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.
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.