constantly used anaesthetics in his +practice. He quickly perceived, however, the short-comings of ether, +and having satisfied himself that they were unavoidable, he set about +his next great step, namely, to discover some substance possessing the +advantages without the disadvantages of ether. In the midst of his now +immense daily work he gave all his spare time, often only the midnight +hours, to testing upon himself the effect of numerous drugs. With the +same courage that had filled Morton he sat down alone, or with Dr. +George Keith and Dr. Matthews Duncan, his assistants, to inhale +substance after substance, often to the real alarm of the household at +52, Queen Street. Appeal was made to scientific chemists to provide +drugs hitherto known only as curiosities of the laboratory, and for +others that their special knowledge might be able to suggest. The +experiments usually took place in the dining-room in the quiet of the +evening or the dead of night. The enthusiasts sat at the table and +inhaled the particular substance under trial from tumblers or saucers; +but the summer of 1847 passed away, and the autumn was commenced +before he succeeded in finding any substance which at all fulfilled +his requirements. All this time he was battling for anaesthesia, which, +particularly in its application to midwifery, was meeting with what +appears now as an astonishing amount of opposition, on varying grounds +from all sorts and conditions of persons; but the vigour and power of +his advocacy and defence of the practice in the days when laughing-gas +and ether were the only known agents, were as nothing to that which he +exerted after his own discovery at the end of 1847. + +The suggestion to try chloroform first came from a Mr. Waldie, a +native of Linlithgowshire, settled in Liverpool as a chemist. It was a +"curious liquid," discovered and described in 1831 by two chemists, +Soubeiran and Liebig, simultaneously but independently. In 1835 its +chemical composition was first accurately ascertained by Dumas, the +famous French chemist. Simpson was apparently not aware that early in +1847 another French chemist, Flourens, had drawn attention to the +effect of chloroform upon animals, or he would probably have hastened +to use it upon himself experimentally, instead of putting away the +first specimen obtained as unlikely; it was heavy and not volatile +looking, and less attractive to him than other substances. How it +finally came to be tried is best described in the words of Simpson's +colleague and neighbour, Professor Miller, who used to look in every +morning at nine o'clock to see how the enthusiasts had fared in the +experiments of the previous evening. + +"Late one evening, it was the 4th of November, 1847, on returning +home after a weary day's labour, Dr. Simpson with his two friends +and assistants, Drs. Keith and Duncan, sat down to their somewhat +hazardous work in Dr. Simpson's dining-room. Having inhaled several +substances, but without much effect, it occurred to Dr. Simpson to +try a ponderous material which he had formerly set aside on a +lumber-table, and which on account of its great weight he had +hitherto regarded as of no likelihood whatever; that happened to +be a small bottle of chloroform. It was searched for and recovered +from beneath a heap of waste paper. And with each tumbler newly +charged, the inhalers resumed their vocation. Immediately an +unwonted hilarity seized the party--they became brighteyed, very +happy, and very loquacious--expatiating on the delicious aroma of +the new fluid. The conversation was of unusual intelligence, and quite +charmed the listeners--some ladies of the family and a naval +officer, brother-in-law of Dr. Simpson. But suddenly there was a +talk of sounds being heard like those of a cotton mill louder and +louder; a moment more and then all was quiet--and then crash! On +awakening Dr. Simpson's first perception was mental--'This is far +stronger and better than ether,' said he to himself. His second was to +note that he was prostrate on the floor, and that among the friends +about him there was both confusion and alarm. Hearing a noise he +turned round and saw Dr. Duncan beneath a chair--his jaw dropped, +his eyes staring, his head bent half under him; quite unconscious, and +snoring in a most determined and alarming manner. More noise still +and much motion. And then his eyes overtook Dr. Keith's feet and legs +making valorous attempts to overturn the supper table, or more +probably to annihilate everything that was on it. By and by Dr. +Simpson having regained his seat, Dr. Duncan having finished his +uncomfortable and unrefreshing slumber, and Dr. Keith having come to +an arrangement with the table and its contents, the _sederunt_ was +resumed. Each expressed himself delighted with this new agent, and +its inhalation was repeated many times that night--one of the ladies +gallantly taking her place and turn at the table--until the supply of +chloroform was fairly exhausted." + +The lady was Miss Petrie, a niece of Mrs. Simpson's; she folded her +arms across her breast as she inhaled the vapour, and fell asleep +crying, "I'm an angel! Oh, I'm an angel"! The party sat discussing +their sensations, and the merits of the substance long after it was +finished; they were unanimous in considering that at last something +had been found to surpass ether. + +The following morning a manufacturing chemist was pressed into +service, and had to burn the midnight oil to meet Simpson's demand for +the new substance. So great was Simpson's midwifery practice that he +was able to make immediate trial of chloroform, and on November 10th +he read a paper to the Medico-Chirurgical Society, describing the +nature of his agent, and narrating cases in which he had already +successfully used it. "I have never had the pleasure," he said, "of +watching over a series of better and more rapid recoveries; nor once +witnessed any disagreeable results follow to either mother or child; +whilst I have now seen an immense amount of maternal pain and agony +saved by its employment. And I most conscientiously believe that the +proud mission of the physician is distinctly twofold--namely to +alleviate human suffering as well as preserve human life." In a +postscript to the same paper he states on November 15th that he had +already administered chloroform to about fifty individuals without +the slightest bad result, and gives an account of the first surgical +cases in which he gave the agent to patients of his friends, Professor +Miller and Dr. Duncan, in the Edinburgh Royal Infirmary. "A great +collection," he says, "of professional gentlemen and students +witnessed the results, and amongst them Professor Dumas, of Paris, the +chemist who first ascertained and established the chemical composition +of chloroform. He happened to be passing through Edinburgh, and was in +no small degree rejoiced to witness the wonderful physiological +effects of a substance with whose chemical history his own name was so +intimately connected." Four thousand copies of this paper were sold in +a few days, and many thousands afterwards. + +It is worthy of mention that, according to a promise, Professor Miller +had sent for Simpson a few days after the discovery to give chloroform +to a patient on whom he was about to perform a major operation; +Simpson, however, was unavoidably prevented from attending, and Miller +began the operation without him--at the first cut of the knife the +patient fainted and died. It is easy to imagine what a blow to +Simpson, and to the cause of anaesthesia this would have been had it +happened while the patient was under chloroform. + +Thus in little more than a year from the date of Morton's discovery of +the powers of ether, Simpson had crowned the achievement by the +discovery of the equally wonderful and beneficial powers of +chloroform. Already he had made two satisfactory answers to the +question he had early set himself--first, the application of +anaesthesia to midwifery practice; and, second, the discovery of the +properties of the more portable and manageable chloroform; the third, +and perhaps the greatest, the defence of the practice, and the beating +down of the powerful opposition to anaesthesia was yet required to +render his reply complete. + + + + +CHAPTER VII + +THE FIGHT FOR ANAESTHESIA. 1847 ONWARDS + + His faith in chloroform--Confused public opinion on the + subject--Personal attacks--Opposition on professional + grounds--His reply--Opposition on moral grounds--His + reply--Opposition on religious grounds--His reply--Her Majesty + the Queen anaesthetised--Indiscrete supporters--The Edinburgh + teaching of anaesthesia administration--The far-reaching effects + of the successful introduction of anaesthesia. + + +Professor Simpson firmly believed that he possessed now in chloroform +an anaesthetic agent "more portable, more manageable and powerful, more +agreeable to inhale, and less exciting" than ether, and one giving him +"greater control and command over the superinduction of the anaesthetic +state." Fortified by this belief, full of facts relating to the +subject, and fired with zeal and enthusiasm, he was prepared to meet +the opposition which from his knowledge of human nature he must have +anticipated. So bravely and so emphatically did he champion the cause +that he became identified with it in the public mind. The revelation +of anaesthesia, the discovery of chloroform, and the application of +anaesthetics to surgery as well as to midwifery were attributed to him +by all classes of the community, not even excepting many of his own +profession. Chloroform was spoken of as if ether had never existed; +and chloroform and chloroforming displaced the terms anaesthetic and +anaesthetising in ordinary talk--such unwieldy terms were naturally +abandoned when there was the excuse that chloroform was universally +considered the best substance of its class. Simpson made no attempt as +Morton had done to patent his discovery under a fanciful name for his +own pecuniary profit; but widely spread abroad every particle of +knowledge concerning it that he possessed, so that every practitioner +was forthwith enabled to avail himself thereof for the benefit of his +patients. + +Partly owing to his own enthusiasm and his strong belief in the +superiority of chloroform over ether, and partly owing to the +confusion prevailing in general circles as to the history of +anaesthesia, no small number of attacks were directed against Simpson +personally by those who either were jealous of his achievements, or +who considered that the part taken by themselves or their friends in +the establishment of this new era in medical science had been slighted +or overlooked. Simpson took all these as part of the fight into which +he had entered. His nature was not sensitive to such personal +attacks; he replied to them, cast them off, and went on his way +unaffected. He handled some of these opponents somewhat severely when +they accused him of encouraging the public belief in him as the +discoverer of anaesthesia. It is clear to us to-day after anaesthesia +has been on its trial for fifty years that Simpson magnified the +superiority of chloroform over ether, and was led by that feeling to +look on the history of ether as but a stage in the history of the +greater chloroform. He regarded chloroform as the only anaesthetic; his +utterances betrayed this feeling, and offence was naturally taken by +the introducers and advocates of ether. His opinion of chloroform was +shared by the leading European surgeons to such an extent in his day +that shortly after his death Professor Gusserow, of Berlin, stated +that with a few exceptions almost all over the earth nothing else was +used to produce anaesthesia but chloroform. + +The real fight for anaesthesia was against those who found in the +practice something which ran contrary to their beliefs or principles. +There were first those who objected on purely _medical_ grounds; +secondly, those who took exception to it from a _moral_ point of view; +and thirdly, those who found their _religious_ convictions seriously +offended by the new practice. + +The _medical_ opponents were, perhaps, the most powerful; certainly it +was they who had first to be won over, for without the support of the +profession the cause was in danger. It was urged first of all that the +use of anaesthetics would increase the mortality, then very great, of +surgical operations, and those who took their stand upon this ground +were men who had at first denied the possibility of making operations +painless, and had been driven to abandon that opinion only by a clear +demonstration of the fact. To meet this form of opposition he +instituted a laborious and extensive statistical investigation in +order to compare the results obtained in hospitals where anaesthetics +were used with those where the operations were performed on patients +in the waking state. He took care that the reports dealt with the same +operations under, as nearly as possible, similar conditions in each +case. He obtained returns from close upon fifty hospitals in London, +Edinburgh, Dublin, and various provincial towns. One of the most fatal +operations in those days, and one dreaded by patient and surgeon +alike, was amputation of the thigh. In 1845 Professor Syme said that +the stern evidence of hospital statistics showed that the average +frequency of death after that operation was not less than 60 to 70 per +cent., or above one in every two operated upon. Simpson fearlessly +collated statistics of this operation amongst the others, and proved +that when performed under anaesthetics amputation of the thigh had its +mortality reduced to 25 per cent. His figures were as follows:-- + +TABLE OF THE MORTALITY OF AMPUTATIONS OF THE THIGH. + + Reporter. Cases. Deaths. % of Deaths. + + Not anaesthetised. + Parisian hospitals--Malgaigne 201 126 62 in 100 + Edinburgh " --Peacock 43 21 49 " + General collection--Phillips 987 435 44 " + Glasgow hospitals --Lawrie 127 46 36 " + British " --Simpson 284 107 38 " + + Cases on patients in an + anaesthetised state 145 37 25 " + +He pointed to the above table as a proof that far from increasing the +mortality of this operation the introduction of anaesthetics had +already led to a saving of from eleven to twenty lives out of every +hundred cases. He acknowledged that the number of cases he had +collected (145) was somewhat small from a statistical point of view; +but he confidently asserted that future figures would show greater +triumphs. The tables of other operations showed similar results, and +he entered exhaustively into the subject in a paper published in 1848. +The paper was entitled, "Does Anaesthesia increase or decrease the +mortality attendant upon surgical operations?" According to his wont, +he headed it with a quotation from Shakspeare: + + "Why doest thou whet thy knife so earnestly? + ... Shylock must be merciful. + On what compulsion must I? Tell me that!" + +Victorious in this encounter, he turned to those who urged that +anaesthetics were responsible for various kinds of ills such as a +tendency to haemorrhage, convulsions, paralysis, pneumonia, and various +kinds of inflammatory mischief as well as mental derangement. He +combated these contentions until the end of his career; and not only +proved that the objections were visionary, but showed that for one of +the alleged evils formerly often seen after operations, viz., +convulsions, chloroform, far from being a cause, was one of our most +powerful remedies. + +But the professional opponents of anaesthesia were most emphatic in the +denunciation of its use in midwifery. Pain in the process of +parturition was, they said, "a desirable, salutary, and conservative +manifestation of life-force": neither its violence nor its continuance +was productive of injury to the constitution. Strong opposition on +these grounds came from the Dublin School, and with characteristic +boldness Simpson turned to the statistics of their own lying-in +hospital to prove his contention that to abolish parturient pain was +to diminish the peril of the process. Again the statistics stood him +in good stead; he flourished them triumphantly before his opponents, +and proceeded to deal with those who asserted that the use of +anaesthetics was accompanied by danger to life. He pointed out that, +although unquestionably there were some dangers connected therewith, +they were insignificant compared with the dangers in both surgery and +midwifery which their use averted. Pain itself was a danger; shock in +surgery was responsible for many untimely deaths upon the operating +table; by preventing these chloroform saved countless lives. His +arguments were characterised by painstaking thoroughness and evidenced +wide reading. In addressing Professor Meigs, of Philadelphia, he +said:-- + +"First, I do believe that if improperly and incautiously given, and in +some rare idiosyncrasies, ether and chloroform may prove injurious or +even fatal--just as opium, calomel, and every other powerful remedy +and strong drug will occasionally do. Drinking cold water itself will +sometimes produce death. 'It is well known,' says Dr. Taylor, in his +excellent work on Medical Jurisprudence, 'that there are _many_ cases +on record in which cold water, swallowed in large quantity and in an +excited state of the system, has led to the destruction of life.' +Should we therefore never allay our thirst with cold water? What would +the disciples of Father Mathew say to this? But, secondly, you and +others have very unnecessary and aggravated fears about the dangers of +ether and chloroform, and in the course of experience you will find +these fears to be, in a great measure, perfectly ideal and imaginary. +But the same fears have, in the first instance, been conjured up +against almost all other innovations in medicine and in the common +luxuries of life. Cavendish, the secretary to Cardinal Wolsey, tells +us in his life of that prelate, that when the cardinal was banished +from London to York by his master--that regal Robespierre, Henry the +Eighth--_many_ of the cardinal's servants refused to go such an +enormous journey--'for they were loath to abandon their native +country, their parents, wives, and children.' The journey which can +_now_ be accomplished in six hours was considered then a perfect +banishment.... In his Life of Lord Loughborough, John Lord Campbell +tells us that when he (the biographer) first travelled from Edinburgh +to London in the mail-coach the time had been reduced (from the former +twelve or fourteen days) to three nights and two days; 'but,' he adds, +'this new and swift travelling from the Scots to the English capital +was wonderful, and I was gravely advised to stop a day at York as +several passengers who had gone through without stopping had died of +apoplexy from the rapidity of the motion' ('Lives of the Lord +Chancellors'). Be assured that many of the cases of apoplexy, &c., +&c., alleged to arise from ether and chloroform, have as veritable an +etiology as this apoplexy from rapid locomotion, and that a few years +hence they will stand in the same light in which we now look back upon +the apoplexy from travelling ten miles an hour. And as to the supposed +great moral and physical evils and injuries arising from the use of +ether and chloroform, they will by and by, I believe, sound much in +the same way as the supposed great moral and physical evils and +injuries arising from using hackney coaches, which were seriously +described by Taylor, the water-poet, two or three centuries ago when +these coaches were introduced. Taylor warned his fellow-creatures to +avoid them, otherwise 'they would find their bodies tossed, tumbled, +rumbled, and jumbled' without mercy. 'The coach,' says he, 'is a close +hypocrite, for it hath a cover for knavery; they (the passengers) are +carried back to back in it like people surprised by pirates, and +moreover it maketh men imitate sea-crabs in being drawn sideways, and +altogether it is a dangerous carriage for the commonwealth.' Then he +proceeds to call them 'hell-carts,' &c., and vents upon them a great +deal of other abuse very much of the same kind and character as that +lavished against anaesthetics in our own day." + +Following out the same line of reasoning he brought to the minds of +medical opponents how the introducers of such useful drugs as mercury, +antimony, and cinchona bark had met with now long-forgotten but +stubborn opposition; and he reminded surgeons of the stern obstinacy +with which the introduction of the ligature of arteries had been long +objected to and the barbarous method of arresting bleeding with +red-hot irons had been preferred. But in the history of the discovery +and introduction of vaccination by Jenner he found a strong parallel; +and he wrote a pregnant article to prove that mere opinion and +prejudgments were not sufficient to settle the question of the +propriety or impropriety of anaesthetic agents, illustrating it from +the story of vaccination. The result of vaccination had been to save +during the half century since its introduction a number of lives in +England alone equal to the whole existing population of Wales; and in +Europe during the same period it had preserved a number of lives +greater than the whole existing population of Great Britain. And yet +Jenner, when he first announced his discovery, had encountered the +most determined opposition on the part of many of his professional +brethren, who ridiculed and bitterly denounced both him and his +discovery; whilst ignorant laymen announced that smallpox was ordained +by heaven and vaccination was a daring and profane violation of holy +religion. He pointed out that these objections had been slowly and +surely crushed out of existence by accumulated facts, and predicted +that the ultimate decision concerning anaesthesia would come to be +based, not upon impressions, opinions, and prejudices, but upon the +evidence of "a sufficient body of accurate and well-ascertained +facts." To these facts, as has been indicated, he subsequently +successfully appealed. + +Those who objected to anaesthesia on _moral_ grounds directed their +attacks chiefly against its use in midwifery. They not only condemned +that application as iniquitous, but went the length of asserting that +the birth of past myriads without it proved how unnecessary it was, +and that Nature conducted the whole process of birth unaided in a +greatly superior manner. The pains associated with parturition were +actually beneficial, they said. Simpson answered this by showing that +the proper use of anaesthetics shortened parturition, and by +diminishing the amount of pain led to more rapid and more perfect +recoveries. The leading exponent of the Dublin School of Midwifery at +that time foolishly wrote that he did not think any one in Dublin had +as yet used anaeesthetics in midwifery; that the feeling was very +strong against its use in ordinary cases, merely to avert the ordinary +amount of pain, which the Almighty had seen fit--and most wisely, no +doubt--to allot to natural labour; and in this feeling he (the writer) +most heartily concurred. Simpson's private comment on this remarkable +epistle at once showed his opinion of it, and ridiculed the objection +out of existence. He skilfully parodied the letter thus:--"I do not +believe that any one in Dublin has as yet used a carriage in +locomotion; the feeling is very strong against its use in ordinary +progression, merely to avert the ordinary amount of fatigue which the +Almighty has seen fit--and most wisely, no doubt--to allot to natural +walking; and in this feeling I heartily and entirely concur." + +He twitted the surgeons who opposed him with their sudden discovery, +now that anaesthetics were introduced, that there was something really +beneficial in the pain and agony caused by their dreaded knife. Such a +contention contraverted his cherished principle that the function of +the medical man was not only to prolong life, but also to alleviate +human sufferings. He quoted authorities of all times to show that +pain had been always abhorred by physicians and surgeons, commencing +with a reference to Galen's aphorism--"_Dolor dolentibus inutile est_" +("pain is useless to the pained"); citing Ambroise Pare, who said that +pain ought to be assuaged because nothing so much dejected the powers +of the patient; and, finally, reproducing the words of modern authors, +who asserted that, far from being conducive to well-being, pain +exhausted the principle of life, and in itself was frequently both +dangerous and destructive. He brought forward a collection of cases +where in former days patients had died on the operating-table, even +before the surgeon had begun his work, so great was the influence of +the mere fear of pain; and reminded those who attributed occasional +deaths on the operating-table to the influence of the anaesthetic of +the numerous cases in bygone days where death occurred whilst the +surgeon was at work. He recalled also how the great surgeon of St. +Thomas's Hospital, Cheselden, had abhorred the pain which he caused in +the process of his work, and longed for some means for its prevention. +"No one," said Cheselden, "ever endured more anxiety and sickness +before an operation" than himself. + +Simpson did not forget to look at the subject from the patient's point +of view, and reproduced the letter from an old patient, which has been +already quoted (Chapter VI.). + +The soldier and sailor, brave unto heroism in facing the enemy, never +fearing the death which stared them in the face in its most horrible +form whilst answering the call of duty, would quail like children at +the mere thought of submitting to the deliberate knife of the +surgeon. Were quibbles about the efficacy of pain to stand in the way +of the merciful prevention of such suffering by the process of +anaesthetisation? + +Those who opposed him with this curious idea, that pain after all was +beneficial, were some of them men of no mean standing in the +profession. Gull, Bransby Cooper, and Nunn were amongst those whom +he had to silence. After replying to their arguments _seriatim_ with +all his polemic power, he referred them once more to the evidence +of facts and of facts alone as set forth by his statistics. Had he +lived but a twelvemonth longer than he did he would have been able +to conjure up a picture of the incalculable amount of suffering +prevented by the eighteen hundred pounds of chloroform which were +forwarded to the rival armies from one firm of chemists alone during +the Franco-Prussian war; happily for the wounded within and around +Paris, there was then no longer any doubt as to the propriety of +employing anaesthetics. + +The _religious_ objections to the use of anaesthetics could scarcely be +met with statistics. Foolish as they now appear to us after the lapse +of time, and with the practice they attempted to repel universally +adopted, they were nevertheless urged in good faith by clergy and +laity of various denominations. The same kind of bigotry had met the +introduction of vaccination, and Simpson himself remembered how many +people had opposed the emancipation of the negroes on the ground that +they were the lineal descendants of Ham, of whom it was said "a +servant of servants shall he be unto his brethren." Sir Walter Scott +reminds us, in "Old Mortality," of the spirit which met the +introduction of fanners to separate the chaff from the corn, which +displaced the ancient method of tossing the corn in the air upon broad +shovels. Headrigg reproved Lady Bellenden for allowing the new process +to be used on her farm, "thus impiously thwarting the will of Divine +Providence by raising a wind for your leddyship's ain particular use +by human art, instead of soliciting it by prayer or waiting patiently +for whatever dispensation of wind Providence was pleased to send upon +the sheeling hill." + +To-day in South Africa the same spirit is seen. Honest countryfolk of +European descent are earnestly counselled by their spiritual advisers +to submit patiently to the plague of locusts on the ground that it +comes as a punishment from Providence. These worthy men stolidly +witness their cornfields and their grass lands being eaten bare before +their eyes in a few hours, whilst their more enlightened neighbours, +brought up in another faith, resort with success to all sorts of +artifices to ward off the destructive little invaders. + +It is pleasant to be able to record that Dr. Chalmers, one of the +heroes of Scots religious history, not only countenanced chloroform +by witnessing operations performed under it in the Royal Infirmary, +but when requested to deal in a magazine article with the theological +aspect of anaeesthesia refused on the ground that the question had no +theological aspect, and advised Simpson and his friends to take no +heed of the "small theologians" who advocated such views. This was +futile advice to give to one of Professor Simpson's controversial +propensities; he entered with keen enjoyment into the fray with these +"religious" opponents. His famous pamphlet, entitled, "Answer to the +Religious Objections advanced against the employment of Anaeesthetic +Agents in Midwifery and Surgery," fought his enemies with their own +weapons by appealing with consummate skill to Scripture for +authority for the practice. The paper was headed with two scriptural +verses:--"For every creature of God is good, and nothing to be +refused if it be received with thanksgiving" (1 Timothy iv. 4). +"Therefore to him that knoweth to do good and doeth it not to him it +is sin" (James iv. 17). + +The principal standpoint of the religious opponents was the primeval +curse upon womanhood to be found in Genesis. Simpson swept the ground +from under his opponents' feet by reference to and study of the +original Hebrew text. The word translated--"sorrow" ("I will greatly +multiply thy sorrow ... in sorrow shalt thou bring forth")--was the +same as that rendered as "sorrow" in the curse applied to man ("in +sorrow shalt thou eat of it all the days of thy life"). Not only did +the Hebrew word thus translated sorrow really mean labour, toil, or +physical exertion; but in other parts of the Bible an entirely +different Hebrew word was used to express the actual pain incident to +parturition. The contention, then, that sorrow in the curse meant pain +was valueless. Chloroform relieved the real pain not referred to in +the curse, whereas it had no effect upon the sorrow or physical +exertion. + +If, however, the curse was to be taken literally in its application to +woman as these persons averred, and granting for the moment that +sorrow did mean pain, their position was entirely illogical. If one +part of the curse was to be interpreted literally, so must be the +other parts, and this would have a serious effect of a revolutionary +nature upon man and the human race all over the face of the earth. +Literally speaking, the curse condemned the farmer who pulled up his +thorns and thistles, as well as the man who used horses or oxen, +water-power, or steam-traction to perform the work by which he earned +his bread; for was he not thereby saving the sweat of his face? + +Pushed further, the same argument rendered these contentions more +absurd and untenable. Man was condemned to die--"dust thou art +and unto dust thou shalt return." What right had the physician or +surgeon to use his skill to prolong life, at the same time that he +conscientiously abstained from the use of anaesthetics on the +ground that they obviated pain sent by the Deity? Nay, more; sin +itself was the result of the Fall; was not the Church herself +erroneously labouring to turn mankind from sin? + +In a truer and more serious religious spirit he reminded his foolish +opponents of the Christian dispensation, and pointed out how the +employment of anaesthesia was in strict consonance with the glorious +spirit thereof. + +Some persons broadly stated that the new process was unnatural; even +these he condescended to answer. "How unnatural," exclaimed an Irish +lady, "for you doctors in Edinburgh to take away the pains of your +patients." "How unnatural," said he, "it is for you to have swam over +from Ireland to Scotland against wind and tide in a steam-boat." + +A son of De Quincey in his graduation thesis humorously supported +Professor Simpson. He argued that the unmarried woman who opposed +anaesthetics on the ground that her sex was condemned by the curse to +suffer pains, broke the command herself "in four several ways, +according to the following tabular statement":-- + +"1. She has no conception. + +2. She brings forth no children. + +3. Her desire is not to her husband. + +4. The husband does not rule over her." + +De Quincey himself supported his son in a letter appended to the +thesis thus:--"If pain when carried to the stage which we call agony +or intense struggle amongst vital functions brings with it some danger +to life, then it will follow that knowingly to reject a means of +mitigating or wholly cancelling the danger now that such means has +been discovered and tested, travels on the road towards suicide. It is +even worse than an ordinary movement in that direction, because it +makes God an accomplice, through the Scriptures, in this suicidal +movement, nay, the primal instigator to it, by means of a supposed +curse interdicting the use of any means whatever (though revealed by +Himself) for annulling that curse." + +But the Bible furnished Simpson with the most powerful argument of all +in Genesis ii. 21, where it is written: "And the Lord God caused a +deep sleep to fall upon Adam; and he slept; and He took one of his +ribs and closed up the flesh instead thereof." He strengthened his +position by explaining that the word rendered "deep sleep" might more +correctly be translated "coma" or "lethargy." He had taken the full +measure of his opponents when he answered them with this quotation; it +was a reply characteristic of the man, and completely defeated these +self-constituted theologians with their own weapons. They had attacked +him as a man of science, and found that his knowledge of the +Scriptures excelled their own. He did not fail to read these people a +lesson, and point out the harm done to true religion by such conduct +and arguments as theirs, reminding them that if God had willed pain to +be irremovable no possible device of man could ever have removed it. + +Such was the great fight--the fight for anaesthesia--which Simpson +fought and won. He was the one man who by his own individual effort +established the practice of anaesthesia, while Morton has the honour of +being the one man without whom anaesthesia might have remained unknown. +Such was the opposition encountered, and such was the timidity of his +professional brethren, that but for Simpson's courageous efforts it +would have been the work of years to bring about what it was granted +to him to accomplish in a brief period; if fear, ridicule, contempt, +and bigotry had not perhaps sunk the new practice into oblivion. Of +the hundreds who are daily mercifully brought under the influence of +chloroform and ether, few are aware what they owe to Simpson, even if +they know how great is the suffering which they are spared. + +Simpson felt that the victory was indeed complete when in April, 1853, +he received a letter from Sir James Clark, physician in ordinary to +Her Majesty, informing him that the Queen had been brought under the +influence of chloroform, and had expressed herself as greatly pleased +with the result. It was at the birth of the late Prince Leopold that +Her Majesty set her subjects this judicious example. + +Much trouble to the cause was occasioned by enthusiasts who +administered chloroform with more zeal than discretion, and +without any study of the principles laid down by Simpson. As a result +of imperfect trials, some persons went the length of saying that +there were people whom it was impossible to anaesthetise at all, and +others who could be only partially anaesthetised. Wrong methods of +administration were used. Simpson patiently corrected these, and +carefully instructed his students, so that the young graduates of +Edinburgh University carried his teaching and practice into all +parts of the world. Syme also took up the cause, and valuable work +was done in London by Snow, and later by Clover. The teaching of +Simpson and Syme led to such successful results that their methods +are followed by the Edinburgh School to this day practically +unaltered. So satisfactory an agent is chloroform in Edinburgh +hands, that other anaesthetics are in that city but rarely called +into requisition. All the world over it is the anaesthetic in which +the general practitioner places his trust. + +Having seen what Simpson did for anaesthesia, we may briefly review +what anaesthesia has done for humanity. That it has entirely abolished +the pain attendant upon surgery is easily recognised by the profession +and patients alike. The patient never begs for mercy nowadays; he +dreads the anaesthetic more than the knife; he has no anxiety as to +whether he will feel pain or not, but rather as to whether he will +come round when the operation is over; happily after one experience he +realises that his fears were unfounded, and, if need be, will submit +cheerfully to a second administration. + +The horrors of the operating-room referred to in the preceding chapter +were vanquished with the pain; the surgeon has no longer to steel +himself for the task as formerly, to wear a stern aspect and adopt a +harsh manner. The patient has no longer to be held down by assistants; +instead of having to be dragged unwillingly to the operating-table--a +daily occurrence sickening to the hearts of fellow-patients and +students, while it served only to harden the surgeon and the +experienced old nurse of those days--he will walk quietly to the room, +or submit patiently to be carried there, and at a word from the +surgeon prepare + + "... to storm + The thick, sweet mystery of chloroform, + The drunken dark, the little death-in-life." + +The operation is no longer a race against time; order, method, +cleanliness, and silence prevail, where there was formerly disorder, +bustle, confusion, dirt, and long-drawn shrieks. Nothing illustrates +better the progress of surgery than a picture of the operating-room in +the first decade placed beside that of an operating theatre in one of +our leading hospitals in this the last decade of the nineteenth +century. In the quiet of the patient, in the painlessness of the +operation, in the calm deliberation of the operator, and the +methodical order of all around him, in the respectful silence that +prevails in the room so soon as the patient is laid on the table, we +see the direct results of the introduction of anaesthetics. But there +are other great, if less direct, results, each making its presence +known to the professional spectator. By anaesthesia successful +operations previously unheard of and unthought of were made possible +after the principle of antiseptic surgery had been established; by +anaesthesia experimental research, which has led to numerous beneficent +results in practical surgery and medicine, was made possible. Its +introduction is an achievement of which the Anglo-Saxon race may well +be proud. Wells, Morton, and Simpson are its heroes. The United States +has by far the greater share of the honour of its discovery; but to +Scotland is due the glory which comes from the victorious fight. No +event in surgery up to 1847 had had such far-reaching effects. Simpson +himself looked forward to the discovery of some agent, better than +both chloroform and ether; and it is still possible that there may be +an even greater future in store for anaesthesia than was ever dreamt of +in his philosophy. + + + + +CHAPTER VIII + +HOME LIFE--CONTROVERSIES + + The foundations of his fame; Comparison with Boerhaave--Family + letters--Home amusements--Affection for children--And for + animals--Puck--Holidays--Wide area of practice--"The arrows of + malignancy"--Squabbles--Homoeopathy--Mesmerism--Refuses to leave + Edinburgh. + + +Great as was Simpson's contemporary fame, the chief part of it had its +origin in his indescribable personal power over his fellows, and in +his inexhaustible energy. When to these was added the reputation won +by the discovery of chloroform's anaesthetic properties, he stood not +only as the most famous physician of his day, but also as a man marked +out for posthumous fame. The personal characteristics of the man were +speedily forgotten after his death, save by those who had been brought +under their influence; the marked prominence given to Simpson and the +"discovery of chloroform" in the numerous recent reviews of Queen +Victoria's reign on the occasion of the Diamond Jubilee, indicates +that it is by chloroform that Simpson will ever be remembered. His +lasting reputation depends on this work, not upon the characteristics +which made him famous in the judgment of his contemporaries. The only +physician in comparatively modern times, whose reputation approached +Simpson's in magnitude was Hermann Boerhaave (1668 to 1738), the Dutch +physician, whose fame and influence during his own lifetime were +immense. Boerhaave's leading characteristics greatly resembled +Simpson's: he had an enormous capacity for acquiring information, and +a wonderful facility for imparting instruction to others; his energy +and industry were indefatigable, and his memory prodigious. He taught +from separate chairs in Leyden the Theory of Medicine, the Practice of +Medicine, Botany, Chemistry, and Clinical Medicine, and at the same +time carried on his large practice. Patients of both sexes flocked to +him from all quarters of the globe, and he is said to have accumulated +from his practice a fortune of L200,000 in five and thirty years. +Although his treatment and method were, according to our modern +knowledge, unscientific, his success in practice was as great as +Simpson's; it sprang from the same cause; a wonderful magnetic +personal influence, which commanded confidence and faith, so that he +succeeded with the same possibly quite simple means which were +fruitless in the hands of others. In his day all Europe rang with +Boerhaave's name. To-day he is practically unknown. His books are +antiquated, and if known, are neglected by modern physicians. He +achieved nothing of lasting benefit to humanity. His fate, at least so +far as the public is concerned, would undoubtedly have been Simpson's, +in spite of his obstetric and gynaecological work, had it not been for +the discovery of chloroform. + +The increased fame and greatly increased professional income which +followed the successful struggle for anaesthesia did not affect +Simpson's homely characteristics. He found time in the midst of it all +to enjoy the pleasures of home in the society of those he loved best, +and of intimate friends. He took a keen delight in quite the smallest +enjoyments of the home circle. A characteristic letter was written to +his wife in the summer of 1849; she had gone with the children to the +Isle of Man; he told her the great and small events of his daily +life:-- + +"Delighted to hear from you that all were so well. Everything goes on +nicely here. I have been looking out for a headache (but keep +excellently well), for I have been working very busily, and scarcely +with enough of sleep. Yesterday _beat_ (as Clark writes it) any day I +ever yet saw in the house. Did not get out till half-past four, and +the drawing-room actually filled beyond the number of chairs and +seats! Have had a capital sleep, and got up to look at the ducks; but +none laying this morning, so I write instead. To-day I have a fancy to +run out to Bathgate, and I think I will.... Yesterday dined with +Miller, and Williamson, the Duke of Buccleuch's huntsman, enlightened +us about dogs. Miller and I go to Hamilton Palace on Saturday.... My +ducks won't lay any more eggs, at which I feel very chagrined.... Two +salmon came as presents last week. I gave one to Mrs. Bennet. We are +beginning a new batch of examinations at the college. _Such_ a sleep +as I had yesterday morning! I came home by the last Glasgow train, +_very_ tired. Tom came to waken me at eight, but I snored so that he +didn't. He called me at half-past nine. I don't think I had stirred +from the moment I lay down. This morning I have been reading in bed +since six. I did not rise till now (half-past seven), because there +was no duck laying." + +In another letter written on the same occasion he says:-- + +"... Tell Davie I expect a letter from him. Say to Walter that +yesterday Carlo jumped into the carriage after me and saw with me +several patients. He usually mounted a chair at the side of each bed +and looked in. But Mrs. S. gave him too much encouragement. He leaped +into bed altogether and tramped upon a blister! which was very +painful." + +It was his custom to keep open house at breakfast and luncheon time; +but the evening meal was, as a rule, reserved so that he might see and +enjoy his own family and intimates. He lived exceedingly plainly +himself; he did not smoke; his drink was water: but he delighted in +setting a goodly repast before his guests. He loved a romp with his +children, and spared an occasional hour from the afternoon for that +enjoyment. The same energy entered into his play that was seen in his +work. A craze ran through fashionable circles in the fifties for +_tableaux vivants_, and was taken up by the Simpson household. He +entered with spirit into the new amusement, perhaps more keenly +because he saw an opportunity of combining in such representations +instruction with amusement. Historical personages and scenes were +represented, as well as illustrations of poetry and fiction. With his +infective enthusiasm he pressed poets and painters, grave and gay, +into service, and there is a record of one highly successful +entertainment at 52, Queen Street, in 1854, to which young and old +alike were invited. On this occasion most of the scenes represented +serious events in Scots history, but Simpson himself seems to have +supplied a little comedy. Sandwiched between a scene of "Flora +Macdonald watching Prince Charlie" and one of "Rebecca and Eleazar at +the Well" came that of "The Babes in the Wood." Simpson and a +professional colleague disported themselves as the Babes, and appeared +sucking oranges and dressed as children--short dresses, pinafores, +frilled drawers, white socks, and children's shoes. They wandered +about a while, and then lay weeping down to die to an accompaniment of +roars of laughter and to the great delight of the juveniles. It is +but a small incident to chronicle, but it shows in his home life the +great physician who was beloved by thousands. His deep sympathies made +him delight in the society of children. As years increased, and with +them work became overwhelming and worries and troubles persistent, he +appreciated more and more the refreshment of a frolic with his +children. He echoed Longfellow's pure words:-- + + "Come to me, oh ye children, + For I hear you at your play, + And the questions that perplexed me + Have vanished quite away. + + . . . . . . . . . . + + For what are all our contrivings, + And the wisdom of our books, + When compared with your caresses + And the gladness of your looks." + +His affectionate disposition and kindly manner gained the devotion of +his many child patients; and his own family bereavements made him a +sympathetic physician and friend to many a sorrowing mother. There was +no cant or affectation in his sympathy; it grew out of his large +heart. + +Animals also he was fond of and gentle to, as we know from the history +of the dogs who successively reigned in the household, so charmingly +given to us by his daughter. One episode in the life of Puck, a black +and tan terrier more intelligent than "breedy," deserves repetition. +The dog had accompanied the Professor and some of his children into +the country one afternoon on an expedition to dig for antiquarian +relics. "After tea Puck, seeing every one carrying something to the +station, demanded the honour of relieving his master of a _Lancet_, +and went off with his small burden looking very important.... At the +station the dog was missing. All got into their places but Puck. 'I +will follow in the next train,' said the Professor; 'Puck is too dear +a little friend to lose....' All he found of Puck was a muddy +_Lancet_, and the last that had been seen of the old dog was that he +was pushing his way through a crowd of idle colliers, where it was +supposed his energies had been so engrossed in guarding the _Lancet_ +that he had lost sight of his party.... His master stayed there until +next morning, and some remembered afterwards how Puck's loss gave them +another evening's talk with one they loved, though he broke in on the +reminiscences with 'I wonder where little Puck is,' or 'Is that his +bark?' No Puck came to demand entrance, and hope of his return was +given up after three days passing without news of him. His master was +thinking of the sorrowful letter he would have to write to Puck's +companions when late one night, as he paced wearily up and down the +room, he thought he heard a faint bark. There had been a great deal of +listening of late for the little dog's bark; but it seemed vain to +think of Puck's retracing his steps through an unknown country for so +many miles. Still the Professor opened the door and called. Up the +area steps something did limp into the hall. That it was Puck seemed +doubtful at first, for he was quick and bright, and this animal was a +lame ball of mud hardly able to crawl. The bright eyes, however, were +Puck's; and he confirmed his identity by exerting his remaining +energies to give one leap gratefully to kiss the friendly face that +bent over him.... His truant play-fellows received a long letter from +their father telling them of Puck's adventure and imagining Puck's +feelings and trials through his long wanderings.... That letter always +recalls Puck and his never-resting master bending over his desk, +despite press of business, to send the news to Puck's companions." + +Simpson looked no further than his own nursery and circle of close +friends for the refreshment and recreation which nature demanded in +the course of his busy daily life. But holidays were necessary +sometimes. He exhibited all the aversion of an enthusiastically +busy man to leaving his work, but would yield sometimes to the +solicitations of friends and would more readily leave his patients for +a time if a prospect was held out of some interesting archaeological +research to be indulged in. In 1850 he suffered from an abscess, +caused by blood-poisoning contracted during professional work. At +the request of his friends Professor Syme was called in, somewhat +to the chagrin of Simpson's old friend and colleague, Miller. It is +interesting to note that in spite of the recent controversy on +anaesthetics, Montgomery of Dublin, who had keenly opposed him, was +amongst the first to write a sympathetic note on hearing of his +illness; although dissenting from some of Simpson's professional +utterances, Montgomery was influenced by the Professor's personality +to respect him as a man and a worker. + +After this illness Simpson took a rapid run round the Continent, +visiting those cities where anything professional was to be picked up. +As he expressed it himself he "scampered" round the Universities, +Museums, and Hospitals, seeing and hearing all that was to be seen and +heard. He stowed away the newly acquired knowledge in the recesses of +his mighty brain, and hastened on to the next place of interest before +his companions had gained their breath sufficiently to regard with +intelligent interest the objects he had already left behind. In Paris, +on the occasion of one of his flying visits into a hospital, he was +present at an operation, unknown to the surgeon, in which chloroform +was used not only as a preventive of pain, but also for its remedial +effect; after the operation the surgeon addressed his students upon +the subject of chloroform, and Simpson had the pleasure of listening +to a hearty eulogy of it. When, at the end, he handed in his card, the +operator's delight was genuine and effusive, and the students +enthusiastically appreciated the somewhat dramatic scene. On such +occasions when he had to submit to the embraces of delighted foreign +scientists, the exuberant manner in which they kissed him was not to +his liking; even the remote strain of French blood in his own veins +did not help him to enjoy the Continental mode of salutation. All over +Europe his name was honoured and revered. It is said that when in +later years an Edinburgh citizen was presented at the Court of Denmark +the King remarked, "You come from Edinburgh? Ah! Sir Simpson was of +Edinburgh!" + +The last trip to the Continent, indeed his last real holiday, was +taken in 1868, when he ran over to Rome. So public was the life he +led, such matters of interest to his fellow-countrymen were his +comings and goings, that the _Scotsman_ newspaper chronicled his +doings, relating the sights and places of interest which he visited, +and noting that his professional services were taken advantage of by +many Roman citizens during the few days that he was there; and that if +time had permitted a public reception would have been given to him. In +all his foreign trips his object was to learn, not to teach; he +followed Sir Isaac Newton's advice to Ashton, and let his discourse be +more in queries than in assertions or disputings. He took care neither +to seem much wiser nor much more ignorant than his company. + +Sometimes feeling the need of rest himself he would take one or +perhaps three days for a rapid run to the Lakes, or would spend +another in the country unearthing some antiquarian object. It was +always a pleasure to him to visit Bathgate, where his uncle and +friend Alexander had latterly resigned the baker's business and taken +up the _role_ of banker. One of his favourite resorts was a small +house called Viewbank which he had taken, situated on the shores of +the Firth of Forth. Here he was close to the fishing village of +Newhaven; the fisher folks--the men and the picturesquely attired +"fish-wives"--a sturdy and original set of people, were a great +interest to him. They knew him well both as an occasional visitor and +as the good physician. + +One of his letters written in 1856 gives an indication of the wide +area over which his services were requisitioned and rendered. + + "_Sunday._ + + "I write this at Viewbank, which is very pretty this afternoon, + but where I have not been for a week or more. This year I have not + yet had one single holiday, and scarcely expect one now. I have + had many long runs during the past few months. I have been often + up in England, professionally, during the summer; once as far as + Brighton seeing a consumptive case; once at Scarboro' where my + wife went with me; once or twice in London where I saw the Queen; + once at Ambleside. I long and weary for a _real_ jaunt without a + sick patient lying at the end of it. And I had a great fancy to + run from Manchester to Douglas and send all the patients far + enough; I have been too hard worked to write, but I _must_ write + one or two papers now. Queen Street has been a little hotel + during the summer--always some sick lady or another sleeping in + it, sometimes several at night." + +Even on these professional journeys he found time to examine objects +of interest in the neighbourhood; or if he was unable to leave the +immediate proximity of his patient, he brought pen and paper to the +bedside and worked while he waited; thus he economised time as he +advised his students always to do. It is doubtful if any one less +great than Simpson would have ever been allowed to labour thus by a +sufferer's bedside; indeed even he was not always permitted to do so. +It is recorded that, at least, one lady rose hastily and seized his +pen so that he was obliged to desist. + +The striking form with which Nature had endowed him, became more +remarkable when affected by years, work, and domestic afflictions. +Though of medium height his presence, even beside typically large-built +and large-boned fellow-countrymen, was never insignificant. His +features, overhung by his massive forehead, surrounded by the long and +thick hair, spoke his character. Firm, concentrated mouth and piercing +eyes, when his mind was fixed on a scientific or practical object. A +soft, womanly tenderness about the lips, and a genial, sympathetic +emotion in his deep-set eyes when aroused by an object of pity or +pleasure. His hand was "broad and powerful, but the fingers were +pointed and specially sensitive of touch." To see him was to see one of +the sights of the modern Athens. His features are familiar to us +to-day as one of the ring of brilliant, intellectual faces forming a +frame to the picture of Queen Victoria in this the year of her Diamond +Jubilee--a year of triumphant retrospection, unprecedented in the +history of nations. + +It was impossible that a man holding Simpson's position, engaged in +his work, and possessed of distinct fighting characteristics, should +not make enemies. He could say, as Jenner said before him, "As for +fame, what is it? A gilded butt for ever pierced by the arrows of +malignancy. The name of John Hunter stamps this observation with the +signature of truth." + +The arrows of malignancy did not hurt Simpson. He was very little, if +at all, affected by them; but he paid, perhaps, more attention to them +than we might have expected him to pay; certainly more than they +deserved. His love of the fray led him oftentimes to answer what had +better have been left unnoticed, and dragged him into prolonged, +sometimes bitter, and, it is to be regretted, often unworthy, +controversies. There was so much valuable work to be done, and his +efforts were always so fruitful in result that we grudge the time +spent in these squabbles; there arises an instinctive feeling that had +he devoted the energy wasted in these contests to furthering some +single branch of science, he would have made distinct advances +therein. There was nothing superficial about his work; whatever the +object it was thoroughly entered into; his writings convey to one a +sense of the power he had of seeing all round and through a question, +and of weighing and judging evidence. There was likewise no scamping +in his mode of treating his opponents in these squabbles; he used his +weapons fearlessly and administered many a trouncing to weak +opponents. + +It was a time of upheaval in things medical. The microscope and +stethoscope had been introduced into the science and practice of the +healing art. Scientific experiment and research were beginning to lay +the foundations of rational medicine and surgery. Edinburgh was in the +front rank of modern progress, as she has ever been. Men like Simpson, +Syme, Miller, Alison, and Christison, were not likely to lag behind. +But, unfortunately, it was equally unlikely that such great minds +could all think alike in matters concerning the principles of the +science and art which they taught and practised. Thus it happened that +the Edinburgh School became notorious for its internal quarrels, and +in these Simpson was, as a rule, to be found busy. + +Quite apart from these professional differences were the disputes +arising from attacks made upon Simpson by professional brethren +and laymen, who accused him of wrong treatment or neglect of +patients. His fame endowed him with almost superhuman powers in the +minds of patients and their friends. When all other means had failed +Simpson was hastened to as a last but sure resource; bitter the +disappointment, bitter was the grief, and also sometimes bitter the +things said of him when the anxious friends of a sufferer found +that even Simpson's powers of healing were limited. These attacks were +some of the "arrows of malignancy," which naturally fell about the +over-busy man. He thought it necessary to stop, pick up these arrows, +and challenge the assailants; we may regret that he stooped so often +to this action, but we feel that it sprang as much from the love of +truth and justice as from the dictates of a disposition inclined +towards quarrel. + +It is impossible to pass over the great controversy which raged in +Edinburgh about 1850 on the merits of homoeopathy, in which Simpson, +of course, took a leading part. About the beginning of the century the +practice of medicine by the apothecaries, as the general practitioners +were then called, consisted in the most unscientific, nay, haphazard +administration of drugs in large quantities and combinations. It was +an age of drugging doctors, and the custom had become so thoroughly +established that it is doubtful whether any less completely opposite +system than that introduced by Hahnemann would have convinced the +public that after all so many drugs were not required, nor such large +quantities of them. Homoeopathic practice was founded on facts +improperly interpreted, and laid down for general use a procedure +that was applicable in only a limited number of cases. As Dr. Lauder +Brunton has recently pointed out, it is in many instances only a +method of faith-cure, and as such has its value. The success which its +practitioners certainly obtained in many cases where the ordinary +wholesale drugging of the day had proved futile, at once made men +pause ere allowing their bodies to be made receptacles for the +complicated preparations of the physician. In Edinburgh at this time +the influence of homoeopathy had been felt. Alison, a physician of +great renown, was to the end a pronounced polypharmacist, and was said +scarcely ever to leave a patient without a new bottle or prescription. +Graham, another university professor, was also a thorough-going old +school therapeutist. On the other hand, Syme treated all medicine +except rhubarb and soda with disdain; and Henderson, the professor of +Pathology, and also a practising physician, after professing to +consider no medicine of very much value, became a pronounced sceptic, +and finally horrified his colleagues by making trials of homoeopathy, +and gradually becoming enamoured of it until he confessed himself a +full follower of Hahnemann's doctrines. Christison was leading the +school which urged that the action of medicines should be studied +experimentally if their administration was to be founded on scientific +grounds. The behaviour of Henderson, who so greatly owed his position +as professor to Simpson, stirred the wrath of the latter. He examined +and condemned the irrational system of Hahnemann, and threw himself +into an attitude of strong opposition. Syme and Christison ably +seconded him in strong public action. Henderson was obliged to resign +his chair owing to "loss of health." Homoeopathy was thoroughly +crushed in Edinburgh. The contest between the old system of drugging +with large complicated doses of powerful remedies, and the new one of +giving on principle infinitesimal doses of the same medicines, served +a good purpose. It gave an opportunity for establishing rational +therapeutics, a science which is making daily progress, and in the +presence of which neither the old system nor homoeopathy can stand. + +About this same period mesmerism was again coming to the front, this +time cloaked as a science termed electro-biology. Simpson acknowledged +that there was a great deal in mesmerism demanding scientific +investigation; but with his reasoning powers he could not realise the +existence of the mystically-termed higher phenomena of animal +magnetism, _e.g._, lucidity, transference of the senses, and, above +all, clairvoyance. It happened that a professional mesmerist gave a +performance in Edinburgh; learning that the "professor's" daughter was +stated to be able to read anything written on paper, or to divine any +object enclosed in a sealed box while under her father's mesmeric +power, Simpson attended the performance. He took with him a +specially-prepared test--a sealed box with certain unknown contents; +this he presented at a suitable opportunity. Against their own wishes, +but on the insistence of the audience, the performers made an attempt +by their methods to detect the nature of the contents of this +test-box. They pronounced it to be money; on opening it millet seed +was found, and a piece of paper, on which was written, "humbug." + +An accusation, couched in bitter terms, that Simpson was really a +supporter of mesmerism as it was then known, was published in one of +the leading professional journals in London. He indignantly repudiated +the suggestion and proposed to settle the matter finally by a simple +expedient. He offered to place five sealed boxes each containing a +line from Shakspeare written by himself on paper, in the hands of the +editor of the journal who had permitted the attack to appear in his +columns. To any clairvoyant who read these lines according to the +professed method, and to the satisfaction of a committee of eminent +medical men, he promised the sum of five hundred pounds. The offer, +however, was not accepted. + +The brilliant attainments of many of its teachers at this period not +only placed the Edinburgh school at the head of the British schools of +medicine, but also led to tempting offers being made to individual +professors by rival schools anxious to secure their services. + +London was a much more lucrative field for practice than the Scots +metropolis, and several of the most eminent Edinburgh men had from +time to time yielded to the temptation to migrate southwards. Indeed, +London as a medical school owes a great deal to the Scotsmen whom she +imported. Liston had left for London in 1834, and Syme followed, for a +brief period, on Liston's death. In 1848 a strong effort was made to +secure Simpson as a lecturer on midwifery at St. Bartholomew's +Hospital; without any hesitation he decided to remain in the city +where he had fought his way to fame, and where he enjoyed popularity, +and a practice sufficiently lucrative to satisfy the most ambitious +man. Every patriotic Scot applauded the decision. + +During these years of fame and prosperity Simpson concerned himself in +schemes for the improvement of the surroundings of the working +classes, and helped with speech and purse those who worked among the +poor. He strongly supported the establishment of improved dwellings +for workpeople and gave much attention to the subject of Cottage +Hospitals. He did not neglect the poor amongst whom he had laboured in +his early days. He loved old Edinburgh, and the poor inhabitants of it +were near his heart. "The Professor" was known in many a "wynd" and +"stair," where his services were rendered willingly and without +reward. + + + + +CHAPTER IX + +ARCHAEOLOGY--PRACTICE + + His versatility--The Lycium of the Muses--The Catstane--Was the + Roman Army provided with medical officers?--Weems--His lack of + business method--Fees and no fees--Generosity often imposed + upon--His unusual method of conducting private practice--The + ten-pound note--Simpson and the hotel proprietors. + + +Professor Simpson's versatility was remarkable. He turned from one +subject to another and displayed a mastery over each; it was not +merely the knowledge of principles which astonished but the intimate +familiarity with details. He was able to discuss almost any subject in +literature, science, politics, or theology with its leading exponent +on equal terms. He had the power of patient listening as well as the +gift of speech; more than that he had the ability to charm speech from +others, of making each man reveal his inmost thoughts, betray his most +cherished theories, or narrate his most stirring experiences; the most +reticent man would not realise until he had left Simpson's presence, +that in a brief interview, perhaps the first, he had told his greatest +adventures, or laid bare his wildest aspirations before this student +of mankind who was summarising his life and character as he spoke. +Simpson built up his knowledge not so much from books as by the +exercise of his highly developed faculty of observation aided by his +memory. He enjoyed the study of his fellowmen and extracted all that +was worth knowing from those with whom he came into contact. He never +undertook work without a definite object in view, and rarely abandoned +his task before that object was accomplished. Quite small researches +would lead to considerable and unexpected labour. He preserved his +scientific method, his desire to appeal only to the evidence of +facts--not to other men's fancies--through his archaeological work as +well as in more professional lines of study. He laboured long and +carefully over such an object as the study of old skulls dug up in +antiquarian excursions; setting before himself the object of finding +out by the condition and wear of the teeth what kind of food had been +consumed by the owners, probably primeval inhabitants of some +district. He impressed his methods upon those who worked for him or +with him. We find him writing to his nephew, who was about to visit +Egypt, telling him when there to gather information as to the +suitability of the country for invalids, and directing him how to +employ his leisure in furthering this object. He was to study German +on the voyage thither, and to take with him as models Clarke's book on +Climate and Mitchell's on Algiers, and any French or German books on +the subject he might hear of. He would require to collect (1) The +average daily temperature; (2) The hygrometric and barometric states +daily; (3) The temperature of the Nile; (4) The temperature of any +mineral springs; (5) The general character of the geology; (6) The +general character of the botany of the country. He asked him to +inquire specially as to the effect of the climate on consumption, and +pointed out that Pliny described Egypt seventeen centuries ago as the +best climate for phthisical patients. For amusement he was to take +some good general book on Egypt and Egyptian hieroglyphics. The +serious study of a succession of inquirers was to be the young man's +holiday amusement! + +Simpson's most notable contributions to archaeology were made when his +time was most occupied professionally. The researches on Leprosy were +first enlarged and improved. In 1852, when in the British Museum, his +eye was attracted by a small leaden vase bearing a Greek inscription +signifying the _Lycium of the Muses_. By a painstaking inquiry he +established that this lycium was the _Lykion indikon_ of Dioscorides, +drug used by ancient Greeks as an application to the eyes in various +kinds of ophthalmia. It was obtained from India, and is still used for +these purposes in that country. He discovered that there were three +other examples of this ancient receptable for the valued eye-medicine +in modern museums. + +He had correspondents in different parts of Scotland engaged in making +researches into antiquities, which he encouraged and directed. Among +such were inquiries into the whereabouts of a church said to possess +holy earth brought from Rome; and a hunt for ancient cupping-vessels. +The work on the Catstane of Kirkliston was elaborate, and a perfect +example of his method. Probably this stone, a massive unhewn block of +greenstone-trap, had been a familiar object to him in his youth, for +it lay alone in a field close to the Linlithgow road. In his monograph +he endeavoured to show by close reasoning, with profuse references to +forgotten authorities and ancient history, that the stone was the tomb +of one Vetta, the grandfather of Hengist and Horsa. His argument ran +as follows: The surname Vetta, which figured on the inscription carved +upon the stone, was the name of the grandfather of Hengist and Horsa, +as given by the oldest genealogists, who described him as the son of +Victa. The inscription ran thus: VETTA F(ilius) VICTI. Vetta was an +uncommon Saxon name, and no other Vetta, son of Victa, was known in +history. Two generations before Hengist and Horsa arrived in England a +Saxon host was leagued with the Picts, Scots, and Attacots in fighting +a Roman army, and these Saxons were probably commanded by an ancestor +of Hengist and Horsa. The battlefield was situated between the two +Roman walls, and consequently included the tract where the stone is +now placed. The palaeographic characters of the inscription indicated +that it was carved about the end of the fourth century. Latin (with a +very few exceptions in Greek) was the only language known to have been +used at that time by Romanised Britons and foreign conquerors for the +purpose of inscriptions. The occasional erection of monuments to Saxon +leaders is proved by the fact mentioned by Bede that in his time, the +eighth century, there stood in Kent a monument commemorating the death +of Horsa. In 1659 a writer had described this tomb of Horsa as having +been destroyed by "storms and tempests under the conduct of time." + +In 1861 Simpson was president of the Society of Antiquaries of +Scotland, and delivered an address on the past and present work of +archaeology which greatly stimulated antiquarian study in his country. +Amongst the honours which his antiquarian achievements brought upon +him was that of being appointed Professor of Antiquities to the Royal +Academy of Scotland; he was also elected a member of the Archaeological +Societies of Athens, Nassau, and Copenhagen. + +He made researches into the subjects of lake dwellings, primeval +pottery, and burial urns. One of his most valuable writings was upon +the subject, "Was the Roman Army provided with Medical Officers?" He +answered the question in the affirmative after a laborious hunt +amongst votive and mortuary tablets; no Roman historians had left +clear indications of the existence of any army medical department. He +found that several tablets were preserved bearing inscriptions +referring to army surgeons, which suggested that although they were +all known as _medicus_ there were degrees of rank amongst them, +notably the _medicus legionis_ and the _medicus cohortis_. There is a +well-preserved tablet in the Newcastle Museum found in that +neighbourhood, commemorating a surgeon of the first Tungrian cohort, +and one in Dresden, referring to a _medicus duplicatorius_, a term +which indicates that the surgeon had been fortunate enough by his +attainments to merit, and, we hope, receive double fees for his +services. + +All his antiquarian study was looked upon by Simpson himself as no +more than a relaxation. Fatigued by days and nights of anxious +consecutive professional work, he would suddenly dash off for a day +into some part of the country where he knew there was a likely "find," +leaving patients and students to the care of his assistants. Here he +would press into service and infect with his spirit all sorts of local +worthies from the squire or laird down to the labourer, who woke up at +his stimulation to find that what had been of no concern to them and +their fathers before them--perhaps objects of vituperation or +superstitious dread--were objects of keen delight and interest, and +actually valuable to this astonishing man. Once on a professional +visit to Fifeshire he quite casually discovered some remarkable though +rough carvings in caves, representing various animals and curious +emblems, and he was able to show that they presented features hitherto +unnoticed. Fifeshire was famous for its underground dwellings, or, as +they are locally called, "weems"--a term which gave origin to the +title of the Earldom of Wemyss. After such an excursion he would +return to Queen Street full of boyish spirits, eager to narrate his +discoveries to interested friends, and refreshed ready to resume the +daily round of work. Archaeology was his hobby--the hobby on which he +rode away for refreshment and relief from the monotony of his life's +work; not only did the hobby constantly restore his flagging energies, +but as it is given to few men to do, he put new life into his hobby +whenever he bestrode it. + +In the conduct of his practice he was somewhat negligent. He was one +of the old school in these matters; he trusted his head rather than +paper, and his head had had such a careful self-imposed training since +childhood that it was a good servant. But where the brain has such +enormous duties to perform, those which appear to it unimportant must +of necessity be comparatively neglected. + +Had he been more careful of pounds, shillings, and pence, he would +have been more attentive to the details of practice. To Simpson, +provided he had sufficient money for all his wants--and his wants +were wide, for they included those of many others--pecuniary and +business matters were of secondary consideration. In his student days +he had lived carefully, accounting, as has been seen, for every +trivial expenditure to those to whom he was indebted. But now he was +free from the harassing necessity of exercising rigid economy, he cast +aside the drudgery of business methods and disdained commercial +considerations. He certainly received some very large fees, but the +curious mixture of human beings who crowded his waiting-rooms were +treated all alike whether they paid princely fees or no fee at all; +lots were drawn daily for precedence, and they entered his presence +according as they drew. His valet seems to have attained considerable +skill in estimating the probable remunerative value of a roomful of +waiting patients, and would grumble at night if on emptying the +professor's pockets, as was his duty, the result fell short of his +calculated anticipations. The man did not approve of the master's +habit of giving gratuitous service. There were many who were never +asked for a fee, and many others whose proffered guineas were refused. +Simpson would not ask for money from those to whom he thought it was a +struggle to pay him; the magnitude of his profit-yielding practice +rendered this form of charity possible for him; from the really poor +he always refused remuneration. His house was filled with all sorts +of presents from patients, grateful for benefit conferred, grateful +for generosity and consideration. He was also a free giver, and +besides supporting orthodox charities made many gifts of goodly sums +to persons who appeared to him to be in want, or who succeeded in +impressing on him their need for help. He was imposed upon often +enough; not seldom by pseudo-scientists full of some great discovery +which a little more capital might enable them to complete. Once he +corresponded with an enthusiast of this description who confessed that +he had been breakfasting on a waistcoat, dining on a shirt, and +supping on a pair of tough old leather boots, with the object of +finding a solid substance, which combined with lead or tin would form +gold--nothing more or less than the time-honoured philosopher's stone! +To such a man Simpson gave freely not only once. + +To young students entering upon professional life with no other +capital than their newly acquired qualifications to practice, he was +ever generous. The Scots Universities sent forth many such youths, +sturdy and independent, and with feelings that would be easily wounded +by any attempt to patronise. But his gentleness, and the sympathy born +of his own early experiences and shining in his eyes, made help from +him something to be proud of. + +It could never be urged against Simpson that he was avaricious. Just +as when honours were showered upon him he accepted them with less +thought of the personal honour than of the appreciation of his +friends and the public, and rejoiced that they were pleased; so he +rejoiced in the acquisition of ample means chiefly because of the +pleasure he might derive therefrom by helping others. + +His method of seeing patients was boldly haphazard; we learn with +astonishment that he kept no list of his visits to be made, and +started a day's round with only his prodigious memory to guide him as +to where he should go. Such a method must have had the result that +only cases of interest or urgency were seen. No doubt the able staff +of assistants attended to the others, but these comprised not only +sufferers from trivial complaints but those afflicted with imaginary +ills who had come to see Simpson, not his assistant. Possibly they had +already suffered many things of many physicians and were none the +better. Such persons blamed Simpson with some reason. In the case of +neurotic persons only was his method not reprehensible; continued +attendance might have undone the benefit of the one application, if we +may so term it, of his strong personality, which sometimes was all +that was required, so superstitious was the reverence for his powers. +A precise system of registration of engagements and visits ought +certainly to have been adopted. We can sympathise with those who felt +aggrieved that they could not obtain more attention from the great +man, but it must be remembered that by his own method he saw a great +number of difficult and dangerous cases, and was able to originate out +of his wide and unprecedented experience, modes of treatment which are +to-day valued highly and successfully made use of by his professional +successors. He never wittingly left a fellow-creature's life in +danger, but would hasten at all hours to cases of real urgency. + +As is usual where large numbers are striving after the same object +some were highly careless in their communications with him. Fees were +sent to him with a request for a receipt, but no address was given. +Engagements were asked for by persons who neglected to say at what +hotel they were staying; and others worried him for letters on quite +trivial subjects. On one occasion, it is authentically related, a +ten-pound note was forwarded to him by a man who might more reasonably +have paid one hundred pounds. The note was somewhat carelessly not +acknowledged, and the sender kept writing letters demanding an answer +in increasing severity of tone. But he was left to rage in vain. A few +nights later Simpson's sleep was disturbed by a rattling window; in +the dark he rose and groped for a piece of paper wherewith to stuff +the chink and stop the irritating noise. His only comment next morning +when his wife, having removed the paper and discovered its nature came +to him with it, was, "Oh! it's _that_ ten pounds!" + +There was a great want of method in all his arrangements, and Dr. Duns +confesses to having had considerable difficulty in arranging +Simpson's letters and papers, so carelessly were they kept. + +The leading hotels in the city benefited by Simpson's reputation. +Patients and pilgrims filled their rooms long before tourists began to +crowd Scotland as they do to-day. When Simpson was elected to the +Chair of Midwifery loud complaints were uttered by the hotel +proprietors. His predecessor, Professor Hamilton, had been a man of +such wide reputation that they derived much profit from the patients +sent in from the surrounding country to be attended by him. How could +a young man like Simpson equal this? And yet when he died there was +more than one hotel proprietor who could attribute no small measure of +his own success to the patients and visitors who crowded not only from +the country districts of Scotland but from the most remote parts of +the British Empire, as well as from the great cities of Europe and +America, to gain help or speech from or perhaps only to see this same +Simpson. And his fame had reached the high point it ever after +maintained when he was but a young man--before he was forty years of +age. It was estimated that no less than eighty thousand pounds per +annum was lost to the hotel, lodging, and boarding-house keepers of +Edinburgh when he died. + + + + +CHAPTER X + +PERSONAL--PROFESSORIAL--PROFESSIONAL + + His genius--Fertility of resource--Personal influence--Work in + obstetrics and gynaecology and surgery--His lecturing and + teaching--The healing of wounds--Acupressure--Hospitalism--Proposal + to stamp out infectious diseases. + + +Professor A. R. Simpson has said that his uncle Sir James Simpson's +genius showed itself in his power of seeing things, in his power of +adapting means to ends, and in his power of making others see what he +had seen and do what he had done. We have seen these characteristics +displayed in his work upon anaesthesia; it is literally true that he +left no stone unturned to gain his end and to make others look upon +anaesthesia in the same light as he regarded it. He declared all the +while that if he found the opposition to the administration of +chloroform in midwifery practice too powerful to conquer alone, he +would finally overcome it by bringing about such a state of public +opinion on the subject as would compel the profession to adopt his +methods. + +Whether we regard Simpson as a physician or as a surgeon, as a +gynaecologist or as an accoucheur, we find that his success was always +due to the same causes. He possessed no secret remedies such as an +ignorant and imaginative section of the public often credit to +successful medical men. He performed no operations with which other +surgeons were not equally familiar and equally capable of performing; +indeed he frequently sent his surgical cases to operators in whose +hands he considered they would be more skilfully treated than in his. +In obstetrics and gynaecology his skill arose not only from his +unrivalled experience, but also from his power of rapid diagnosis, and +his promptness and boldness in treatment. + +His readiness in resource was unfailing. On one occasion, it is +related, during an operation the bottle of chloroform was knocked over +and its contents were spilled upon the carpet before the surgeon had +completed his work; whilst his colleagues were wondering what was to +be done or how a further supply of the anaesthetic could be obtained +with sufficient speed, Simpson was on his knees hacking out with his +knife the portion of carpet on which the chloroform had just fallen; +and by means of this extemporised inhaler the operation proceeded +uninterrupted to the end. + +He carried his distinguishing energy and thoroughness into every +branch of his work; even in extempore speeches made at meetings of +professional societies, he placed facts before his listeners in so +convincing and lucid a manner out of the extensive variety of his +knowledge, and aided by his great memory, that if he did not in +reality gain the point he argued in favour of he generally appeared to +do so. On such occasions too his imperturbable temper was a valuable +weapon. + +There is no doubt that the genial professor availed himself fully of +the unbounded confidence placed in him by his patients. Those of us +who did not know him cannot appreciate what we have already said, that +the charm of his personality was one of the greatest factors of his +success in practice, and of his social success; there is the risk of +the appearance of exaggeration in any description of this personal +influence. The sympathy of his heart, a real sympathy, not a thin +professional veneer, was made manifest by deed as well as word. It +aroused in his patient, quite unconsciously to both, a feeling that +this man, above all other men, understood his complaint; that he, the +sufferer was the chief, if not the only object of his thought and +care. It was said over and over again of him that his words and look +did more good than all his physic, so able a wielder was he of that +healing power which reaches the body through the mind. Those who knew +him not, but falling sick hastened to Edinburgh to be healed by him, +were oftentimes cured simply because they felt beforehand that he +would cure them. They followed unconsciously the ancient command of +the Talmud, where it says, "Honour your physician before you have +need of him," and went to him full of respect and fired by faith. Wise +men have striven through all ages to take advantage of this influence +of the mind over the body, and the necessity of possessing a healthy +mind if the body is also to be healthy. A striking proof of the +antiquity of the thought has been recently furnished in a fashion that +would have delighted Simpson. On a papyrus, dated A.D. 200, brought to +light by Egyptian explorers, it is written that Christ said: "A +prophet is not acceptable in his own country, neither doth a physician +work cures upon them that know him." + +The advances which Simpson made in the science and practice of both +midwifery and gynaecology were due to the magnitude of his experience +and the readiness of his genius to profit by experience. His one +thought being the relief of suffering and the prolongation of life, he +approached the bedside as a man with less high aspirations would fail +to do. He considered only the patient's interest, and gave his genius +free play. He took midwifery and gynaecology by storm, and urged them +on to great developments; he believed in observing, helping, or +imitating nature rather than acting, as his predecessors had done, +upon preconceived ideas which oftener than not ran contrary to +nature's commands. He avoided meddlesomeness, and stepped in only as +the ally of nature. He took numerous hints from bygone practitioners +and writers, and developed them. To-day we are profiting by his +teaching, and the instruments which he devised or perfected. + +To mention all his suggestions and all his contributions to the arts +which he specially practised would here be obviously impossible as +well as out of place; but to medical readers the mention of one +instrument associated with his name, and known as _the sound_, will +give a small indication of how much we are in his debt. The principle +of this instrument had been known long before he took it in hand, but +it was left for him to introduce it into practice, perfect it, and +preach its value in diagnosis and treatment. So thorough was his work, +so farseeing his science, that our knowledge of its utility has +scarcely been added to since he first drew attention to it in 1843. + +Towards operative work his attitude was characteristically conscientious. +We are told that he habitually put the following question to himself when +contemplating a serious operation: "Am I conscientiously entitled to +inflict deliberately upon my fellow-creature with my own hands the +imminent and immediate chance of death for the problematic and +prospective chance of his future improved health and prolonged life?" +The fact that he habitually thus questioned himself is an evidence of the +state of surgery at that time. Operations were undertaken only as a last +resource to save life; the surgeon knew full well that he placed his +patient in further peril merely by cutting through the skin, in a manner +which has now happily become a thing of the past. + +His work was so pre-eminently practical that he never stopped to +collect together his experiences into a scientific treatise. Although +he revivified midwifery, and was one of the original founders of +gynaecology, he left to aftercomers the labour of studying what he had +done, and drawing the conclusions on which to strengthen the fabric of +the science. His pamphlets, papers, and reports are very numerous. It +would be wrong to say that modern thought has approved all that he +wrote; but however much time and increased knowledge may have modified +his teaching, they have not detracted from the value of his +researches, discoveries, and suggestions, or from the stimulating +influence of his work upon contemporary practice and thought. + +As a lecturer and teacher Simpson succeeded as in the other branches +of his work. His brilliant exposition of his subjects and his careful +practical manner of teaching his young listeners doubled the fame +which had begun with his predecessor, Professor Hamilton, and has ever +since belonged to the Edinburgh school of obstetricians. But here +again his personal attractiveness and power gained for him the greater +part of his success. In the words of the _Lancet_, written when +reviewing a posthumous collection of some of his writings, his +lectures used to brighten the gloomy days of the Edinburgh winter; in +perusing the publication under review, Edinburgh men would "almost +think they saw the big head and face of the great obstetrician, as +they used to see him beaming with satisfaction or twinkling with +genial humour as he told a good story, or related a happy case, +illustrative of his own bold and original practice." Both as a +lecturer and as a bedside teacher he captured his students by the +charm of his diction, the wide range of his knowledge, and as +Professor Gusserow has pointed out in his masterly memoir, by his +peculiar talent of having his knowledge at his fingers' ends, and that +often in very remote details. + +Year by year he never failed to obtain the affection of his students; +scarcely a man that had been taught by him but would proudly boast +that he was his friend as well as his teacher. He treated his large +class in a confiding spirit--not as the superior person delivering _ex +cathedra_ utterances, but as the friend rejoicing in his function of +admitting those around him into the knowledge in which he seemed to +revel. He had a happy method of getting on good terms with his +audience before proceeding to the serious business of the lecture. +When his health began to fail he was sometimes unwillingly laid aside, +and the lectures were delivered by a substitute. On one occasion he +re-appeared pale, weak, and lame, after such an enforced holiday, and +was greeted enthusiastically by a crowded class. He told them that his +servant had said to him that a rumour was abroad that he was in +Morningside Asylum. He had asked what answer he had made, and heard +that he had replied that so far from being wrong in his mind his +master was writing a book in bed. While he did not say that this +answer was strictly correct, he was happy to assure them, his pupils, +that he was quite right in his mind, although a friend had hinted that +morning that he was rather weak in his _understanding_! + +Old fellow-students meeting each other in after life as staid +practitioners take pleasure in recalling the idiosyncrasies and +peculiarities of their teachers; it is probable that no professor has +ever been talked over with the appreciation which breathes through the +reminiscences of Simpson conjured up by those whom he taught. + +Simpson left his mark in other departments besides those of the +subject of his professorial chair and of anaesthesia. About ten +years after the introduction of chloroform he turned his attention +to the process of wound-healing--the repair of necessary wounds +inflicted by surgeons in the course of their work--and although he +was promptly told to go back to his midwifery, he worked persistently +at the subject. In those days the subject was the most burning one in +surgery and the methods employed to bring about successful results +varied in different schools. The object of all methods was the +same, viz., to obtain a healthy, clean, and sightly result after +an operation; to leave the part which had been of necessity cut in a +condition as nearly as possible approaching that in which it had +been found, without the incidence of any of the too frequent grave +complications. Surgeons did not recognise at first the power of +nature to effect for them what they strove after; they thought to +attain their object by compelling the tissues to heal as they +desired by complicated applications, and many were the layers of +ointments and masses of dressings heaped on wounds for this +purpose. For a long time all efforts were directed to the discovery +of some specific substance, the application of which would give the +necessary impulse towards healing in the desired manner. Before +Simpson's day it had been generally recognised that the cause--but +its nature was quite undreamt of--of the trouble lay in the air +surrounding the wound, and more dressings were piled on to keep +out the air. But at the same time bleeding was arrested by tying the +cut arteries with ligatures--chiefly silken--and these were left +with long ends hanging out of the wound to work their way out by a +process of ulceration, or irritation of the tissues until liberty was +obtained. This process was practically incompatible with the ideal +form of healing, known as healing by _first intention_, _i.e._, +union without appreciable loss of substance or the formation of +_pus_ or matter. So-called "surgical fever," secondary haemorrhage, +and blood-poisoning were the frequent fatal results of operation +wounds treated in this manner. Simpson and others thought to prevent +these alarming diseases by devising other means of closing the +arteries; thinking that if some method or material were used, +which nature resented less, the wound would more readily close by +first intention. In 1858 Simpson stated that he had for some time +past been experimenting with substitutes for the ordinary silk and +thread ligatures, and in the course of his experiments had made use +of iron, silver, and platinum wires. In his usual way he hunted up +old authorities, and found a record of both silver and gold threads +having been experimentally used by bygone practitioners. He seems to +have been pleased with his results, stating that he found the +tissues much more tolerant of these metallic ligatures than they were +of the ordinary organic ones; that only "adhesive inflammation," not +ulcerative suppurative inflammation, was excited. This success, +however, was probably due to the superior cleanliness of the metal, +but this he did not recognise; had he done so he might have been led +to strive after surgical cleanliness, and have partly anticipated the +great work done subsequently by others. He went off, however, on a +different line, and searched for some readier method of using +metallic means of closing the blood vessels, being stimulated by +the desire to abolish ligatures altogether. Thus he was led, after +ten years' careful research, to the introduction of a method entirely +original--that of _Acupressure_. This consisted in the introduction +of a fine needle through the tissues across the course of the +artery, so that while the needle pressed upon one side of the artery +the resisting tissues of the body exerted counter-pressure on the +opposite side. He claimed for his method the merits of simplicity, +elegance, and cleanliness, and urged that not only did the tissues +tolerate the needle as they did not tolerate silk or hemp, but that +unlike the ligature the needle could be withdrawn as soon as +nature had closed the blood vessel by the process of coagulation of +the blood within it set up by the pressure; thus the prolonged +irritating presence of a body within the wound which delayed +healing until it had ulcerated its way out was rendered unnecessary, +and a better and more rapid result was attained. He verified his +theoretical considerations by experiments on animals and in one or +two operations on the human subject, and in 1859 read a communication +on the subject to the Royal Society of Edinburgh. + +The paper was written under great pressure of work, indeed he stated +that at that time he was hardly ever able to write except when himself +"confined"; it was hastily prepared to take the place of that of +another Fellow which had failed to be forthcoming a few days before +the appointed meeting. It was composed at a country house where he had +to sleep for two or three nights watching a case of diphtheria. It was +headed as usual by a Shakspearian quotation, this time briefly in +Justice Shallow's words, thus:--"Tut, a pin!" On the evening of its +delivery an abstract of the paper was forwarded to the leading +surgeons in England, Europe, and America, and diverse were the +opinions expressed. + +In Scotland the new method met with the greatest favour and the +strongest opposition at one and the same time. Throughout Europe and +America it was everywhere received with applause and support. +Excellent results were obtained when the method was properly applied, +but technical considerations, particularly the difficulty of using it +upon blood vessels far removed from the surface, rendered it +unsuitable for universal application. + +Professor Syme met the innovation with vehement opposition; +possibly he resented this intrusion of the gynaecologist into the +regions of general surgery. He took into his class-room one pamphlet +on the subject by Simpson, which had especially aroused his wrath; he +stormed at the author before his students for "his vulgar insolence," +and then, in a dramatic scene, expressed the violence of his contempt +by savagely tearing the pamphlet into pieces and casting it away. +In a subsequent controversy between these two old opponents, who +had been temporarily united by Simpson's conduct in consulting Syme +professionally, by their joint action against homoeopathy, and by +Simpson's defence of Syme when publicly attacked by an English +surgeon, the feud was renewed. + +Simpson persisted for years in collecting reports of operations in +which acupressure was employed, and published them from time to time +in the _British Medical Journal_ and elsewhere. In 1864 his work +on the subject took the form of a volume containing 580 quarto pages. +His friends endeavoured to rank acupressure with chloroform as one +of the blessings to humanity made manifest by him. He himself +recognised that he had failed to gain for acupressure a place in +practice such as he had gained for chloroform, but he looked forward +to a time, perhaps a quarter of a century distant, when his method +would be beginning to be thought about. In this he was mistaken for, +on the contrary, acupressure was beginning to be forgotten long before +twenty-five years had elapsed. Another worker on more strictly +scientific lines had by that time made healing by first intention, +without complications, the rule instead of the exception, and +conferred a benefit on humanity as great if not greater than that of +anaesthesia. In 1867, while Simpson was still alive, Mr. (now Lord) +Lister (then a hospital surgeon in Glasgow, and subsequently Syme's +successor in Edinburgh) enunciated the new principle of "antiseptic +surgery," which recognised the living infective micro-organisms of +the air as the cause of the trouble in wounds. He directed that as +these invisible organisms (known only by means of the microscope) +were present everywhere in the air, found their way into all sorts of +wounds, and set up the decomposition which led to disastrous +results, they were to be destroyed or excluded from wounds; and he +suggested effective means of accomplishing this end. He further +abolished the long ligatures which irritated by their presence, and +by the organisms they conveyed into the wound when imperfectly +cleansed as they usually were; and substituted non-irritating +ligatures which nature herself was able to remove by the process of +absorption. The recognition of this antiseptic principle effected a +much needed revolution in surgery, and in this revolution acupressure +was practically annihilated. Simpson did not live long enough to +see the complete establishment of the Listerian principle; at +first he vigorously opposed what he considered to be an attempt to +retain the old-fashioned ligatures in preference to his new +acupressure; but with his penetrative eye he must have foreseen +that should the new practice prevail and short absorbable ligatures +be made possible, acupressure would be completely superseded. + +In the estimation of the writer of the obituary notice of Professor +Simpson in the _British Medical Journal_, the greatest of all his +works was that undertaken in the subject of Hospitalism. As early as +1847 he had been horrified to read in a report of the work done in the +Edinburgh Infirmary, that out of eighteen cases of primary amputation +performed during a period of four years only two survived. He faced +this fact with the courage of the reformer, and sought far and near +for other facts to support the theory which he gradually evolved, that +this melancholy failure of surgeons to save their patients' lives was +due not so much to the operation or the operator as to the +environment of the patient. In later years he himself often shrank, on +account of unfortunate experiences, from performing capital operations +which he had formerly unhesitatingly undertaken. The unhealthiness of +hospitals had long been recognised; and was especially observed at +times when they were overcrowded, as happened during war time. When +the public had thoroughly grasped the utility of anaesthetics, and +recognised that operations could be performed painlessly, there were +fewer refusals to submit to the knife; there was a rush to the +hospitals, and the surgical wards throughout the length and breadth of +the land became crowded with men and women actually longing for +operation. Amongst these all the dreaded sequelae of surgical +interference, which no power seemed able to check, ravaged with +alarming severity. + +It is to Simpson's credit that he perceived how the introduction of +anaesthesia had taxed the hospitals and bewildered the operators, who +sought diligently but unsuccessfully in every direction for some means +of reducing hospital mortality. He was one of the first to set to work +with method to investigate this question of Hospitalism. + +It was towards the end of his career, when the old Edinburgh Infirmary +stood condemned, and various proposals for rebuilding it on a new site +and improved plan were under discussion, that his voice was most +loudly heard. For many years he had thought and taught that the great +mortality after operations in hospitals was due to the impure state of +the air therein, derived from the congregation of a large number of +sick persons under one roof. He picturesquely stated that the man laid +on a hospital operating table was exposed to more chances of death +than the English soldier was on the field of Waterloo. His original +suggestion was that hospitals might be changed from being crowded +palaces, with a layer of sick on each floor, into villages or +cottages, with one, or at most two, patients in each room; the +building to be of iron, so that it could be periodically taken down +and reconstructed, and presumably thoroughly renovated. This drastic +proposal brings nowadays a smile to the lips, for we see now how he +was groping in the dark; but the magnitude of it is but the shadow of +the evil it was designed to cure. The change was so great as to be +impracticable in the eyes of most men; he, on the other hand, +contended that it was to be of incalculable benefit to humanity, and, +therefore, no difficulty, however great, should be allowed to stand in +the way. He did not understand that the evils arose not from the air +itself but from what was in the air, known to us now as the +micro-organisms. His remedy was a proposal to run away from the evils +without receiving any guarantee that they could not and would not +successfully pursue. Had Lister not arisen, Simpson's proposals might +have possibly prevailed, for he laboured with all his persistent +energy. + +The general belief of the profession--but it was no more than a +belief--was that operations performed in country practice were not so +frightfully fatal as those performed in town hospitals. This was +Simpson's opinion, and he determined to test its truth by appeal to +facts. He drew up a circular with a schedule for the insertion of +results in a statistical form, and sent it far and wide amongst +country practitioners. He awaited the result with anxious expectation; +the circular asked for a plain statement of facts only, and for all he +knew the facts might be against his theory; but they were not. From +all over England and Scotland, particularly from mining districts, +where severe operations after accidents were common, the filled-up +schedules flowed in, to the number of 374. These were collected, +carefully classified and summarised. The operations selected were +amputations, and the result briefly was this:-- + + Total number of cases 2,098 } Mortality, + " " deaths 226 } 10.8 per cent. + +The relative mortality of the different amputations was also shown:-- + + 669 Thigh cases; deaths, 123; mortality, 18.3 per cent. + 618 Leg " ; " 82; " 13.2 " + 433 Arm " ; " 19; " 4.3 " + 378 Forearm " ; " 2; " 0.5 " + +The table on the next page compared the results of operations for +injury with those performed for disease. + +FOR INJURY. + + Cases. Deaths. Mortality. + per cent. + Thigh 313 80 25.5 + Leg 409 57 13.4 + Arm 344 14 4.0 + Forearm 313 2 0.6 + +FOR DISEASE. + + Cases. Deaths. Mortality. + per cent. + Thigh 356 43 12.0 + Leg 209 25 12.0 + Arm 89 5 5.6 + Forearm 60 0 -- + +These statistics were accompanied by an exhaustive detailed +examination and explanation; every possible point of attack was +considered and protected. "I doubt not," he said, "that the +segregation of the sick from the sick--every diseased man being a +focus of more or less danger to the diseased around him--is a +principle of no small moment and value." He attributed the comparative +brilliancy of these statistical results to the _isolation_ of the +patients only; he endeavoured to show that the operations were often +performed amidst dirty and squalid surroundings, on dirty and squalid +persons. He did not attribute sufficient importance to the fact urged +by many of his correspondents, who supported his general contentions +almost to a man out of their own experience, that where fresh air, +ventilation, and cleanliness prevailed, the results were always the +most satisfactory. + +The next step was to take hospital statistics of similar operations, +and the general result appears in the table on page 183. + +This testimony to the truth of Simpson's opinion was more pronounced +than even he himself had anticipated. "Shall this pitiless and +deliberate sacrifice of human life to conditions which are more or +less preventable be continued, or arrested? Do not these terrible +figures plead eloquently and clamantly for a revision and reform of +our existing hospital system?" This was his cry until at length +breath failed him. The opposition was not strong, but the support +was weak. Although there was much criticism, his conclusions were +scarcely called in question at all; trifling holes were picked in +his statistics, but his contentions were universally acknowledged +to be correct; a few reformers only, persuaded as he was of the +evils of hospitalism and working at the subject, lent him their +advocacy. But he alone stood unperturbed at the extent of the evils +and the magnitude of the change which he proposed in order to +uproot them; death laid him low as he stood, but not before he had +modified his proposals by suggesting that existing hospitals might be +reconstructed, and new hospitals built on the now almost universally +adopted pavilion system on which the new Edinburgh Royal Infirmary was +one of the first to be built. + + Column Headings-- + C: Cases. + D: Deaths. + _______________________________________________________________________ + | | | + | HOSPITAL. | FOR INJURY. | + |_______________________|_______________________________________________| + | | | | | | + | | Thigh. | Leg. | Arm. | Forearm. | + | |___________|___________|___________|___________| + | | | | | | | | | | + | | [C] | [D] | [C] | [D] | [C] | [D] | [C] | [D] | + |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| + | | | | | | | | | | + | Edinburgh Infirmary | 134 | 48 | 28 | 9 | 7 | 3 | 19 | 7 | + | Glasgow " | 100 | 60 | 93 | 50 | 101 | 38 | 66 | 9 | + | Nine London Hospitals | 320 | 123 | 173 | 53 | 48 | 13 | 37 | 7 | + |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| + | | | | | | | | | | + | Total | 631 | 239 | 283 | 89 | 78 | 22 | 75 | 15 | + |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| + | | | | | | + | Mortality per cent. | 64.4 | 54.8 | 40.1 | 14.8 | + |_______________________|___________|___________|___________|___________| + + _______________________________________________________________________ + | | | + | HOSPITAL. | FOR DISEASE. | + |_______________________|_______________________________________________| + | | | | | | + | | Thigh. | Leg. | Arm. | Forearm. | + | |___________|___________|___________|___________| + | | | | | | | | | | + | | [C] | [D] | [C] | [D] | [C] | [D] | [C] | [D] | + |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| + | | | | | | | | | | + | Edinburgh Infirmary | 65 | 48 | 58 | 29 | 21 | 12 | 39 | 5 | + | Glasgow " | 177 | 68 | 82 | 27 | 23 | 6 | 19 | 1 | + | Nine London Hospitals | 139 | 88 | 179 | 102 | 97 | 33 | 64 | 11 | + |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| + | | | | | | | | | | + | Total | 304 | 196 | 330 | 181 | 219 | 88 | 169| 25 | + |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| + | | | | | | + | Mortality per cent. | 37.8 | 31.4 | 28.2 | 2.0 | + |_______________________|___________|___________|___________|___________| + + The total number of cases 2,089 } mortality 41 per cent. + The total number of deaths 855 } + Placed side by side the Town (hospital only) and Country (private + practice only) figures compared as follows:-- + _Hospital_ cases 2,089; deaths 855; mortality 41 per cent. or 1 in 2.4 + _Country_ " 2,098; " 226; " 10.8 " 1 in 9.2 + +The steady advance of aseptic surgery has slowly but surely brought +about the results which Simpson strove to attain by a radical measure. +The enemy which had baffled surgeons for centuries was revealed by +Lister. He sent surgeons smiling into the operating-room practically +certain of success instead of dreading the terrible onslaught upon +their own handiwork of the formerly unseen and unknown destroyer. The +death rate of operations is being daily brought nearer and nearer to +vanishing point. In his review of the progress of wound treatment +during the Victorian Era published in the Diamond Jubilee number of +_The Practitioner_, Mr. Watson Cheyne says the mortality of major +operations does not now exceed in hospitals more than three or four +per cent., and this is made up practically entirely by cases admitted +almost moribund and operated on _in extremis_ with faint hope of +survival. The field of surgery, too, has been vastly enlarged, and the +term "major operation" includes not merely operations of necessity, +undertaken through ages past as the only possible means of saving +life, but also operations which have become possible only in recent +years--some of them performed merely to make the patient "more +comfortable," or even only "more beautiful." And this glorious result +is due, as Mr. Cheyne truly says, to the immortal genius of Lister. + +In 1867 Simpson propounded in the _Medical Times and Gazette_ a +proposal for stamping out smallpox and other infectious diseases such +as scarlet fever and measles. In spite of vaccination, which, however, +was imperfectly carried out, smallpox alone carried off five thousand +lives annually in Great Britain. A serious outbreak of rinderpest in +the British Islands amongst cattle had recently been arrested and +exterminated by the slaughter of all affected animals. The disease +spread as smallpox did by contagion, and Simpson fell to wondering why +smallpox could not also be exterminated. His paper was a noteworthy +contribution to the then infant science of Public Health, and his +proposal, which was, however, universally regarded as impracticable, +sprang from his courageous enthusiasm as did that concerning +hospitals. He suggested that the place of the pole-axe in the +extermination of rinderpest might in the arrest of smallpox be taken +by complete isolation, and he laid down simple but rigid rules for its +enforcement. An attempt was made to utilise these a few years after +when an epidemic of fatal violence broke out in Edinburgh. He was in +no way an anti-vaccinationist, but his isolation measures were too +strong for the people in those days. We are not surprised that he +boldly proposed this measure, for he related glaring instances of +neglect of the simplest precautions. Beggars held up infants with +faces encrusted with active smallpox into the very faces of passers-by +in the streets of Edinburgh; and on one occasion a woman was found in +Glasgow serving out sweetmeats to the children of a school with her +hands and face covered by the disease. He cried aloud for legislation +to prevent such gross abuses, which he did not hesitate to stigmatise +as little short of criminal. + + + + +CHAPTER XI + +FURTHER REFORMS--HONOURS + + Professional and University Reform--Medical women--Honours--The + Imperial Academy of Medicine of France--Baronetcy--Domestic + bereavement--The University Principalship--Freedom of the City of + Edinburgh--Bigelow of Boston--Views on education--Graduation + addresses. + + +Professor Simpson took a warm interest in medical politics, and made +himself heard as a member of the Senatus of the University. That body +was not renowned for any spirit of harmony prevailing in its midst; it +included the medical professors many of whom were in professional +opposition to each other and were actuated by conflicting interests. +The rivalry prevailing amongst the leaders of the profession in the +Scots capital was amusingly shown in one of Sir James's letters, where +he related how Professor Miller had just given a capital address to +the young graduates and recommended them to marry chiefly because Mr. +Syme had advised the reverse two years before. "At least," he said, +"so Mr. Syme whispered to me, and so, indeed, did Miller himself +state to Dr. Laycock!" + +On the principles of Medical Reform and University Reform the +professors were, however, practically unanimous, but their interests +came into conflict with those of the extra-academical school. The +two opposing bodies worked hard to gain their own ends when a +Parliamentary Committee was appointed in 1852 to inquire into +medical reform. The modern Athens became once more disturbed by +wordy warfare. The general ends aimed at by the reformers were the +obtaining of a proper standing for qualified practitioners; some +satisfactory means of enabling the public to distinguish between +regular and irregular, quack, practitioners; and to define the amount +of general and professional knowledge necessary for degrees and +qualifications. It was also desired to remove the absurd anomaly +whereby, although Scots medical education was then ahead of English, +Scots graduates had no legal standing in England. The Medical Act +which was passed in 1858 carried out many of the best suggestions +made before the Committee, and effected desirable improvements both +in the status of practitioners and in medical education; but it was +inadequate, as time has shown, and the question of reform still +burns. Simpson took an active interest in the proceedings before the +Committee, and made several dashes up to London to further the +projects which he had at heart. The annual meeting of the British +Medical Association was held in Edinburgh in July, 1858, at the +moment when the fate of the Bill hung in the balance. As the journal +of the Association said at the time the fruit of a quarter of a +century's growth was plucked in the midst of the rejoicings. Sir +Robert Christison publicly stated that owing to Simpson's energetic +efforts certain far-reaching and objectionable clauses, which had +been allowed to creep into the Bill, were expunged at the last +moment. Simpson went up to London by the night train, employed the +following day in effecting his purpose, and returned the next night; +this was when the journey took nearly twice as many hours as now. + +The Universities (Scotland) Act was also passed in 1858; by it the +complete control of the University, and with it the patronage of many +of the Chairs, was lost to its original founders, the Town Council, +who had so carefully and successfully guided it through nearly three +centuries. The Council did not part from their charge without a +struggle; in urging their cause they proudly pointed to the fact that +they had appointed Simpson to the Chair of Midwifery against the +opposition of the medical faculty. To have elected him, they thought, +under such circumstances displayed their discernment, vindicated their +existence, and pleaded for the perpetuation of their elective office. + +When the question of the admission of women to the study of medicine +came up in Edinburgh and divided the ancient city once more into two +hostile camps, Simpson's sympathies appear to have gone with the sex +to which he was already a benefactor. He recognised that there was a +place, if a small one, within the ranks of the profession for women; +and when the question came to the vote he cast his in their favour. +The proposal, however, was rejected, and has only quite recently +become law in the University. + +Numerous honours were heaped upon him during the last five-and-twenty +years of his life. In 1847 he filled the office of President of the +Edinburgh College of Physicians, and in 1852 held the corresponding +post in the Medico-Chirurgical Society. In the following year the +Imperial Academy of Medicine of France--a body which lacks an analogue +in this country--conferred upon him the title of Foreign Associate. +This was a jealously guarded honour awarded only to the most highly +distinguished men of the day, and it was conferred upon Simpson in an +altogether unprecedented manner which doubled its value. According to +custom a commission of members prepared a list of renowned men whom +they advised the Academy to elect; in the list no British name +appeared although Owen, Faraday, and Bright were entered as +"reserves." On the day of election the members accepted all the +candidates named in the original list until the last was reached. When +the president asked for the vote for this individual a sensational +and truly Gallic scene was enacted. Almost to a man the members rose, +and loud and long proclaimed Simpson's name. Excited speeches were +made, and amidst great enthusiasm he was elected to the one remaining +vacancy by an overwhelming majority. It had remained for Simpson to +prove, as the President courteously pointed out at the time, that +there existed a greater honour than that of being elected by the +Academy--viz., that of being chosen in _spite_ of the will of the +Academy itself. + +This was by no means the only honour awarded to him by France. In 1856 +the French Academy of Sciences voted him the Monthyon Prize of two +thousand francs for "the most important benefits done to humanity." +Other foreign societies added their compliments, and he was elected +Foreign Associate of the Belgian Royal Academy of Medicine, of the +Parisian Surgical and Biological Societies, and of the Medical +Societies of Norway, Stockholm, Copenhagen, New York, Massachusetts, +Leipsic, and other places. + +In 1866 his own country made an acknowledgment of his eminent +attainments when the Queen offered him a baronetcy on the advice of +Lord John Russell. Twice before he had refused a title, but this +time he wrote to his brother that he feared he _must_ accept +although it appeared so absurd to take a title. This honour was the +first of its kind ever conferred upon a doctor, or even upon a +professor, in Scotland. It was entirely unsought, and scarcely +welcomed by its recipient for its own sake; he regarded it not merely +as a personal honour but also as a tardy recognition of the services +of the Edinburgh school in the cause of medicine. He enjoyed the +congratulations which showered upon him, and felt glad when the +citizens flocked to Queen Street to express their feelings, much to +Lady Simpson's delight. The medical papers unanimously approved of +the honour, the _Lancet_ remarking that apart from his connection with +chloroform, Simpson was distinguished as an obstetric practitioner, as +a physiologist, as an operator, and as a pathologist of great +research and originality. + +Domestic bereavement quenched the rejoicings over the baronetcy, and +condolences displaced congratulations. He fell ill for a time himself, +and in a condition of unusual mental depression spoke of the baronetcy +as appearing even more of a bauble in sickness than in health. In less +than a fortnight after the offer of the title his eldest son David +died after a short illness. He had been educated for the medical +profession, and was a youth of considerable promise and of an earnest +temperament; his death fell as a severe blow, and Simpson even +contemplated abandoning the baronetcy which had not yet been formally +conferred. The words of his friends, however, and the thought that his +dead son had particularly insisted on its acceptance, persuaded him. + +A coat of arms had to be drafted for the new Baronet, and this was a +pleasant interest for one of his tastes. The family history was +searchingly entered into, and the arms of his father's family were +differenced on the most correct lines with those of the Jervays from +whom his mother had sprung. In the matter of a crest he was able to be +boldly original, and adopted the rod of AEsculapius over the motto +_Victo dolore_, and thus handed down to his family the memory of his +great victory over pain. In June of the same year, 1866, the +University of Oxford conferred upon him one of the few honours which +reached him from England in awarding him the honorary degree of Doctor +of Civil Law. The University of Dublin made him an honorary Doctor of +Medicine, and he was created an honorary Fellow of the King's and +Queen's College of Physicians of Ireland. + +By the death of the veteran Sir David Brewster, in February, 1868, the +office of Principal of Edinburgh University fell vacant. This post is +a survival from the earliest days. The College out of which the +University grew was established in 1583 by the Town Council under a +charter granted by James VI. Only one regent or tutor was necessary at +first to teach the "bairns," as the students were termed in the +contract entered into between Rollock, the first regent, and the city +fathers. Rollock was promised that as the college increased "in policy +and learning" he should be advanced to the highest post created. By +his own efforts the number of students increased so greatly that +within the first few years several other regents were appointed, and +the Council, remembering their promise, dignified him with the title +of Principal or First Master in 1586. This office was held during the +succeeding two centuries by a series of more or less worthy men, +prominent among whom were Leighton, afterwards Archbishop of Glasgow, +and William Carstares, better known as a statesman and for his +connection with the Rye House Plot in 1684. During Carstares's tenure +the tutors were turned into professors, and the college became more +strictly speaking a university, although from the first it had assumed +without any right by charter the function of degree-granting. Although +the utility of the post quite vanished when the college became a +university, and the principal had no place in the constitution of a +university, nevertheless the principalship was not abolished. The +Universities Act of 1858 recognised the office, but only as that of an +ornamental head, acting as president of the assembly of professors +constituting the Senatus Academicus. The salary is a thousand pounds a +year with an official residence, not within the precincts or the +University. The former head master of the college, known by and +knowing every student, became a sinecurist of whose existence it is no +exaggeration to say many of the students are, through no fault of +their own, unaware. Brewster had been a distinguished occupant of the +post--distinguished not as a principal, for he received the +appointment only at the age of seventy-eight, but as a scientist. To +the public he was best known as the author of the "Life of Sir Isaac +Newton," and as the inventor of the kaleidoscope. It is said that +Brewster never spoke as much as five lines at the meetings of the +Senatus Academicus without having previously written them down; and it +is probable that this lack of spontaneous utterance from the Chairman +gave the tone to the assembly. The rival professors doubtless nursed +their animosities for some less dignified meeting-place, differing +there only on the most correct academic lines. + +It is not surprising that Simpson at first refused to be a candidate +for the vacant post. He would undoubtedly have made an unrivalled +figure-head for his _Alma Mater_; he was the leading figure in +Scotland already and "did the hospitalities" of Edinburgh to +distinguished visitors of all classes. But he would probably have been +obliged to resign his professorship and have thus been cut off from +his sphere of greatest usefulness; and although he would have grasped +with ease the details of university affairs it is open to question +whether he would have suitably filled the post of president over men +to many of whom he was in professional opposition. The most that the +suggestion that he should be a candidate conveyed was a well-meant +compliment, but it would have been a greater compliment on his part if +he had really ended his life as the ornamental head of the University +he had already done so much to adorn. He would certainly have turned +his position to good account, and perhaps might have earned the +gratitude of all succeeding students by improving their position in +the University and bettering their relationship with their teachers--a +much needed reform at that time. But he was a man for more active +occupation, and it was more fitting that he should persevere to the +end in the work of his life. Simpson expressed his opinion that the +most suitable man for the post was the one already named by Brewster +and desired by a majority of the Senatus; but that man, Professor +Christison, then over seventy years of age, generously said that Sir +Alexander Grant, an active candidate, would better fill the post. A +strong section of Edinburgh folks persisted in pushing Simpson, and in +deference to their wishes he consented to enter the lists. It cannot +be said that he displayed any of the eager energy which had marked his +candidature for the midwifery chair; but his friends made up for his +comparative apathy. They were met by a strong opposition, not +instigated by his rivals for the post, but offered by insignificant +persons who cherished ill-will against him and spread untrue +statements with the object of damaging his character. Greatly owing to +the reports spread in this manner he was not elected. Sir Alexander +Grant became the new Principal. The fact that he could not gain the +post was communicated to him in a letter which reached him one morning +before prayers. He conducted the worship as usual after reading the +letter, and when the family had afterwards all assembled at the +breakfast table he intimated the fact to them and dismissed the +subject from his mind with the quiet remark, "I have lost the +Principalship." + +An interesting episode pertaining to this period was narrated by the +Free Church minister of Newhaven. "The election," he wrote to Dr. +Duns, "took place on a Monday, and it was on the Sabbath preceding, +between sermons, that one of my people, a fisherman, called on me +stating that his wife was apparently dying, but that she and all her +friends were longing most intensely for a consultation with Sir James. +I did not know well what to do, for I knew that his mind was likely to +be very much harassed, and I shrank from adding to his troubles. But +in the urgency of the case I wrote him a note simply stating that one +of the best women in the town was at the point of death and longed for +his help, leaving the matter without another word to himself. The +result was that he came down immediately, spent three hours beside his +patient, performed, I am told, miracles of skill, and did not leave +her till the crisis was over. She would, I am assured, have died that +evening, but she was one of the sincerest mourners at his funeral, and +she still lives to bless his memory. After all was over he went into a +friend's house and threw himself down on a sofa in a state of utter +exhaustion. This was the way in which, without hope of fee or reward, +and while others were waiting for him able to give him both, Sir James +spent the evening preceding the election. Some will say it was no +great matter after all. Why, for that part of it, neither was the cup +of cold water which the dying Sir Philip Sidney passed from his own +lips to those of a wounded soldier in greater agony than himself. But +the incident is recalled whenever his name is mentioned as adding to +the glory of the knight _sans peur et sans reproche_, and the incident +I have mentioned in the Newhaven fisherman's house surely gives to Sir +James a place beside him in the glorious order of chivalrous +generosity." + +Among the last of the honours offered to Simpson was the Freedom of +the City of Edinburgh; a fitting tribute from the City in which and +for which he had so nobly and untiringly laboured. It was proposed to +present him with the burgess-ticket at the same time that it was +publicly presented to another hero in a different sphere, Lord Napier +of Magdala; but by his own desire the ceremony was postponed so far as +he was concerned in order that full honour might be paid to Lord +Napier. At the eventual presentation the Lord Provost made a short +speech recapitulating the achievements for which they desired to +honour him, and referring to his reputation as being great on the +banks of the Thames and the Seine, as well as on the shores of the +Firth of Forth; he likewise expressed the pride of his fellow-citizens +that Sir James had remained amongst them and had not been drawn away +like other men of genius before him by the attractions of the greater +metropolis of the south. Simpson's reply took the form of an impromptu +review of his career from the time he first entered the City as a +wonderstruck boy. "I came," he proudly said, "to settle down and fight +amongst you a hard and up-hill battle of life for bread and name and +fame, and the fact that I stand here before you this day so far +testifies that in the arduous struggle I have--won." + +The accounts of the speeches delivered on this occasion which reached +America raised the indignation of Dr. Bigelow, of Boston. Reference +had been made to chloroform in a manner which appeared to slight +Morton's work in introducing ether as an anaesthetic before chloroform +was heard of. In Bigelow's estimation Simpson posed as a hero at the +expense of Morton. Simpson had certainly been far from liberal in his +allusions to Morton and others in his article upon Anaesthesia in the +_Encyclopaedia Britannica_, and had written almost entirely about his +own discovery. A controversy was excited, and on his deathbed Simpson +wrote a letter to Bigelow to prove that he had duly considered the +priority and the value of Morton's and Wells's work. In his concluding +sentences he expressed regret at having taken up so much of his own +and his correspondent's time in such a petty discussion, but blamed +his illness which prevented him from writing with the force and +brevity required. "With many of our profession in America," he said, +"I have the honour of being personally acquainted, and regard their +friendship so very highly that I shall not regret this attempt--my +last, perhaps--at professional writing as altogether useless on my +part if it tend to fix my name and memory duly in their love and +esteem." + +The widespread national expression of the sense of loss and of +sympathy which reached Edinburgh from the United States after Sir +James's death testified to the regard in which he was held from one +end to the other of that country. In Boston itself the Gynaecological +Society, of which he had been the first honorary member, convened a +special memorial meeting, which was solemn and impressive. He had not +been mistaken in presuming with his last breath that he held the +regard of his American _confreres_. + +On the subject of education Simpson held what were considered advanced +opinions, but which had already been expressed by Mr. Lowe. A few +years before his death he delivered a lecture on Modern and Ancient +Languages at Granton, in which he lamented the common neglect of +modern languages in the education of the day. He had personally felt +the want of a mastery over French and German, both in the course of +his studies and during his travels; nor did he feel the want +compensated for by his ability to write and talk in Latin. He +strongly advocated the paying of more attention to the modern and +less to the dead languages, and he urged that natural science should +take its place in the ordinary curriculum of the great public schools. +These views were used as an argument against his fitness for the post +of Principal of the ancient University. + +On three separate occasions it fell to Simpson's lot to deliver the +annual address to the newly-fledged graduates, which is the duty of +the professors of the medical faculty in rotation. This ceremony +remains deeply impressed in the memory of Edinburgh men, simple and +dull as it undoubtedly is. The homily delivered by the orator of the +day contains excellent counsels appropriate to the occasion, but +the young man eager to rise and confidently try his wings pays +little attention to the words of wisdom; unless it be to feel wonder +that just as he is about to leave them, probably for ever, his _Alma +Mater_ and her priests have discovered an affectionate regard for +him and his welfare. A few years later the struggling young +practitioner may perhaps turn to the copy of this graduation address, +forwarded to him by post with the author's compliments, and find +in such an one as Simpson delivered much to strengthen and encourage +him. In 1842 and 1855 he delivered addresses from which quotations +have already been made; and in the third one, spoken in 1868, he +made a forecast of the future of medical science, predicting _inter +alia_ that by concentration of electric or other lights we should yet +be enabled to make many parts of the body sufficiently diaphanous for +inspection by the practised eye of the physician. It was his habit +to commit such lectures to memory and to deliver them without notes. +He was a ready public speaker on any subject in which he was +interested; speeches made on the spur of the moment teemed with +pleasantly-put facts and apt anecdotes from the vast storehouse of +his memory. A speech from Sir James was one of the treats in which +Edinburgh folks delighted. + + + + +CHAPTER XII + +FAILING HEALTH--DEATH + + Poetical instincts--Religious views--Religious and emotional + influences in his life--Doubts--Revivalism--Health--Overwork + tells--Bed--Gradual failure--Death on May 6, 1870--Grave offered + in Westminster Abbey--Buried at Warriston--Obituary notices--Bust + in the Abbey--His greatness. + + +The emotional part of Sir James Simpson's nature found some small +expression in versifying both, as we have seen, in early years and in +later days. We know that he was a close student of Shakspeare, but +Miss Simpson states that her father probably never entered a theatre, +so that he can never have seen a representation. He was familiar with +modern poets, especially with Burns. It is related that he once tested +a lady friend's insight into the vernacular by quoting from memory for +explanation the following lines from the national bard:-- + + "Baudrons sit by the ingle-neuk, + An' wi' her loof her face she's washin', + Willie's wife it nae sae trig, + She dichts her grunzie wi' a hooschen." + +His own verses were neither better nor worse than those written by +other men whose abilities have led them to excel in more practical +pursuits. In youth they celebrated student life, or were, as usual, +dedicated to Celia's eyebrows; in mature life they were of a more +serious, and latterly of a strong religious description. At all times +he delighted in writing little doggerel verses to his children or +friends; valueless as such efforts are, they served a useful purpose; +their composition was a recreation and pleasant relief to his +over-taxed brain, while it was an amusement to him to watch their +effect upon the recipients, and perhaps to receive a reply clothed +also in the garb of rhyme. + +Sir James's example so influenced the people amongst whom he lived +that it is impossible to omit reference to his attitude throughout +life towards religion and an account of what is one of the most +interesting phases in his history. Up to Christmas, 1861, he had +been, in the eyes of the religious public, an ordinary citizen; as +regular in church-going as his professional engagements permitted; +thoroughly interested in Church affairs, and a strong supporter of +his own Church; possessing to the full the national characteristic +of intimate acquaintance with the letter of the Old and New +Testaments; and something of a theologian as well, as his answer to +the religious objections to anaesthesia showed. At that period, to +the delight of many, and the genuine astonishment of others among +his fellow-citizens, he became a leading spirit in the strong +Evangelical movement which was then spreading through the country, +"Simpson is converted," cried the enthusiastic revivalist. "Simpson +is converted now," laughed those who had opposed every action of +his. "If Professor Simpson is converted, it is time some of the rest +of us were seeing if we do not need to be converted," wisely +answered one of his friends. In the ordinary sense of the word Simpson +was not converted. Had he passed away without developing this +latter-day Evangelical enthusiasm, all sects would still have +united in thankfulness that such a man had lived. Why this religious +revival during the sixties affected him as it did becomes evident +in looking at the religious, moral, and emotional influences which +affected him throughout his career. + +The simple-minded, devout mother, strong in faith and strong in works, +who passed out of his life when he was but nine years old, left a +vivid impression on the boy's mind. In after years he would call up +the picture of the good woman retiring from the shop and the worries +and troubles of daily life into which she had so vigorously thrown +herself and so bravely faced even with failing health, into the quiet +little room behind, to kneel down in prayer; and would describe how at +other times she went about her work chanting to herself one of the old +Scots metrical psalms: + + "Jehovah hear thee in the day, when trouble He did send + And let the name of Jacob's God thee from all ill defend. + Let Him remember all thy gifts, accept thy sacrifice, + Grant thee thine heart's wish and fulfil thy thoughts and counsel + wise." + +He used to relate one memory of her, touching in its simplicity: how +one day he entered the house with a big hole in his stocking which she +perceived and drew him on to her knee to darn. As she pulled the +repaired garment on she said, "My Jamie, when your mother's away, you +will mind that she was a grand darner." He remembered the words as if +they had been spoken but yesterday, and subsequently offered to a lady +who had established a girls' Industrial School in his native village a +prize for the best darning. + +The simple faith which beat in the life of the Bathgate baker's +household was ingrained into James Simpson; he went forth into the +world full of it, and full of the determination that by his fruits he +should be known. + +The tender, loving care for his welfare of his sisters and brothers, +particularly of Sandy, who never faltered in his inspired belief in +James's great future, kept alive in Simpson something of his mother's +affectionate nature, and kindled the sympathies and emotions which +bulked so large in his character. His goodness was displayed in his +kindly treatment of the poor, who formed at first the whole and +afterwards no small part of his patients. When name and fame and bread +were his, he did not turn his back on the poor, but as we have seen, +ever placed his skill at their disposal for no reward, as readily as +he yielded it to the greatest in the land. As in his daily practice, +so in his greatest professional efforts, the revelation of chloroform, +the fight for anaesthesia, the introduction of acupressure, the crusade +against hospitalism, one thought breathed through his work--that he +might do something to better the condition of suffering humanity. He +never attempted to keep discoveries in his own hands, to profit by the +monopoly, but scattered wide the knowledge which had come to him that +it might benefit mankind and grow stronger and wider in the hands of +other workers. + +In his domestic life he was a tender, loving, and companionable +husband and father, a charming host, and a warm-hearted friend. "In +this Edinburgh of ours," says a recent writer, "there are familiar +faces whose expression changes greatly at the mention of his name; +there are men whose speech from formal and precise turns headlong and +extravagant, as if it came from a new and inspired vocabulary." In +Scotland his personal influence was immense. As was afterwards written +of him, "Great in his art, and peerless in resource, yet greater was +he in his own great soul;" such a man stood in no need of the violent +revolution in mode of life implied in conversion. A gradual process of +development led to his feeling that although to labour was to pray, +there was a need for more attention to the spiritual, even in his +self-sacrificing life. + +There is evidence that during a brief period of his career Simpson +became affected by speculative doubts; indeed it would have been +surprising if his mind had not been affected by some of the new +schools of thought which sprang up in the footsteps of Charles Darwin, +and appeared for a time to threaten a mortal antagonism to all that +was dear to orthodox Christians. But these did not influence him long; +true to his character he examined every new thought and finding it +wanting remained firm in his old and tried faith, and ranged himself +on the side of those who perceived nothing seriously incompatible +between religion and modern science. + +In his bearing, when the angel of sorrow afflicted his household with +no unsparing hand, we find him always a religious-minded man. The +first trial was the loss of the eldest child, his daughter Maggie, +in 1844. Another daughter, Mary, was lost in early infancy. In +1848 his friend of boyhood and student days, Professor John Reid, was +smitten with a painful malady and died after a prolonged period of +suffering during which, knowing that the shadow of death was hanging +over him, he devoted himself in retirement to religious thoughts. +Experiences such as these made Simpson pause and question himself. +Brimful of life and vigour, however much he came in contact with +death in his professional rounds, the sight of it in his own inner +circle powerfully stirred his emotional nature. His friend the Rev. +Dr. Duns noticed in him after these sad events a gradually +increasing earnestness in his spiritual life, and a closer inquiry +into the meanings of the Scriptures. He sought out the company, and +placed himself under the influence of those among his patients whom he +knew to possess fervid religious temperaments. The last mental +stumbling-block was the question of prayer; he had seriously +doubted in examining the question intellectually that human prayer +could influence the purpose of the Deity. It is difficult, if not +presumptuous, to inquire into the process whereby, under the +guidance of spiritually minded friends, his doubts were satisfied. + + "... One indeed I knew + In many a subtle question versed." + + * * * * * + + "He fought his doubts and gathered strength, + He would not make his judgment blind, + He faced the spectres of the mind, + And laid them--thus he came at length" + + * * * * * + + "To find a stronger faith his own." + +The simple earnest faith of his fathers in which he had commenced +life, ran all through his mature years and prompted his strong +purposeful energies. After the combat with the only seriously +perplexing doubt he re-embraced his faith with the simplicity of a +child and the strength of a giant. For one accustomed to apply to +every subject taken in hand the rigid process of careful scientific +investigation, it required no small effort to lay aside his usual +methods and suffer himself to be led wholly by faith. + +It was impossible for Simpson to enter into any movement without +taking a prominent part in it. That Christmas Day on which all doubts +left him was followed by days of extraordinarily zealous work, such as +would have been expected of him after he had convinced himself that he +had a mission to spread abroad this, the latest, and, in his opinion, +the greatest, of his discoveries. He plunged at once into the midst of +Evangelical societies, missions, and prayer-meetings, amongst the +upper and lower classes of Edinburgh, and made excursions into the +mining districts of his native county to deliver addresses. He +interested himself in the education of theological students, and in +foreign missions, and added to his literary work the writing of +religious addresses, tracts and hymns. His example had a powerful +influence in Edinburgh. It is said that he frequently addressed on a +Sunday evening Evangelical assemblies of two thousand persons. The +news of his so-called conversion was gleefully spread by well-meaning +folks, who had given credence to statements published by his enemies, +and imagined that here was a bad if a great man turned aside from the +broad to the narrow path. This enthusiastic revival movement died down +in time, and Simpson returned to his ordinary everyday life. + +More sorrow soon fell to his lot. In 1862 his fifth child, James, who +had always been an invalid, was taken from him at the age of fifteen. +In 1866 the sad death of Dr. David Simpson, the eldest son, which has +already been referred to, was followed in about a month's time by that +of the eldest surviving daughter, Jessie, at the age of seventeen. The +death of James, a sweet-natured child, stimulated him in the revival +work. Pious friends had surrounded the little sufferer and led him to +add his innocent influence in exciting his father's religious +emotions. + +There is reason to believe that Simpson perceived much insincerity in +the revival movement, and attempted to dissociate himself from active +participation in it, on account of finding it impossible to work in +harmony with some who, though loud in profession, flagrantly failed in +practice. + +The subject of Simpson's health has been little referred to in these +pages, because throughout his life he paid little attention to it. The +chief remedy for the feeling of indisposition was change of work. He +found it impossible to be idle, and sought as recreation occupations +such as archaeological research, or a scamper round foreign hospitals, +which to most people would have savoured more of labour. The part of +his body which was most worked, his nervous system, was naturally the +one which most often troubled him with disorder; like other great men +of high mental development he suffered from time to time with severe +attacks of megrim, which necessitated a few hours of rest. The +blood-poisoning, for which he availed himself of Professor Syme's +services, was soon recovered from with prompt treatment ending in a +foreign tour; but after it little illnesses became more frequent, and +he was perforce occasionally confined to the house. During these times +he busied himself, for the sake of occupation and to distract his +attention from his sufferings, in professional reading or the +preparation of literary papers. Rheumatic troubles became frequent, +and soon after his eldest son's death he had to run over to the Isle +of Man to free himself from a severe attack of sciatica. + +Long, weary nights spent at the bedside of patients or in tiresome +railway journeys, and exposure to all varieties of weather, had a +serious effect upon him. Travelling was slow, according to modern +ideas, and long waits at wayside stations in winter-time helped to +play havoc with his constitution. He was well known to the railway +officials in Scotland. The figure of the great Edinburgh professor was +familiar at many a station, striding up and down the platform with the +stationmaster, chaffing the porter, or cheerily chatting to the driver +and stoker leaning out of the engine. After his death many of these +men would proudly produce little mementoes of their services to him, +which he never forgot to send. + +The little rest house, Viewbank, on the Forth, had to be more +frequently sought refuge in, if only to get away from the harassing +night-bell and secure a full night's sleep. In the last year or two of +his existence he found the work of his practice and chair hard to +carry on, not because of any defined illness, but on account of the +loss of that buoyant elasticity of constitution which had enabled him +to bear without apparent effort or injury the fatigue which would have +been sufficient to prostrate more than one ordinary man. He had early +trained himself to do with a minimum of sleep; to snatch what he could +and when he could, if it were only on a sofa, a bare board, or in one +of the comfortless railway carriages of the day. He took full +advantage during his career of the modern facilities for travelling +which he had seen introduced and developed. Many a night was spent in +the train, going to or returning from a far-distant patient, or after +a combined professional and archaeological excursion; the next morning +would find him busy in his usual routine. On the day after receiving +the degree of D.C.L. at Oxford in 1866, he started for Devizes, which +was reached the same evening; here he had a hasty meal and drove on to +Avebury to see the standing stones there. He returned at midnight, and +at five o'clock next morning set off for Stonehenge, a place he had +long desired to see, thoroughly examined the remarkable remains, and +on his return took train to Bath, where he found time to examine more +antiquities. At midnight a telegram reached him calling him +professionally to Northumberland. He snatched a few hours' sleep, and +taking the four a.m. train to London set out for Northumberland, where +he saw his patient, and then proceeded to Edinburgh. This is no +solitary instance of his journeyings, but an example of many. + +When the year 1870 had been entered upon, he awoke to the fact that +his flesh was too weak for his eager spirit; despite this, he held on +his course, and worked without ceasing, never refusing an urgent call, +although he now suffered from angina pectoris. On February 12th he +hastened to London to give evidence in a notorious divorce case. He +arrived only to find that the trial had been postponed for four days. +He returned to Edinburgh on the 14th, spent the next day in +professional visits in the country, and arrived again in London in +time to appear in the witness-box on the 16th, although chilled to the +bone by the coldness of the long journey. On the following day he +stopped at York on his way home, dined with Lord Houghton, and +visited, at 11 p.m., his friend Dr. Williams, in Micklegate. During +the remainder of the journey from York to Edinburgh he suffered +severely, and "was glad to rest for awhile upon the floor of the +railway carriage." + +A few days after this last run to London he was summoned to see a +patient in Perth, but was this time so fatigued by the effort, that +after his return on February 25th he was obliged to take to bed. The +news sped to all quarters of the globe that Simpson was gravely ill, +for nothing but grave illness could compel that vigorous man to +completely lay down his work. + +His symptoms improved at first under appropriate treatment +sufficiently to allow him to be placed on a bed in the drawing-room; +and he even once more took up his favourite archaeology, revising some +of his work in that subject. Patients also were not to be denied; many +were seen and prescribed for in his sick room, some even being carried +up to his presence. But the fatal disease regained ascendancy, and the +fact became apparent to all, not excepting himself, that the last +chapter of the closely written book of his life had been entered upon. +Towards the end of March, by his own request, his eldest surviving son +was telegraphed for to be near him, and he wrote a touching letter to +his youngest son, then a student in Geneva, encouraging him in his +studies, asking him to look for cup-markings cut in the curious islet +rock in Lake Geneva, and ending with an expression of his feeling of +impending death, for which he felt perfectly and happily prepared. In +these last days he loved to have his nearest and dearest around him; +Lady Simpson and others read to him, and his daughter tells us how she +daily prepared her school lessons in the sick room with his help; to +the last he interested himself in the work of his relations and +friends. He answered the attack of Bigelow, of Boston, conscious that +it was his last effort on behalf of chloroform, and wrote to all his +old opponents asking their forgiveness if at any time words of his had +wounded their feelings. He might well have spared himself the +regrets--such as they were--which troubled him. "I would have liked +to have completed hospitalism," he said, "but I hope some good man +will take it up." On another occasion he asked, "How old am I? +Fifty-nine? Well, I have done some work. I wish I had been busier." + +He expressed a desire that his nephew should succeed him in the Chair +of Midwifery--he would, he thought, help to perpetuate his treatment. + +There was much communing with himself on his future, and all his +sayings on the subject breathed the simple faith first inculcated in +him in the Bathgate cottage. His great sufferings, sometimes allayed +by opiates and his own chloroform, were bravely borne, but the days +dragged sadly on. On the evening of May 5th Sandy took his place at +his side, and the last conscious moments of the great physician were +spent with his head in the arms of him who had helped and guided him +through the difficult days of his career. At sunset on May 6th he +passed peacefully away. + +The extent of the feeling evoked by the tidings of his death was +represented in Mr. Gladstone's remark that it was a grievous loss to +the nation and was truly a national concern. There was a universally +expressed opinion that he merited without a shadow of doubt the rare +national honour of public interment in Westminster Abbey. A committee +was formed out of the leading medical men in London to carry out this +suggestion. Their task was light, for the Dean acceded to the request +at once. Much as his family and the Scots people valued this tribute +to his greatness, they decided otherwise. Scotland has no counterpart +of Westminster in which to lay to rest those whom she feels to have +been her greatest; but Edinburgh felt that she could not part with him +who in life had been her possession and her pride. He had long ago +chosen a piece of ground in the Warriston cemetery, and Lady Simpson +decided, to the gratification of his fellow-citizens, that he should +be buried there beside the five children who had preceded him. His +resting place was well chosen; it nestled into the side of the +beautiful city, and from it could be viewed some of the chief objects +of the scene he knew so well--on the south the stately rock crowned +with the ancient castle, and the towering flats of the old town +stretching away to Arthur's Seat; on the north the long stretch of the +Firth of Forth and in the distance on the one hand the Ochills; on the +other the Bass Rock. + +The funeral was one of the most remarkable ever witnessed in Scotland. +It took place on May 13th in the presence of a crowd estimated to +consist of thirty thousand persons. The hearse was followed by a +representative procession comprising close upon two thousand persons. +His own relatives assembled at 52, Queen Street, the general public +and the Town Council in the Free Church of St. Luke, and the +representatives of the University, the Colleges of Physicians and +Surgeons, and the Royal Society and many other public bodies, in the +Hall of the College of Physicians. At each of these meeting-places +religious services were held. The whole city ceased to labour that +afternoon in order to pay the last tribute to its dearly loved +professor. The poor mourned in the crowd as deeply and genuinely as +those with whom he had been closely associated in life mourned as they +followed his remains in the procession. Every mourner grieved from a +sense of personal loss, so deeply had his influence sunk down into the +hearts of the people. + +The companion of his troubles and his triumphs, who had bravely joined +him to help him to the fame he strove after, was soon laid beside him. +Lady Simpson died on June 17th of the same year. + +But two notes were struck in the countless obituary notices and +letters of condolence which appeared from far and near--those of +appreciation of his great nature, and sorrow for the terrible loss +sustained by science and humanity. The Queen caused the Duke of Argyle +to express to the family her own personal sorrow at the loss of "so +great and good a man." A largely attended meeting was held in +Washington to express the feeling of his own profession in the United +States, at which Dr. Storer moved, "that in Dr. Simpson, American +physicians recognise not merely an eminent and learned Scots +practitioner, but a philanthropist whose love encircled the world; a +discoverer who sought and found for suffering humanity in its sorest +need a foretaste of the peace of heaven, and a devoted disciple of the +only true physician, our Saviour Jesus Christ." + +The following original verses from the pen of a well-known scholar in +the profession, were given prominence in the columns of the +_Lancet_:-- + +PROMETHEUS. + +(Our lamented Sir James Simpson was the subject of angina pectoris.) + + 1 + + "Alas! alas! pain, pain, ever forever!" + So groaned upon his rock that Titan good + Who by his brave and loving hardihood + Was to weak man of priceless boons the giver, + Which e'en the supreme tyrant could not sever + From us, once given; we own him in our food + And in our blazing hearth's beatitude; + Yet still his cry was "Pain, ever forever!" + + Shall we a later, harder doom rehearse? + One came whose art men's dread of are repressed: + Mangled and writhing limb he lulled to rest, + And stingless left the old Semitic curse; + Him, too, for these blest gifts did Zeus amerce? + He, too, had vultures tearing at his breast. + + 2 + + Hush, Pagan plaints! our Titan is unbound; + The cruel beak and talons scared away; + As once upon his mother's lap he lay + So rests his head august on holy ground; + Spells stronger than his own his pangs have found; + He hears no clamour of polemic fray, + Nor reeks he what unthankful men may say; + Nothing can vex him in that peace profound. + + And where his loving soul, his genius bold? + In slumber? or already sent abroad + On angels' wings and works, as some men hold? + Or waiting Evolution's change, unawed? + All is a mystery, as Saint Paul has told, + Saying, "Your life is hid with Christ in God." + +In a peaceful corner of the St. Andrew Chapel in Westminster Abbey, +alongside memorials of Sir Humphry Davy and a few other scientists of +note, stands a speaking image in marble--perhaps the most expressive +representation that exists--of this wonderful man, + + "To whose genius and benevolence + The world owes the blessings derived + From the use of chloroform for + The relief of suffering. + LAUS DEO." + +Mr. Jonathan Hutchinson, when writing to the medical journals in +support of the proposal to secure Simpson's burial in Westminster +Abbey, foretold that his reputation would ripen with years, that +jealousies would be forgotten, and antagonism would be buried. +Twenty-seven years have elapsed since then, and few remain with whom +he came in conflict; those who do remain exchanged, along with others +of his opponents, friendly words of reconciliation in the end, and +took the hand which he held out from his deathbed. As a man, Simpson +had his faults; but they were exaggerated in his lifetime by some, +just as his capabilities and achievements were magnified by those who +worshipped him as inspired. He was full of sympathy for mankind, +benevolent and honest to a fault, and forbearing to his enemies. He +rushed eagerly into the combat and oftentimes wounded sorely, and +perhaps unnecessarily. His genius was essentially a reforming genius, +and impelled him to fight for his ends, for genius is always the +"master of man." We can forgive him if sometimes it caused him to +fight too vigorously, where the heart of a man of mere talent might +have failed and lost. His social charms were excelled only by his +marvellous energy, his prodigious memory, and his keenness of insight; +but he was regrettably inattentive to the details of ordinary everyday +life and practice. + +He approached the study of medicine when the darkness of the Middle +Ages was still upon it, and was one of the first to point out that +although many diseases appeared incurable, they were nevertheless +preventable. Although no brilliant operator himself, he so transformed +the surgical theatre by his revelation of the power of chloroform, and +by his powerful advocacy of the use of anaesthetics, that pain was shut +out and vast scientific possibilities opened up; many of which have +been brilliantly realised by subsequent workers. He devoted himself +specially to the despised obstetric art, fighting for what he +recognised as the most lowly and neglected branch of his profession, +ranging his powerful forces on the side of the weak, and left it the +most nearly perfect of medical sciences. + +He was enthusiastic in his belief in progress, and in the power of +steady, honest work to effect great ends. With the exception of the +time of that temporary burst into revivalism in 1861, his motto +throughout life might very well have been _laborare est orare_. He was +no believer in speculations, but curiously enough kept for recreation +only the subject of archaeology, in which he entered into many +intricate speculative studies. In his professional work he avoided +speculation, and never adopted a theory which was not built upon firm +fact. + +If we are asked for what we are most to honour Simpson, we answer, not +so much for the discoveries he made, not for the instruments he +invented, not for his exposure of numerous evils, not for the +introduction of reforms, not for any particular contribution to +science, literature, or archaeology; but rather for the inspiring life +of the man looked at both in outline and in detail. He was guided by +high ideals, and a joyous unhesitating belief that all good things +were possible--that right must prevail. He was stimulated by a genius +which, as has been pointed out, gave him the energy to fight for his +ends with herculean strength. The fact that chloroform was by his +efforts alone accepted as _the_ anaesthetic, and ether, which from the +first was generally thought to be safer in ordinary hands, was +deliberately put on one side practically all over the world, testified +to his forcible and convincing method, and to his power of making +others see as he saw. As a man of science alone, as a philanthropist +alone, as a worker alone, as a reformer alone, he was great. But +although to the popular mind he is known chiefly because of his +introduction of chloroform, medical history will record him as greater +because of his reforming genius, and will point to the fight for +anaesthesia, and his crusade against hospitalism as the best of all +that he accomplished or initiated. And he who, while making allowances +for the weaknesses of human nature which were Simpson's, studies the +life which was brought all too soon to a close, will recognise the +great spirit which breathed through all his life. + + +THE END. + + + + +APPENDIX + + +I. + +The following is a list of Sir James Simpson's contributions to +_Archaeology_. His professional writings, in the form of contributions +to the medical journals, or of papers read to various societies or +meetings, number close upon two hundred. + +1. "Antiquarian Notices of Leprosy and Leper Hospitals in Scotland and +England." (Three papers read before the Medico-Chirurgical Society, +March 3, 1841.) _Edinburgh Medical and Surgical Journal_, October, +1841, and January and April, 1842. + +2. "Notice of Roman Practitioner's Medicine Stamp found near Tranent." +Royal Society of Edinburgh; Dec. 16, 1850. + +3. "Ancient Roman Medical Stamps." _Edinburgh Journal of Medical +Science_, Jan., March, April, 1851. + +4. "Was the Roman Army provided with any Medical Officers?" Edinburgh, +1851, private circulation. + +5. "Notes on some Ancient Greek Medical Vases for containing Lykion; +and on the modern use of the same in India." Edinburgh, 1856. + +6. "Notice of the appearance of Syphilis in Scotland in the last years +of the fifteenth century." 1860. + +7. "Note on a Pictish Inscription in the Churchyard of St. Vigeans." +Royal Society, April 6, 1863. + +8. "Notes on some Scottish Magical Charm-Stones or Curing Stones." +_Proceedings of Antiquarian Society of Scotland_, vol iv., 1868. + +9. "An Account of two Barrows at Spottiswoode, Berwickshire, opened by +the Lady John Scott." _Proceedings of Antiquarian Society of +Scotland_, vol iv., 1868. + +10. "Did John de Vigo describe Acupressure in the Sixteenth Century?" +_British Medical Journal_, Aug. 24, 1867; _Medical Times and Gazette_, +1867, vol. ii., p. 187. + +11. "Account of some Ancient Sculptures on the Walls of Caves in +Fife." 1867. + +12. "Notices of some Ancient Sculptures on the Walls of Caves." +_Proceedings of the Royal Society_; Edinburgh, 1867. + +13. "Cup-cuttings and Ring-cuttings on the Calder Stones, near +Liverpool." 1866. _Transactions of the Historical Society of +Lancashire and Cheshire._ + +14. "Archaeology--its past and its future work." Annual Address to the +Society of Antiquarians of Scotland, January 28, 1861. + +15. "The Cat Stane, Edinburghshire." _Proceedings of the Society of +Antiquaries, Scotland_, 1861. + +16. "Archaic Sculpturings of Cups, Circles, &c., upon Stones and Rocks +in Scotland, England, and other countries." 1867. + +17. "Is the Pyramid at Gizeh a Meteorological Monument?" _Proceedings +of the Royal Society_; Edinburgh, 1868. + +18. "Pyramidal Structures in Egypt and elsewhere." _Proceedings of the +Royal Society_; Edinburgh, 1868. + +19. "Cell at Inchcolm." + +The above list is founded on that given by Professor Gusscrow in his +"Zur Erinnerung an Sir James Y. Simpson." Berlin, 1871. + + +II. + +On _post mortem_ examination the following observations on Sir James +Simpson's head were made:-- + + Skull--circumference round by occipital protuberance and below + frontal eminences, 22-1/2 inches. + --from ear to ear, 13 inches. + --from occipital protuberance to point between superciliary + ridges, 13 inches. + Brain--weight of entire brain (cerebrum and cerebellum) was 54 + ounces; the cerebellum, pons, and medulla oblongata weighed + 5-1/4 ounces. + +The convolutions of the cerebrum were remarkable for their number, +depth, and intricate foldings. This was noticed more particularly in +the anterior lobes and the islands of Reil. + +Extract from _British Medical Journal_, May 14, 1870. + + + + +INDEX + + + A + + Academy of Sciences (France), 194 + Acupressure, 173 + Adam Street, Simpson's lodgings in, 20, 30 + Addresses, Graduation, 74-77, 200 + Alcohol as an anaesthetic, 93 + Alison, Professor, 56, 59, 73, 148 + America, United States of, and anaesthesia, 83, 96, 199 + Anaesthesia, 88, 178 + opposition to: + (1) medical, 113 + (2) moral, 120 + (3) religious, 123. + Discovery of, 88 + results of, 130 + Antiquarians, Scots Society of, 8, 71, 156 + Appendix, 223 + Archaeological works, Simpson's, 223 + Archaeology, 4, 8, 152, 223 + Argyle, Duke of, 217 + Arts, curriculum of, 14, 19, 20 + Aytoun, 27 + + + B + + Baden, Princess Marie of, 69 + Ballingall, Professor, 60 + Baronetcy, Simpson's, 190 + Bathgate, 4, 7, 8, 34, 142 + Bell, Sir Charles, 60, 61 + Bennet, 42 + Bigelow, Dr., of Boston, 198, 214 + Blantyre, Lord, 80 + Boerhaave, 134 + Boston, U.S.A., 97, 98, 199 + Braid, Dr., 95 + Brewster, Sir David, 27, 192 + British Medical Association, 188 + _British Medical Journal_, 176, 177, 188, 225 + Bruce, Robert, 72 + Brunton, Dr. Lauder, 148 + Burke and Hare, 23 + Bursary won by Simpson, 20 + + + C + + Carstares, William, 192 + Catstane, the, of Kirkliston, 8, 155 + Chalmers, Dr., 27, 125 + Cheselden, 122 + Cheyne, Mr. Watson, 184 + Children, Simpson's, 85, 207 + Chirurgeons, incorporation of, 58 + Chloric ether, 99 + Chloroform, 215, 221, 219 + discovery of, 105 + composition described by Dumas, 106 + Flouren's experiments, 106 + discovery of properties, 106 + used in obstetrics, 108 + Simpson's opinion of, 111 + administration, teaching of, 130 + Christison, Professor, 56, 59, 84, 148, 188, 195 + Clark, Sir James, 129 + Clover, 130 + Cockburn, Lord, 23, 27 + College of Physicians, Edinburgh, 53, 58, 189 + Cooley, Mr., 97 + Cooper, Bransby, 123 + Crest, Simpson's, 192 + Cullen, 2, 27, 41 + + + D + + Davy, Sir Humphry, 95, 96, 219 + Dawson, Dr., 69 + De Quincey, 127, 128 + Disruption, the, 85 + Doctor of Medicine, degree of, 38 + Dumas, 106 + Dunbar, Professor, 18 + Duncan, Dr. Matthews, 105 + Duns, Dr., 34, 162, 196, 207 + Du Potet, 94 + + + E + + Edinburgh, 17, 27, 197 + _Edinburgh Medical and Surgical Journal_, 52, 72 + Education, Simpson on, 199 + Elliotson, Dr. John, 94, 95 + _Encyclopaedia Britannica_, 198 + Erskine House, Simpson's visit to, 80 + Esdaile, Dr., 95 + Ether, 99, 104, 112 + Evangelical work, Simpson's, 209 + Extra-mural Medical School, Edinburgh, 26, 31 + + + F + + Faraday, 96 + Fohman, Professor, 45 + Forbes, Edward, 41 + Foreign tour, Simpson's, 43-46 + Free Church, 85 + Freedom of Edinburgh city, 197 + Funeral, Simpson's, 216 + + + G + + Gairdner, Dr., 37 + Girdwood, Dr., 37 + Gladstone, Mr., 215 + Goodsir, Professor, 42 + Graduation addresses, 74-77, 200 + Graham, Professor R., 59, 148 + Grant, Sir Alexander, 195 + Gregory, Dr., 32, 33 + Grindlay, Miss Jessie, 46, 55, 57 + Grindlay, Mr., 46, 61, 68 + Gusserow, Professor, 113, 170, 225 + Gynaecological Society of Boston, 199 + Gynaecology, 86 + + + H + + Hahnemann, 147 + Hamilton, Duchess of, 69 + Hamilton, Professor James, 32, 40, 56, 59, 69, 163, + 169 + Hamilton, Sir William, 27 + Health, Simpson's, 210 + Henderson, Professor, 148 + Home, Professor James, 59 + Homoeopathy, 74, 147 + Hope, Thomas, 56, 59 + Hospitalism, 177-184 + Hospitality, Simpson's, 81-83 + Hotels, the Edinburgh, and Simpson, 163 + Houghton, Lord, 213 + Hutchinson, Mr. Jonathan, 219 + Hypnotism, 94, 149 + + + I + + Imperial Academy of Medicine (France), 189 + Indian hemp, 92 + Infirmary, Royal, of Edinburgh, 31, 109, 177, 178, 187 + + + J + + Jackson, Dr., of Boston, U.S.A., 96 + James VI., 192 + Jameson, Professor R., 59 + Jeffery, Lord, 27 + Jenner, 119, 145 + + + K + + Keiller, Dr., 30 + Keith, Dr. George, 105 + Kennedy, Dr. Evory, 61, 63 + Knox, Robert, 23, 24, 25, 26, 28 + + + L + + _Lancet_, the, 95, 169, 191, 218 + Laughing-gas, _vide_ nitrous oxide + Laycock, Professor, 186 + Leighton, Archbishop, 193 + Leprosy and leper-houses, 70 + Lippi, 45 + Lister, Lord, 176, 179, 184, 188 + Liston, Professor, 26, 31, 91, 95, 104, 151 + Lizars, John, 26 + London, Simpson's journeys to, 80, 187, 213 + Long, Dr., of Athens, U.S.A., 96 + Lycium, the, of the Muses, 154 + + + M + + MacArthur, Mr., 20, 21, 22, 26, 39 + Macintosh, Dr., 55 + Maclagan, Sir Douglas, 43 + Maclaren, Mr. Duncan, 61 + _Maga_, the university, 41 + Mandrake, 93 + Master of Arts, the degree of, 19 + Medical faculty, the, 57, 59, 60, 187 + Medical Reform Act, the, 187 + Medical student, the Edinburgh, 33 + _Medical Times and Gazette_, the, 184 + Medicine, condition of, at Simpson's birth, 1-3 + Medico-Chirurgical Society, the Edinburgh, 189 + Meigs, Professor, 117 + Melbourne, Lord, 28, 73 + Mesmerism, 94, 149 + Midwifery, 3, 32, 39, 40, 53, 86, 104 + Midwifery Chair, 55-65, 188, 215 + Midwifery class, Simpson's, 67 + Miller, Professor, 106, 109, 186 + Moncrieff, Lord, 27 + Monro (Primus), 57 + Monro (Secundus), 56 + Monro (Tertius), 23, 59 + Montgomery, Dr., 140 + Monthyon Prize, the, 190 + Morton, W. T. G., 97, 98, 129, 132, 198 + + + N + + Napier, Lord, of Magdala, 197 + _Nepenthe_, 93 + Newhaven, 143, 196 + Nitrous oxide gas, 97 + North, Christopher, 18 + Nunn, Mr., 123 + + + O + + Oineromathic, the Society, 42 + Oxford, D.C.L., degree of, 192, 212 + + + P + + Pare, Ambroise, 90 + Pathology, 39, 53, 55, 73, 74 + Petroleum, 84 + Physician-Accoucheur to the Queen, Simpson appointed, 86 + Pillans, Professor, 18 + _Post mortem_, 225 + _Practitioner_, the, 184 + Principalship, the, of Edinburgh University, 192 + "Prometheus," 218 + "Puck," 138 + + + Q + + Queen Street, No. 52, 78, 81, 105, 137 + Queen, the, 17, 86, 129, 190 + + + R + + Reform, medical, 187 + Reform, university, 187 + Regents, the, of Edinburgh University, 192 + Reid, Professor John, 18, 20, 21, 22, 25, 26, 39, + 41, 42, 55, 207 + Religious views, Simpson's, 203 + Rinderpest, epidemic of, 185 + Rollock, the Regent, 192 + Roman army, the, 156 + Royal Medical Society, 41, 52, 53 + Royal Physical Society, 41 + Russell, Lord John, 27, 190 + + + S + + _Scots Observer_, the, 82 + _Scotsman_, the, 61, 142 + Scott, Sir Walter, 27, 124 + Senatus Academicus, the, of Edinburgh University, 29, 186, + 194. + Simpson, Alexander, 10, 37, 40, 61, 205, 215 + Simpson, David, 5 + Simpson, David (secundus), 37 + Simpson, David (tertius), 191, 210 + Simpson, Lady, 191, 216, 217 + Simpson, Mary, 10 + Simpson, Miss E. B., 138, 202, 214 + Simpson, Mrs., 5, 6, 204 + Simpson, Professor A. R., 51, 86, 164, 219 + Smallpox, 184 + Snow, Dr., 130 + Snowball riot, the, 42 + Sound, the, 168 + Squabbles, Simpson's, 78 + Stafford House, Simpson's visit to, 80 + St. Bartholomew's Hospital, 151 + Stevenson, R. L., 80 + Storer, Dr., 217 + Student, the Edinburgh medical, 33 + Superstitions, 4, 5, 12 + Surgery at Simpson's birth, 3 + before anaesthesia, 88-91 + after anaesthesia, 131 + Sutherland, the Duchess of, 80, 86 + Syme, Professor, 26, 31, 60, 61, 73, 114, 175, 130, + 140, 148, 151, 186 + + + T + + Thatcher, Dr., 37, 63 + Thesis, Simpson's, for M.D. degree, 39 + Thomson, Professor, 39, 60, 72 + Town council of Edinburgh, the, 28, 58, 60, 63, 65, 73, + 188, 192 + Traill, Professor, 60 + + + U + + Universities (Scots) Act, 188, 193 + University of Edinburgh, 14, 18, 26, 28, 31, 130 + + + V + + Verses, Simpson's, 33, 202 + Viewbank, 143, 211 + + + W + + Waldie, Mr., 105 + Wallace, Professor, 18 + Warren, Dr. J. Collins, 102 + Warriston cemetery, 216 + Weavers, the, of Bathgate, 8, 9 + Wells, Horace, 97, 132, 198 + Wesley, John, 71 + Westminster Abbey, 215, 219 + Williams, Dr., of York, 213 + Wilson, George, 42 + Wilson, Professor John, 18, 27 + Women, medical, 188 + Wound-healing, 176 + + + Y + + York, Simpson's visit to, 213 + Young, Professor Thomas, 59 + + + + +The Gresham Press, UNWIN BROTHERS, WOKING AND LONDON. + + + + +THE CENTURY DICTIONARY + + _Six volumes bound in cloth, gilt lettered, sprinkled edges, per + vol._ =L2 2s.= + _Do. in half morocco, marbled edges, per vol._ =L2 16s.= + _24 Parts, strongly bound in cloth, per part_, =10s. 6d.= + BOOKCASE _for holding the Dictionary, price_ =L3 3s.= + Size of each volume 13 in. x 9-1/2 In. x 2-1/4 In. + +_PRESS NOTICES._ + +"The exceptional merits of the 'Century Dictionary' are beyond +dispute."--_Times._ + +"One of the most notable monuments of the philological industry of the +age."--_Daily Telegraph._ + +"It is a work of great ability, fine scholarship, and patient research +in many widely different departments of learning."--_Standard._ + +"As we turn the leaves of this splendid work, we feel acutely the +inadequacy of any description apart from actual handling of the +volumes."--_Daily Chronicle._ + +"It is fuller, more complete, with fewer faults than any rival."--_Pall +Mall Gazette._ + + * * * * * + +THE CYCLOPAEDIA OF NAMES + + _Cloth, =L2 2s.= net.; half morocco, =L2 15s.= net._ + Size--13 in. x 9-1/2 x 2-1/4 in. + +_PRESS NOTICES._ + +"A book of ready reference for proper names of every conceivable +kind."--_Daily News._ + +"The 'Cyclopaedia of Names' deserves to rank with important works of +reference, for though its facts on any given subject are of course, +elementary, they can be quickly found, and, on the whole, they are +admirably chosen."--_Standard._ + +"A most handsome and solid volume.... 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The book is so +bright and vivid that readers with the common dislike of history may +venture on its pages unafraid."--ANDREW LANG in _Cosmopolis_. + + * * * * * + +SIR WALTER RALEGH + +Being Vol. I. of the series entitled "Builders of Greater Britain," +each vol. with photogravure frontispiece and map. + +_Large crown 8vo., cloth, =5s.= each_. + +"There is not a dull page in it, and, with his skilful telling of +it, the story of Raleigh's life and of his times reads like a +romance."--_Pall Mall Gazette._ + + * * * * * + + + + +Transcriber Notes + +Archaic and variable spelling is preserved, including 'receptable'. + +Passages in italics indicated by _underscores_. + +Passages in bold indicated by =equal signs=. + +Greek transliterations are surrounded by ~tildes~. + + + + + + +End of the Project Gutenberg EBook of Sir James Young Simpson and Chloroform +(1811-1870), by Henry Laing Gordon + +*** END OF THIS PROJECT GUTENBERG EBOOK CHLOROFORM *** + +***** This file should be named 34128.txt or 34128.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/3/4/1/2/34128/ + +Produced by Bryan Ness and the Online Distributed +Proofreading Team at http://www.pgdp.net (This file was +produced from images generously made available by The +Internet Archive/American Libraries.) + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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