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

by G. T. Bettany

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

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

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

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

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

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

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

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

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

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