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

by G. T. Bettany

It was natural that the lack of a hospital appointment should be keenly felt by Mr. Syme, and that he should apply for one when a vacancy occurred at the Royal Infirmary; but his action when this was refused to him, in view of the rivalry existing between himself and Liston, was eminently energetic and commendable. He started a small hospital for twenty-four patients at Minto House on his own responsibility; but although he fortified himself with an influential committee and received a certain amount of annual subscriptions, the principal part of the expense throughout fell upon himself. Thus in the first year the public subscribed £217 and Mr. Syme £779, including £400 which he received in students’ fees. About this time, too, he married a sister of his old schoolfellow Robert Willis, afterwards the biographer of Sydenham, and set up a carriage. These expenses led him into pecuniary difficulties, which were not easily surmounted at first, but in a few years his circumstances became easy through the rapid increase of his practice.

Syme’s clinical lectures became remarkable from the novelty of the method he employed. It had been customary in Edinburgh to lecture on a certain number of cases somewhat resembling each other, without the patients’ presence or anything to emphasise the instruction. The young innovator brought the patients one by one into the lecture-room, questioned them, demonstrated the principal features of their complaint, and then explained the principle of his treatment, in the presence or absence of the patient, according to circumstances, and finally operated, when necessary, in the presence of the pupils. Syme was a man of few words and earnest manner; he illustrated his remarks by few but well-chosen personal experiences, but gave nothing superfluous; and it is not to be wondered at that his success was marked.

Liston’s jealousy increased as the success of Minto House became assured. In 1830 Liston wrote in the subscription book of his rival’s hospital, “Don’t support quackery and humbug.” This led Syme to bring an action for libel against Liston, which the latter had to settle by apologising. In 1831, however, his exertions were successful in gaining the professorship of surgery at the Edinburgh College of Surgeons for his friend Lizars by a majority of one vote over Syme. In 1832, when Liston’s practical treatise “The Elements of Surgery” appeared, Syme also came forward with his more theoretical “Principles of Surgery.” In 1833 Syme took advantage of a chance which he longed for, and agreed with the retiring professor of clinical surgery in the University (Russell) to allow him £300 a year for life if he became his successor. This was after Liston had refused to come to any such arrangement. When it was carried into effect in 1833 the managers of the Infirmary felt that they must allow the new clinical professor to have wards for clinical teaching, notwithstanding Liston’s active opposition.

Syme’s success as a teacher followed him to the Infirmary, and pupils crowded his wards. He was regularly present when Liston operated, but never took any part with him. Syme’s appearance often, it is said, excited the evident scorn of Liston, though no open hostilities took place. The strained condition of affairs was alleviated by the removal of Liston to London in 1835. It is satisfactory to find that the quarrel was finally healed in 1839, when Liston wrote to Syme, “Will you allow me to send you a copy of my last book? Write and tell me that you wish to have our grievances and sores not plastered up, but firmly cicatrised.” A genial correspondence followed.

We wish it could be said of Syme that all his disputes were as happily concluded. His intimate friend Dr. Belfrage, minister of Slateford, whom he consulted in all his difficulties, told him “he was always right in the matter, but often wrong in the manner, of his quarrels;” and this must be held to account in part for the number and seriousness of the controversies in which he became involved, few of which, however, need be referred to here. It may be questioned whether, on numerous occasions when Mr. Syme defended himself against attacks or brought actions for damages, he would not have done better to content himself with appealing to his well-known character and attainments, and living down aspersions. But Gregory and others in Edinburgh had left an evil habit of controversy in the air; and though Syme was more moderate than his predecessors, he often had his hands full. Although he was himself a great improver of professional practice, he was really a conservative in his attitude towards other men and new methods. His opposition to Simpson’s discovery of anæsthetics, and to his introduction of acupressure for closing cut blood-vessels without the use of a ligature, is an example of this. It is to be noted, however, that Syme’s numerous controversies left no detrimental impression on the public, and did not detract from the warmth of affection which a host of friends testified towards him.

Liston’s removal to London left Syme practically in possession of the leading surgical practice in Scotland at the age of thirty-five. So marked was his progress that soon after the Queen’s accession he was appointed Surgeon in Ordinary to the Queen for Scotland. A little later a considerable fortune was left him by an uncle, and thenceforward he enjoyed an ease of circumstances which, while it rendered his actions independent, was not at all detrimental to his professional success. The good work which, in addition to operative successes, he was accomplishing may be judged by the titles of the papers contained in a selection from his published writings, published in 1848. These “Contributions to the Pathology and Practice of Surgery” included, among others, papers on senile gangrene, on the power of periosteum to form new bone, on ulcers of the leg, on amputation at the ankle-joint, on the treatment of popliteal aneurism, on excision of the ankle-joint, on the contractile or irritable stricture of the urethra, and on lithotomy. In all these he introduced new modes of treatment or operation or propounded new views, and many of his improvements are generally adopted. In 1847 Liston’s sudden death led to his chair at University College, London, being offered to Syme. After anxious weighing of the question he decided to accept the post. On his quitting Edinburgh he was entertained at dinner by more than a hundred members of the medical profession. Dr. (afterwards Sir Robert) Christison, who presided, said no man had ever obtained so early in life as Syme the position of consulting surgeon for a whole nation; and this he owed entirely to his intrinsic merits. He referred to the collateral pursuits with which many doctors had recreated themselves. Dr. Cullen had his rural retreat; Dr. Gregory his Latin and polemics; Sir Charles Bell his pencil and his rod; Mr. Liston his hunter; Mr. John Bell his trombone. Mr. Syme had rendered his garden and conservatories conspicuous in a land of gardeners.

Mr. Syme arrived in London in February 1848, and settled in Bruton Street. An amusing incident occurred in connection with his first lecture at University College. Having been accustomed to give clinical lectures in the operating theatre at Edinburgh, which was provided with seats, he supposed a similar arrangement obtained in London, and announced his intention of lecturing in the operating theatre without having previously visited it. On entering the room to deliver his lecture, he found the students were seated inelegantly on the rails which rise behind one another in the amphitheatre. This attitude shocked him at first, but was soon exchanged for a more befitting one.

Difficulties, however, arose in connection with the chair of systematic surgery, which he was asked to undertake with that of clinical surgery. This he felt would occupy too much time, and require a devotion to theoretical surgery and to pathology which did not accord with his bent. On the 7th of May some discourteous demonstrations at the College prize distribution towards two of his colleagues deeply wounded him; and he wrote “that the slightest approach to any insult of the kind, whether offered in the comparative retirement of the lecture-room or inflicted publicly with the silent sanction of the presiding authority of the College (Lord Brougham), would effectually incapacitate him from ever addressing his pupils with satisfaction to himself or benefit to them.” In three days afterwards, having declined the fresh post offered him, he resigned that for which he had quitted Edinburgh. Fortunately his old position at Edinburgh had not yet been filled up, and he returned with alacrity to his familiar theatre and beloved home, his experiment having cost him £2000. He had been well received by the heads of the profession in London, and was rapidly gaining practice. His own brief comment on the change from Edinburgh to London was, that ambition made him sacrifice happiness, and that he found such a spirit of dispeace in University College as to forbid any reasonable prospect of comfort.

The succeeding years furnish a multitude of records of honours paid to Professor Syme, and of distinguished successes in operating. In 1848-9 he was elected president of the Medico-Chirurgical Society of Edinburgh, and greatly elevated the character of its proceedings; in 1850-1 he was president of the Edinburgh College of Surgeons. For years few numbers of the Monthly Medical Journal appeared without a lecture, case, or observation of importance from him. One of his most striking operations was the removal of the entire upper-jaw bone by making one incision in the cheek, with perfect success; the wound healed without a drop of matter, and it was difficult subsequently to trace the line of incision. The patient’s articulation remained quite distinct. Two of his most difficult operations in 1857 were connected with the tying of arteries for cure of aneurisms—one of the carotid, the other of the iliac, artery. The frightful risks and the excellent procedure by which they were successfully encountered still further enhanced Mr. Syme’s great reputation. In 1856-7 his “Principles of Surgery” reached a fourth edition. Its terse style and clear exposition had rendered it a great favourite with practical surgeons. A striking feature in it is the constant reference to fundamental principles. It was said of him at this period, “Mr. Syme is never at fault. Something unforeseen or unexpected may occur, but its import is at once understood and the contingency provided for.”

At the Great Exhibition of 1862 Syme was chosen chairman of the jury on surgical instruments. In 1863 he visited Dublin once more, and expounded his principles before the leading surgeons, being received there as a man of European reputation. His operations for the relief of axillary and carotid aneurisms, as well as his bold excision of the whole scapula for tumour, with safety and without much loss of blood, were continually increasing his fame. In 1864 he published his work on the Excision of the Scapula, and proved that the wound might heal quickly and soundly, and the arm remain strong and useful. A great operation for relief of a distressing disease by excision of a large part of the tongue was wonderfully successful in November 1864. This was the last case Syme had time to publish. In August 1865 he gave the address in surgery at the meeting of the British Medical Association in Leamington. In it he gave a graphic account of modern improvements in surgery, in which he had himself a large share, and contrasted it with the state of things at the beginning of his professional career. It constituted a most valuable review of the history of surgery during the century. Syme was the first representative at the Medical Council of the Universities of Edinburgh and Aberdeen, and might not improbably have been its president but for his illness and death. His last great controversy was that known at Edinburgh as the “Battle of the Sites.” A new hospital was required, and at first, in 1866, Syme was strongly in favour of a new building on the old site. But further experience of erysipelas and pyæmia in the old hospital convinced him of the necessity of having an entirely new building in which the old disadvantages would be absent. He consequently changed his view, and strongly advocated the new plan, which was ultimately, in 1869, accepted. But he did not live to see the new work begun.