Eminent doctors: Their lives and their work; Vol. 2 of 2

by G. T. Bettany

FOOTNOTES:

[3] Surgery, Past, Present and Future, 1877.

[4] Henry Smith, Biographical Sketch of Sir W. Fergusson.

[CHAPTER XV.]
SIR JAMES SIMPSON AND ANÆSTHETICS.

Future ages will perceive in the history of medicine and surgery in the nineteenth century no more remarkable event than the discovery and the introduction of means for relieving and temporarily abolishing pain. And although the name of Simpson is by no means the only one honourably associated with this discovery, his achievement in the introduction of chloroform places him on an enviable pinnacle of greatness.

James Young Simpson, the seventh son and eighth child of a small baker, was born at Bathgate, Linlithgowshire, on the 7th of June 1811. His birth took place when his father’s circumstances were at the lowest ebb. Several of the family, including his mother, had but just recovered from fever. The mother had to rise from her maternal pain to take an active part in business, which she did most energetically and successfully. Her religious character and her thrifty habits deeply impressed the little boy, and he pleasingly recalled in after years her injunction, when she had just darned a big hole in his stocking, “My Jamie, when your mother’s away, you will mind that she was a grand darner.” She died when James was but nine years old, leaving him in the care of his only sister Mary, eleven years older, who proved a tender foster mother. Already as a child James Simpson became known as “the wise wean,” “the young philosopher,” and his voice was sweet and silvery. His industry and retentiveness of memory early gave promise of distinction, which all the family were persuaded would fall to his lot. And he would readily, book in hand, keep the shop for a time, or run with rolls to the laird’s house. “I remember,” says his brother Alexander,[5] “finding him sitting in the street on a very dusty day, sobbing bitterly, the tears running down his cheeks covered with dust. ‘What ails you, Jamie?’ I said, and he answered, sobbing as if his heart would break, ‘I’ve broken the pony’s knees.’” It turned out that Alexander himself had overridden the pony, so that it could not help stumbling.

The father of the family trusted his children in a peculiar way. All were regarded as equally concerned in the family prosperity, and the shop till was unfastened, and free to all; each habitually thought of the general good first. In this way the household prospered ever after James’s birth, and he personally received unremitting attention.

At the age of fourteen James Simpson entered Edinburgh University, “a very very young and very solitary, very poor and almost friendless student,” as he himself said forty years after. For two years he pursued classical and mathematical studies, gaining a small bursary before his second session. One of his earliest purchases was a little book on “The Economy of Human Life,” for which he gave ninepence. An extract from it which he wrote in his cash-book is significant of his temper of mind: “Let not thy recreations be expensive, lest the pain of purchasing them exceed the pleasure thou hast in their enjoyment.” Though an economical student, however, his literary tastes were wide, as he early bought Byron’s Giaour and Childe Harold, and Paley’s Natural Theology. He lodged with Dr. Macarthur, a former usher in the Bathgate School, together with John Reid, an old schoolfellow, afterwards Professor of Anatomy at St. Andrews, in the upper flat of a tall house in Adam Street. Reid’s enthusiasm for anatomy seem to have first inspired Simpson to choose medicine as a profession.

In the winter of 1827 James Simpson entered as a medical student in the University, and, attending Liston’s class on surgery, soon became conspicuous. He took full notes of lectures, and was freely critical of his teachers. He became a dresser under Liston, and received excellent testimonials from him. But he shrank from surgery, having an exquisite tenderness of heart which almost drove him from the profession. After witnessing on one occasion a poor woman’s agony under amputation of the breast, he started off directly to seek employment as a writer’s (or lawyer’s) clerk. He soon returned, however, deeply imbued with the desire to do something to render operations less painful. Simpson’s summer vacations were passed at Bathgate, natural history and antiquarian pursuits occupying his spare time. In January 1830, just before he was going up for his license to practise, his father died after some weeks’ illness, during which James constantly watched at his bedside. Such an interruption to study at a critical moment might have upset so sensitive a mind. But Simpson went in for his examination in April, and became a member of the Edinburgh College of Surgeons before he was nineteen years of age. His brother Alexander, who, with the rest of the family, furnished faithful and persevering help to the young brother of whom so much was expected, gave him a home while he looked out for some post to occupy him while waiting for his Edinburgh degree, which his youth prevented him from taking as yet. One of the situations which he sought was that of parish surgeon in a little village named Inverkip, on the Clyde. “When not selected,” he writes long after, “I felt perhaps 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.”

In 1831 Simpson returned to his university studies, his brother David having commenced business in Stockbridge, Edinburgh, and being able to accommodate the young doctor. He assisted in maintaining himself by becoming assistant to Dr. Gairdner. Thus he was enabled to complete his university course and take his M.D. degree in 1832, giving as his inaugural thesis an essay on “Death from Inflammation.” This attracted much attention, especially from Dr. John Thomson, Professor of Pathology, who at once requested him to act as his assistant with a salary of £50, which the young man made sufficient for all his necessities. In this capacity he prepared a catalogue of the museum of the pathological department. His first experience of obstetric study in attending Professor Hamilton’s lectures had not left his mind under a compulsion to pursue the subject deeply, but Dr. Thomson saw that his assistant, soft-mannered but full of decisive activity, was the very man to succeed in midwifery practice, and he therefore advised him to devote himself specially to it. Another great characteristic was his power of winning the confidence of others, and especially of getting his patients to tell him what it was most important that he should know. But he went immediately to work to become learned in his subject, and then to turn over in his mind everything that he had learnt, until it assumed a new aspect. He always sought new and better ways, and if any department of practice or theory appeared to him defective, he restlessly applied his mind to invent or imagine some improvement. And he had an absorbing desire to gratify his family by achieving success. When his sister Mary told him in 1834 he was injuring his health by overwork, he replied, seriously, “Well, I am sure it’s just to please you all.”

Simpson’s first important paper, on the Diseases of the Placenta, delivered before the Royal Medical Society in 1835, at once showed a master hand. It was translated into French, German, and Italian. He began by exhaustively studying the previous history of every subject he took up, and then tested others’ opinions and facts by his own observation. One of his earliest papers includes nearly one hundred references to previous literature, including many authorities, showing an unusual range of reading. If he could not read the language of an author he got some one who could to do so, and give him the material bearing on his point of inquiry. But while no man regarded more highly than he the patient achievements of the past, no man sat more loosely to tradition and convention.

In 1833 Simpson became a member of the Royal Medical and Physical Societies of Edinburgh. Of the former he was soon President. A writer in the Scotsman for May 10, 1870, thus described his appearance in that capacity. After speaking of his long tangled hair, and very large head, he says: “A poet has since described him as one of ‘leonine aspect.’ Not such do we remember him. A pale, large, 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, and coarsish nose, with dilated nostrils, a finely-chiselled mouth, which seemed the most expressive feature of the face, and capable of being made at will the exponent of every passion and emotion. Who could describe that smile? When even the sun has tried it he has failed, and yet who can recall those features and not realise it as it played round the delicate lines of the upper lip, where firmness was strangely blended with other and apparently opposing qualities? Then his peculiar, rounded, soft body and limbs, as if he had retained the infantile form in adolescence, presented a tout ensemble which even had we never seen it again would have remained indelibly impressed on our memory.”

In 1832 Alexander and Mary Simpson both married. Alexander’s wife, however, became as attached as his sister to James, and there was no interruption to the family helpfulness. When cholera appeared in Bathgate, Alexander made a will securing a provision for James if he died. “I trust,” wrote this true brother, “every one of you will look to him. But I dare say every one of you has a pleasure in doing him good by stealth, as I have had myself.” The brothers Alexander and John enabled James to visit London and the Continent in 1835 to see a variety of practice; his travelling companion was Dr. Douglas Maclagan, afterwards Professor of Medical Jurisprudence at Edinburgh. On his return Simpson gained some practice, but chiefly among those who could pay him little or nothing. In May 1836 he obtained the situation of house-surgeon to the Lying-in Hospital, which he held for a year. This soon led to an increase of practice among better-paying patients. He now gave some courses of lectures on Midwifery in the Extra-Academical School, which were well received, besides being appointed interim lecturer on Pathology, when his friend Dr. Thomson had resigned. He gave great labour to the preparation of his lectures, besides continuing to publish original papers on Midwifery. At this time he rose repeatedly at three in the morning, when he did not sit up all night. But with all his work he found time for social enjoyment, for family interests, for messages to old schoolfellows in humble life.

Neither now nor at any time did Simpson lose his habit of plain speech. He did not always conciliate others by his outspoken expressions, and he did not care to wrap up unpleasant truths in honeyed words. In 1839 some hasty words which passed between Simpson and Dr. Lewins of Leith in reference to an anonymous letter written by the latter, nearly led to a duel; but, fortunately, friends were able to persuade them that both were to blame, and an amicable reconciliation was effected. In the same year, that in which also he had commenced housekeeping on his own account, Simpson became a candidate for the Chair of Midwifery, vacated by Dr. Hamilton’s resignation. The contest was a very severe one, Dr. Evory Kennedy of Dublin having strong claims. Simpson strained every nerve to secure testimonials and to influence electors, publishing an octavo volume of testimonials, extending to more than 200 pages. He was finally elected Professor on the 4th February 1840 by a majority of one vote only, at the age of twenty-eight, with no advantages of social position or long experience to back him. A few weeks previously (December 26, 1839) he had married his second cousin, Miss Jessie Grindlay, of Liverpool, to whom he had long been attached.

But difficulties were not over when the election had taken place. The pecuniary cost of the canvass was about £500, chiefly in printing and postage; and Simpson had less than no money; he was considerably in debt to his relatives. His new colleagues had to a large extent opposed him, preferring Dr. Kennedy; they continued to oppose him, not fancying their association with a small baker’s son. Practice began to flow in, but it necessitated taking a larger house, keeping a carriage, and much greater expenditure; and it was some time before the young couple could make both ends meet. Demands from old friends or from poor people for help, crowded on Simpson faster than fees; and his kindly heart did more for them than sober judgment would warrant. He frequently sat up all night writing for the press. He was beset remarkably early by philanthropic projectors, self-interested promoters, young aspirants to fame, and men anxious to bring forward a pill calculated to make people live to the age of Methusaleh, or desirous of the Doctor’s interest to get them permission to fish in one of his patients’ streams. Nervous headaches and acute pains began to cast their horrible shadows over his life; but work was scarcely ever remitted. His lectures were immediately a great success; he had the largest class in the University. Additional seats had to be supplied, and then there was not room for all to sit. His cares had meanwhile been increased by the birth of a daughter, a fortnight before the session began.

Simpson’s untiring activity could not content itself, however, with strictly professional subjects. Before the end of his first session of professional lectures, he began to work at a memoir which received the title of “Antiquarian Notices of Leprosy and Leper-Houses in Scotland and England.” In it he makes nearly five hundred references to out-of-the-way authorities, and in the appendix is a list and notices of one hundred and nineteen leper-houses which he had traced in Britain. The memoir is a mine of valuable antiquarian information.

By the end of 1842 his pecuniary position was assured beyond all doubt, although his benevolence would have made this difficult had not his skill become so famed. His success when little over thirty years of age was marvellous; the hotels were filled with his patients, and his practice was said to be worth many thousands of pounds a year to these establishments. His house had to be enlarged to receive some who insisted on remaining in the closest proximity to the great doctor. But in the whirl of practice one fault became prominent. Methodical and exhaustive in his literary researches, and possessed of a powerful memory, he could not be persuaded to make systematic notes of his appointments, and seemed to be incapable of so planning out his time as to spend it to the greatest advantage for his patients. He not unfrequently forgot a definite appointment, and was sometimes overpersuaded by pushing people or by professional friends to attend to cases out of their proper turn. That he ever consciously did any one an injustice either for pay or without it is quite untrue. But he was blamed as if he had. He was indeed only too careless about money, and frequently too regardless of his own interest to demand a proper fee. His receipts were stuffed at once into his pockets, which were emptied at night, he knowing nothing of their contents before. Sometimes a fee was received in a letter, and neither taken out nor acknowledged. Once he received £10 thus, when a much larger fee might have been expected, and several notes of expostulation followed on his neglect to acknowledge its receipt. One stormy night Simpson was much disturbed in sleep by the rattling of a window. He got up, felt in his pocket for a bit of paper, and lighted on the £10 note, which was devoted to the tightening of the window-frame. On Mrs. Simpson discovering the nature of the bit of paper in the morning, he merely replied, “Oh, it’s that £10.” A sample of ridiculous expostulations is the case where repeated letters asked Dr. Simpson’s opinion whether three leeches should not be applied to a hip-joint, instead of two, which the family medical man recommended.

In the midst of practice and lectures, he found time to write or dictate many a brief or lengthy article on obstetric practice or diseases of women, always practical, always exhausting previous authorities. It was in this direction especially that his mind was ever at work. Then when he had come to a conclusion, he withheld no item of it. “Keen to perceive the truth,” says the Scotsman,[6] he was equally vigorous in his announcement of it, and cared little to what cherished opinion his statements might run counter. Hence came contests where little quarter was given or received. He was a dangerous antagonist to meet at a joust, and though he could use the keen edge of steel, he oftener despatched his antagonist with a heavy mace of facts or figures, which those who had neither his industry nor his powers of memory could neither refute nor set aside. Hence he made many enemies, for he had run counter to many prejudices, and the old spirit which had opposed his election to the professorial chair cropped out ever and anon, showing that it was smothered, not extinguished.

It should ever be remembered that Simpson’s greatness was established before he had introduced chloroform, and depended on his unsurpassed skill in obstetrics and diseases of women, while yet he was a most accomplished general physician. Already, in January 1847, when he was only just beginning to study anæsthetics, he was made one of the Queen’s Physicians for Scotland. We cannot here attempt a history of previous efforts to secure immunity or relief from pain, but it is evident Simpson was in this respect not a man marvellously in advance of his age; the subject was in the air; unceasing efforts at improvement were being made. Before the end of the last century the brilliant chemical discoveries of Priestley had led to his suggestion that drugs might be administered in definite quantities by inhalation through the lungs. Oxygen was the first gas inhaled for medicinal purposes; and in 1795 Dr. Pearson of Birmingham prescribed the inhalation of ether in cases of consumption, being followed ten years later by Dr. Warren of Boston, U.S.A. In 1800 Sir Humphry Davy, when superintending Beddoes’ Pneumatic Institution at Bristol, founded principally for the medicinal inhalation of oxygen, began to study the effects of nitrous oxide, which he employed, after he had become familiar with its intoxicating effects, to relieve the pain of a severe inflammation of his own gums. In publishing his account of its successful inhalation he said, “As nitrous oxide in its extensive operation seems capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.”[7] Thus we must credit Sir Humphry Davy with the most original observation and experiment on the subject of anæsthetics: another instance in which the investigator seeking to advance science has made an observation and suggestion bearing on the welfare of the whole of mankind. His pupil and successor, Faraday, in 1818 announced that sulphuric ether vapour, when inhaled, produced similar effects to nitrous oxide. Here closes the record of anæsthetics for many years, practically we believe because medicine and surgery had not yet become sufficiently scientific to discern their value.

In 1835 Robert Collyer, an American medical student, inhaled ether at a chemical lecture by Professor Turner at University College, London, being himself made insensible, in company with other students; he noted that his fellow-students under its influence became insensible to pain. In December 1839, Collyer, near New Orleans, reduced a dislocation of the hip for one of his father’s negroes who had fallen down in insensibility on inhaling the fumes of rum. The negro showed no sign of pain. Collyer soon after identified this narcotic state with that produced by mesmerism, under which also some operations were painlessly performed. Collyer lectured on these subjects in 1840 and subsequent years in Philadelphia, Boston, Liverpool, and other places. He made mesmeric and narcotising experiments, the latter with a mixture in which the vapour of alcohol with poppy seeds and coriander steeped in it was inhaled, and in 1842 he states that he administered his alcoholic mixture to a patient in Philadelphia, during tooth-drawing, with a painless result. In 1844 an American chemical lecturer named Coulton exhibited the properties of nitrous oxide at a lecture given at Hartford, Connecticut, at which Horace Wells, a dentist practising there, was present. Having a tooth which he himself wished to get extracted, Wells invited Coulton to administer nitrous oxide to him. This was successfully done, and during Wells’ insensibility his tooth was removed by a friend, Dr. Riggs. Wells on recovering consciousness exclaimed, “A new era in tooth-pulling!” and at once attempted to introduce the practice at Hartford and at Boston; but not using the gas in purity, and not being sufficiently skilful in its administration, his attempts often failed, and at Boston he was hissed, and gave up his efforts in despair. Later, when anæsthetics had become firmly established, he again sought unsuccessfully to introduce nitrous oxide, and at last put an end to his life. It is sad to think of this fate for a man who, with a little more education and a little more perseverance, might have reaped a great harvest of fame.[8]

We cannot go into the controversy as to which American has the greatest merit in the introduction of sulphuric ether as an anæsthetic. Suffice it to mention that Charles Jackson, a chemist of Boston, who had been present at Wells’ demonstration in 1840, first experimented on himself by inhaling pure sulphuric ether, and having produced insensibility, communicated his discovery to W. T. G. Morton, a dentist who had been present at Wells’ demonstration, and prevailed on him to employ it. Morton afterwards alleged that this step was taken independently on his part.

On September 30, 1846, Morton administered ether to Eben Frost for tooth-drawing with complete success, and in October following it was used in an important operation by Dr. J. C. Warren at the Massachusetts General Hospital. The news arrived in England before the end of 1846, and on December 19th, James Robinson, a dentist of Gower Street, London, was the first to operate under ether in this country for the removal of a tooth. On December 21 Robert Liston employed it most successfully at University College Hospital in an amputation of the thigh and in the removal of a great toe-nail, one of the most exquisitely painful operations. Its general adoption followed in the first few months of 1847. Dr. Simpson, as early as January 9, 1847, after previously inhaling it himself, used it in order to relieve pain in childbirth, and found that its anæsthetic effects produced no stoppage or perceptible alteration in the muscular contractions of the womb. This and other cases of his were quickly published, and justify his claim to having introduced ether in its application to midwifery practice.

The inconveniences occasioned by the smell of sulphuric ether, the considerable doses required to be given, and its tendency to irritate the bronchial tubes, led Simpson to inquire for and to try other analogous liquids. He was recommended, among others by Dr. Gregory, to try chloroform, discovered by Soubeiran in 1831 and Liebig in 1832, and accurately investigated by Dumas in 1835. He concluded after much labour, and the expenditure of some hundreds of pounds, that chloroform, without the unpleasant smell of ether, produced more rapid effects with a smaller dose, and he very soon began to use it in midwifery and to introduce it to his surgical friends for operations. It was brought before the Edinburgh Medico-Chirurgical Society on the 10th November 1847; and so well-known and favoured did it become that in a very short time Simpson’s Edinburgh chemists were manufacturing 7000 doses a day. Here we might almost stop in this record, but for two things, one the controversies Simpson had as to the impropriety and irreligiousness of removing pain, supposed to be one of the Creator’s ordinances which ought not to be mitigated; and the other, the deaths that began to occur under the administration of chloroform. As to the first, a specimen of the objectors is furnished by a clergyman, who wrote “that chloroform was a decoy of Satan, apparently offering itself to bless woman; but in the end it will harden society, and rob God of the deep earnest cries which arise in time of trouble for help.” Even the relief of pain in surgical operations was held by many to be unwarrantable. But a powerful counter-argument was found, in the much greater ease and certainty of success with which surgeons could now perform their operations when the cries and writhings of the patient were removed. The controversy that ensued, however, would fill a volume, and Simpson in it proved himself, as ever, a hard hitter.

For many years scarcely anything but chloroform was used for producing anæsthesia; but gradually numerous unexpected deaths under its administration led many to think that it had too depressing an effect on the action of the heart, in some cases at least, and led to the trial of other agents, including bichloride of methylene, the reintroduction of ether, and nitrous oxide. The two latter are very largely used at present, and so also is a mixture composed of one part by measure of alcohol to two of chloroform and three of ether, also known as the A.C.E. mixture, from the first letters of the three constituents. This is now considered by many to be safer than chloroform. What will be the judgment of future experience we can have no pretensions to decide.

We cannot give in detail the subsequent events of Dr. Simpson’s life. It became more busy and active, more benevolent, and more distinctly religious as years went on. He refused advantageous offers to settle in London, and instead patients came from all parts of the world to consult him in Edinburgh. His hospitality was unbounded. His daily breakfasts and luncheons have been graphically described by a well-known poet. “Assembled unceremoniously in a moderate-sized room, with little in common save the wish to meet their host, you found a company drawn together from every latitude and longitude, social and geographical. Of all this motley party there is probably hardly one who is not notable, and the grades and classes of eminence run through the whole gamut of social distinction from duchesses, poets, and earls, down to the author of the last successful book on cookery, the inventor of the oddest new patent, a Greek courtier, a Russian gentleman, or a German count. At your elbow the last survivor of some terrible shipwreck is telling his story to the wife of that northern ambassador, who is meeting, with the softest Scandinavian dialect, the strong maritime Danish of the clever State secretary opposite. Behind you a knot of American physicians, just arrived, are discussing in a loud voice, a speech in Congress, or agreeing, sotto voce , on the particular professional topic upon which they have come to consult the great authority. Turn for a moment from this sculptor, who is waiting to ask the opinion of the many-sided professor on the sketches which he is now showing to that portrait-painter, and to learn which of them shall be done in marble for the nobleman whose attention the doctor has found time to direct to the rising young artist, and you may catch something of yonder violent discussion between those arrivals from Australia, who have come from the land of gold in search of what gold cannot buy.”

But it is by no means only in connection with ether and chloroform that Simpson introduced a new practice. Besides numberless suggestions and novel ideas in midwifery, he brought forward (in 1859, after some years of study) a totally new method of closing arteries after operations and in substitution for ligatures, so often the cause of inflammation. Long before John Hunter had pointed out that needles and pins when passed into and embedded in the living body seldom or never produced any inflammatory action. Simpson was struck with the idea that slender sharp-pointed needles or pins of non-oxidisable iron, somewhat like hare-lip needles, might be used to close together the walls or flaps of wounds, at the same time keeping the blood-vessels closed. These pins could be withdrawn very early, and would greatly favour healing at the earliest possible moment. The new method, called acupressure, of course met with much opposition, and Simpson was severely censured for meddling in a preserve strictly limited to the surgeon. But the help of the Aberdeen surgeons, Keith and Pirrie, was of great service in promoting the fair trial of the practice. His attack on the prevailing hospital system in 1869 was one of his later crusades, and he certainly accumulated a great store of facts showing the unhealthiness of the existing conditions of aggregation in crowded hospitals. His advocacy of a separate system in hospital construction, and of limiting the number of patients close together, of course drew on him further fierce opposition. We cannot here refer to his strong exposure of the fallacies of homœopathy, his vigorous actions in connection with the University of Edinburgh, or the numerous antiquarian papers which his prolific pen gave forth. Every year had crowded into it three times as much research as a very industrious man could manage, ten times as much controversy, and twice as much practice. Honours came thick upon him. In 1856 he was greatly gratified by the French Academy’s award of the Monthyon Prize of 2000 francs for “most important benefits done to humanity.” At the beginning of 1866 he was created a baronet. In 1869 the freedom of Edinburgh was presented to him.

Heavy affliction came now and again to embitter his life. Several children were taken from him in the prime of their life, including his eldest son, who showed great promise of a brilliant medical future, but was cut off within a fortnight after his father was made a baronet. In later life he became an ardent church worker, having joined the Free Church of Scotland when the Disruption took place. 1870 found the vital machine much out of order. Heart pain—angina pectoris —so often the scourge of medical men, came more frequently with its terrible strain. But he never relaxed his work in the intervals, until absolutely compelled. In one of his later conversations he said, “How old am I? Fifty-nine. Well, I have done some work. I wish I had been busier.” One of his expressions showed his distaste for theology. “I like the plain simple Gospel truth, and don’t care to go into questions beyond that.” During almost his last night he was inexpressibly comforted by having with him his brother Alexander, who had watched over him with such tenderness from childhood. He sat on the pillow with Sir James’s head on his knee, and the sufferer again and again slowly uttered the words, “Oh, Sandy, Sandy!” He died on May 6, 1870. He would have been buried in Westminster Abbey but for his own express wish to be buried in Warriston Cemetery, Edinburgh. His funeral was such as Edinburgh had, it is said, never witnessed before, business being generally suspended. His widow survived him but a few weeks, dying on the 17th June following. His eldest surviving son, Walter Grindlay, succeeded him in the baronetcy.