Table of the Mortality of Amputations of the Thigh.

		Reporter.		No. of Cases.	No. of Deaths.	Percentage of Deaths.
Not anæsthetised.	{
		Parisian hospitals	Malgaigne	201	126	62 in 100
		Edinburgh hospitals	Peacock	43	21	49 in 100
		General collection	Phillips	987	435	44 in 100
		Glasgow hospitals	Lawrie	127	46	36 in 100
		British hospitals	Simpson	284	107	38 in 100
Cases on patients in ananæsthetised state				145	37	25 in 100

He pointed to the above table as a proof that far from increasing the mortality of this operation the introduction of anæsthetics 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 Anæsthesia 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 116 urged that anæsthetics were responsible for various kinds of ills such as a tendency to hæmorrhage, 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 anæsthesia 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 anæsthetics 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 117 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 118 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, 119 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 anæsthetics 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 anæsthetic agents, illustrating it from the story of vaccination. The result of vaccination 120 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 anæsthesia 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 anæsthesia 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 121 were actually beneficial, they said. Simpson answered this by showing that the proper use of anæsthetics 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 anæesthetics 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 anæsthetics 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. 122 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 Paré, 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 anæsthetic 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.).

123

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 anæsthetisation?

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 anæsthetics.

The religious objections to the use of anæsthetics could scarcely be met with statistics. Foolish as they now appear to us after the lapse of time, and with the 124 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 125 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 anæesthesia 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 Anæesthetic 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 126 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 127 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 anæsthetics 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 anæsthesia 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 anæsthetics 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. 128

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 129 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 anæsthesia—which Simpson fought and won. He was the one man who by his own individual effort established the practice of anæsthesia, while Morton has the honour of being the one man without whom anæsthesia 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.

130

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 anæsthetise at all, and others who could be only partially anæsthetised. 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 anæsthetics are in that city but rarely called into requisition. All the world over it is the anæsthetic in which the general practitioner places his trust.

Having seen what Simpson did for anæsthesia, we may briefly review what anæsthesia 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 anæsthetic more than the knife; he has no anxiety as to whether he 131 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 132 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 anæsthetics. But there are other great, if less direct, results, each making its presence known to the professional spectator. By anæsthesia successful operations previously unheard of and unthought of were made possible after the principle of antiseptic surgery had been established; by anæsthesia 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 anæsthesia than was ever dreamt of in his philosophy.

133

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—Homœopathy—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 anæsthetic 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 134 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 £200,000 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 135 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 gynæcological work, had it not been for the discovery of chloroform.

The increased fame and greatly increased professional income which followed the successful struggle for anæsthesia 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 136 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: 137 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 138 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 139 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 140 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 archæological 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 anæsthetics, Montgomery of Dublin, who had keenly opposed him, was amongst 141 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 142 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 143 Alexander had latterly resigned the baker’s business and taken up the rôle 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 144 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 145 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 146 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 147 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 homœopathy, 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. Homœopathic practice was founded on facts improperly interpreted, 148 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 homœopathy 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 homœopathy, 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 149 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.” Homœopathy 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 homœopathy 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. 150 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.

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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.

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CHAPTER IX
Archæology—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 153 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 archæological 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 154 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 archæology 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 155 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 156 between the two Roman walls, and consequently included the tract where the stone is now placed. The palæographic 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 archæology 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 Archæological 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 157 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 158 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. Archæology 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 159 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 160 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 161 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 162 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 163 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.

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CHAPTER X
PERSONAL—PROFESSORIAL—PROFESSIONAL

His genius—Fertility of resource—Personal influence—Work in obstetrics and gynæcology 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 anæsthesia; it is literally true that he left no stone unturned to gain his end and to make others look upon anæsthesia 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.

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Whether we regard Simpson as a physician or as a surgeon, as a gynæcologist 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 gynæcology 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 anæsthetic 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 166 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 167 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 gynæcology 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 gynæcology 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 168 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 169 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 gynæcology, 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 170 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 cathedrâ 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 171 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 anæsthesia. 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 172 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 hæmorrhage, 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; 173 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 174 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, 175 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 gynæcologist 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 homœopathy, 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 176 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 anæsthesia. 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 177 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 178 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 anæsthetics, 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 sequelæ 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 anæsthesia 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 179 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.

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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, 10.8 per cent.
Total number of deaths	226

The relative mortality of the different amputations was also shown:—

	Cases.	Deaths.	Mortality. per cent.
Thigh	669	123	18.3
Leg	618	82	13.2
Arm	433	19	4.3
Forearm	378	2	0.5

The table on the next page compared the results of operations for injury with those performed for disease.

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