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.