Sir James Young Simpson and Chloroform

(1811-1870)

BY H. LAING GORDON

  LONDON
  T. FISHER UNWIN
  PATERNOSTER SQUARE
  MDCCCXCVII


Copyright by T. Fisher Unwin, 1897, for Great Britain and Longmans
Green & Co. for the United States of America


MASTERS OF MEDICINE

EDITED BY ERNEST HART, D.C.L


  "HOMINES AD DEOS NULLA IN RE
  PROPIUS ACCEDUNT QUAM
  SALUTEM HOMINIBUS DANDO."

    CICERO.

      Title.                         Author.

  JOHN HUNTER              _Stephen Paget_
  WILLIAM HARVEY           _D'arcy Power_
  SIR JAMES SIMPSON        _H. Laing Gordon_
  EDWARD JENNER            _Ernest Hart_
  HERMANN VON HELMHOLTZ    _John G. McKendrick_
  WILLIAM STOKES           _Sir William Stokes_
  CLAUDE BERNARD           _Michael Foster_
  SIR BENJAMIN BRODIE      _Timothy Holmes_
  THOMAS SYDENHAM          _J. F. Payne_
  VESALIUS                 _C. Louis Taylor_


[Illustration: J. Simpson]


To PROFESSOR ALEXANDER RUSSELL SIMPSON


  "Him by the hand dear Nature took,
  Dearest Nature, strong and kind."

    RALPH WALDO EMERSON.


  "When Nature has work to be done, she creates a genius to do it."

    _Id._




PREFACE


I have endeavoured to condense the vast amount of matter which has
been written concerning this Master of Medicine and his work into the
form of a readable narrative, and to represent him in his social and
intellectual environment in accordance with the object of this Series.
The selections from his own writings illustrate as far as possible his
versatility and many-sided character. I have chosen for quotation out
of the numerous sketches and memoirs of him those written from
undoubted knowledge of the man.

I am indebted especially to Professor A. R. Simpson for kind advice,
to Mr. Cuthbertson of the Edinburgh University Library for useful
help, to Mr. C. Louis Taylor for valuable criticism, and to my wife
for assistance in research and compilation. I have also to thank those
friends who from time to time have favoured me with personal
reminiscences of Sir James.

The following are the chief works, in addition to Simpson's own
writings, from which my information has been drawn:--(1) "The Jubilee
of Anæsthetic Midwifery"; (2) "Keiller and Credé"; (3) "History of the
Chair of Midwifery in the University of Edinburgh," being addresses by
Professor A. R. Simpson; (4) Miss Eve B. Simpson's "Sir James
Simpson"; and her (5) "Dogs of other Days;" (6) "Twenty Years and
their Lesson; a Retrospect and Review" (_Scots Observer_, 1891); (7)
Dr. Duns's "Memoir of Sir J. Y. Simpson"; (8) Professor Gusserow's
"Zur Erinnerung an Sir J. Y. Simpson"; (9) Mr. Cuthbertson's
"Student's Pilgrimage"; (10) "The Story of Edinburgh University," by
Sir A. Grant; (11) "The Life of Sir Robert Christison"; (12) "The Life
of Robert Knox"; and numerous back numbers of the _Century Magazine_,
the _Lancet_, the _British Medical Journal_, the _Medical Times and
Gazette_, the _Edinburgh Medical Journal_, &c., &c.

FOREST HILL, _October, 1897_.




CONTENTS


  CHAP.                                                          PAGE.
     I. Birth and Childhood. (1811-1825)                             1
    II. Student Days. (1825-1830)                                   17
    III Further Studies. (1830-1835)                                36
    IV. Early Practice and Professorship. (1835-1840)               52
     V. Professor and Physician. (1840-1847)                        66
    VI. The Discovery of Anæsthetics. (1844-1847)                   88
   VII. The Fight for Anæsthesia. 1847 onwards                     111
  VIII. Home Life--Controversies                                   133
    IX. Archæology--Practice                                       152
     X. Personal--Professorial--Professional                       164
    XI. Further Reforms--Honours                                   186
   XII. Failing Health--Death                                      202
        Appendix                                                   223
        Index                                                      227




SIR JAMES SIMPSON

CHAPTER I

BIRTH AND CHILDHOOD. 1811-1825

  The state of the healing art at Simpson's birth--Birthplace--Family
  superstitions--His father's bakery--His mother's Huguenot
  descent--Commencement of schooldays--Natural and antiquarian
  features of Bathgate district--The village hand-loom weavers as
  antiquarians and naturalists--His interest in Nature and craving
  for knowledge--Brothers' and sister's care for him--Size of his
  head--Village doctor's record of his birth--Schooldays cease at age
  of fourteen--Influence of his environment in developing his
  character.


James Young Simpson, who will ever be remembered as the discoverer of
the pain-annulling power of chloroform, was born in the year 1811, at
a period when there was room for a hero in the practice of the healing
art in the British Islands.

It is true that in the seventeenth century Harvey had laid bare the
great fact of the circulation of the blood and the practical Thomas
Sydenham had swept aside the highly empirical systems and theories of
medicine which had successively supplanted each other since
Hippocrates first taught, and urged men to found their knowledge upon
what they actually saw--on observation and experiment; and that in the
eighteenth century men like Cheyne, Heberden, Cullen, and the
wonderful Jenner had appreciably assisted in developing medicine at
the same time that Hunter was raising surgery nearer to the level of a
science. But even while Simpson was growing out of childhood all the
powers of such professional giants as Bright, Addison, Abernethy,
Astley Cooper, and Charles Bell, were insufficient to dispel the
massive cloud of mystery and superstition which enveloped the practice
of both medicine and surgery in this country and obscured whatever
there was of truth in the teaching of these men.

In the first decade or two of this century the medical profession had
not yet entirely abandoned the use of the golden-headed cane, nor had
what Oliver Wendell Holmes calls the solemn farce of overdrugging yet
ceased. "Humours," "impostumes," "iliac passions," and such like were
still spoken of--terms now heard only amongst country-folks in remote
districts and that rarely, or encountered in curious old medical
publications. Messes and abominations, prepared by the apothecaries
according to more or less secret recipes handed down through the
Middle Ages, were swallowed in good faith; blood-letting was still a
panacea; and such remedies as that of holding a live puppy to the
body for the relief of colic still had their professional advocates,
but happily a decreasing number; whilst those pains

          "... In the hour,
  When the veil of the body we feel
  Rent round us--while torments reveal
  The motherhood's advent in power"

--pains which Simpson was the first truly to relieve by his
application of anæsthetics, were gravely said to be alleviated by
the swallowing of a concoction of white onions and oil. Surgery
was no doubt ahead of medicine; but the early surgical records of
this century have little more than a curious interest to modern
practitioners. Operations entirely unknown to our professional
forefathers less than a century ago are now performed in safety
daily. Such mysterious diseases as "icteric irritative fever" and
"acute sinking" after operations, dreaded then with the fear that is
always inspired by unseen or ill-understood dangers, have vanished
before the progress of modern science in which the introduction of
anæsthesia was the first great step.

The practice of the branch of medicine which Simpson made so
peculiarly his own--that of obstetrics--originally in the hands of
women only, had been fiercely contested for by the two sexes during
two centuries, and such was the feeling against man-midwives in
Scotland that the dispute had scarcely ceased at Simpson's birth. The
stronger sex, however, was then at last asserting its superiority,
and to be an accoucheur was beginning to be considered after all as
worthy of a gentleman. The despised art was preparing for its
renaissance.

Simpson grew to manhood whilst science, aided by precise methods of
accurate observation, was shedding new light upon physic, surgery,
and obstetrics. In fulfilling his great part in establishing the
healing art on a firm scientific basis, Simpson encountered the full
force of the ignorance and prejudice of his day both within and
without his profession. It was, perhaps, fortunate that he was brought
up in a small village and in a rank of life where he would meet from
his earliest days with many superstitious beliefs and practices,
strange and utterly irrational. A mind such as his would meet,
reason, and experiment these out of existence. Probably through
these circumstances he conceived the taste for archæology and
antiquarian research which were his recreation in later years; but,
what was more important, he gained also some training for the
struggle with ignorance, untruth, and irrationalism, into which he
threw with his eager vigour the whole strength of his manhood.

Simpson was born in the village of Bathgate, in Linlithgowshire, where
his father, David Simpson, was the local baker. David's father, who
died at the ripe age of ninety-one a few years after James's birth,
was the descendant of a line of small hard-working farmers, who added
to his work and his profit the practice of farriery. Although modern
science has, by the aid of bacteriology, proved such practitioners of
the rough veterinary medicine of the day to have been right in
ascribing to unseen influences many of the diseases of animals which
they found themselves powerless to check, the methods they employed
for treatment when what they called witchcraft was at work scarcely
have the support of present-day practitioners. In one of his addresses
upon archæology Simpson records how his grandfather ordered and his
own father took part in the burial alive of a cow in order to appease
the evil spirit which was spreading the plague of murrain with fatal
effect. And the older gentleman was known to have had more than one
serious encounter with a witch. On one occasion an old beggar woman,
who plied her calling in quite an original method--that of being
wheeled in a barrow from farm to farm--hurled curses at old Simpson
for ordering a servant to wheel her from his house on to her next
calling-place, and vowed an awful vengeance on his family if he did
not replace the servant with one of his stalwart sons. The farmer
recollected that an ill event had followed the old woman's last visit,
and quickly drew a sharp flint from his pocket and made a gash across
her forehead with it. "Ah," he exclaimed, "I see what ye're noo, ye
auld witch; but I've scored ye aboon the braith and my house is
safe."

Simpson noted these and many other curious practices and beliefs, and
afterwards pointed out in one of his addresses that they were
probably, for the most part, relics of the pagan creeds and customs of
our ancestors. He urged the making of a collection of the folk-lore of
Scotland, ere it utterly disappeared before the march of modern
civilisation, and suggested that, perhaps, some archæological Cuvier
might one day be able to re-construct from these mythological
fragments distinct pictures of the heathen practices, rites, and
faiths of our forefathers.

In his early boyhood he listened to many stories of local and family
superstitions told to him with all the earnestness of a firm believer
by his father. He himself was the object of superstitious admiration
to the simple villagers all through his boyhood, and they freely
foretold great deeds from him in later years; for he was a seventh
son, and the good luck which seventh sons were supposed to bring had
appeared in the family soon after his birth. Up to the day on which
James first saw the light, June 7, 1811, the baker's business had been
going steadily from bad to worse, and the shop books showed that on
that very day the lowest depths were reached. The baker, David
Simpson, seems to have been curiously lacking in business method,
although he was a hard-working man. But after James's birth he wisely
interested his wife in his affairs, with the result that she
energetically and successfully bestirred herself to recoup their
fallen fortunes. Mrs. Simpson was directly descended from a fugitive
Huguenot family, settled for many years on a farm near Bathgate, and
intermarried with well-known families. Through her, indeed, Simpson
claimed a distant relationship with the national hero, Sir William
Wallace. The cares of her family and the strain of managing the
increasing baker's business proved too much for her always delicate
constitution, and she died when James was only nine years oldat the youngest child and favourite son had an unusually
large share of his mother's society during those years; he was a
peculiarly attractive child, "a rosy bairn wi' laughin' mou' and
dimpled cheeks," and his manner, even when he was little more than an
infant, was quiet and affectionate. When physical sufferings overtook
the mother, the child's quiet sympathy and engaging manner helped and
comforted her. Her own nature was bright, vivacious, and energetic,
quick to think and prompt to act; and she was full of love, sympathy,
and piety. These maternal traits influenced the youth, and added a
soft, refined--delicately refined--tone to the paternal influence,
whence he received self-reliance and habits of persevering industry.

The boy's school-life began at the age of four years. The orthodox
learning came very easily to him; he entered into both work and play
so whole-heartedly that he at once became known as the "wise wean,"
and was at the same time ever sought after by his school-mates as a
companion in out-door sports. The parish schoolmaster was one James
Taylor, who had considerable ability for the post, and encouraged his
pupils by kindly personal interest to develop affection for learning.
But for Simpson there were other teachers and greater subjects for
study in the countryside around Bathgate. The district was full of
rich treasures for the field naturalist and for the antiquarian.
Bathgate lies between the Firth of Forth and the Pentland Hills, in a
geologically varied district, with a varied and abundant flora and
fauna--more so in those days when Bathgate was a small village of
hand-loom weavers than latterly, when it was a thriving little town,
the centre of a coal, shale, and ironstone mining industry. The
archæological features of the neighbourhood were full of interest.
There was the famous "Catstane," of Kirkliston, which had puzzled
antiquarians even before the establishment of the Scots Society in
1780, and at Kipps was one of the few remaining cromlechs--and that a
ruined one--in Scotland; whilst the line of the Roman wall between the
Firth of Forth and the Clyde was not far distant. There were traces of
a Cistercian monastery founded by David I., and various hills and
fields and caves were associated with the names of Sir William
Wallace, Robert Bruce, and King Edward I.

Simpson thoroughly familiarised himself in boyhood with the natural
features, as well as with the antiquarian objects in the district.
He continued to investigate them during his vacations when a student
at Edinburgh University, and rendered the neighbourhood famous
archæologically by masterly monographs written when he was at the
height of his fame. Amongst the village hand-loom weavers, a race
of peculiarly observant and intelligent men, there were some who
studied both the antiquarian objects and the natural history of
Linlithgowshire. Simpson used to speak of one man, a daily labourer
at the loom, who was able to write, in correct Latin, an accurate
description of any plant or animal brought before him, although
his earnings at the loom never amounted to fifty pounds a year.
These men thoroughly enjoyed the evident interest of the "young
philosopher" in their discussions and demonstrations, at the same
time kindly directing his mind towards the simple, painstaking, true
methods of observing and reflecting upon nature. There was no lack
of change in his environment for him; his interest in natural
phenomena was roused and kept alive during his drives round the
countryside delivering bread to the farmers and cottagers, or in
occasional visits to his parents' relations. He daily took his turn
behind the shop counter, reading, writing, or drawing in the
interval of waiting for customers. He trained himself to read or
do his school lessons as readily in a roomful of romping children
as in the quiet of the bedroom. It has been said that he never knew
an idle moment from the day of his birth onwards, and his was such
an indomitable and persevering energy that the remark is no
exaggeration. But the pathway to greatness was made specially smooth
for James Simpson. He was set upon it, and protected in his
childhood, and guided in his youth, with the one definite object
always in view. The Simpson family as well as the whole Bathgate
community, took it for granted that eminence was to be his in
whatever walk of life he entered seriously upon. His sister Mary and
his brother Alexander looked upon him as a special care; the former
watched over him as a mother, and the latter helped him in the ups
and downs of boyhood, just as he constantly stood by him throughout
the difficult days of his later career. It had always been a
custom in Scots families of humble rank that one child, either from
the exhibition of a natural aptitude, or through the ambition of
the parents, was singled out to receive the advantages of a fuller
education such as is within the reach of every able lad in Scotland.
Honour and glory would thus be brought to the family, greatest of
all if from the pulpit, while the less favoured members of the family
would plod on in the same sphere of life as their parents. The world
owes a great deal to the Simpsons, and particularly to Alexander, who
cheerfully seconded their father's efforts to help forward their
young brother, without a suspicion of jealousy. They knew he would
be great some day, and therein they looked for their reward.

Happily there were ample means for all their requirements derived from
the now prosperous bakery. The money was kept in one drawer, the till
where the shop earnings were placed. All the household were free to
draw thence supplies for their ordinary wants, James without stint;
and he alone was exempted from the condition that he who profited must
also contribute by the sweat of his brow. The boy took very full
advantage of his fortunate circumstances and drank deeply of all the
knowledge that came near and ever hunted for more. With each
succeeding year the craving to know, and to know thoroughly, became
more and more his ruling passion; by the time his schooldays were over
it had gained complete mastery over him; happily for the human race
Providence had so endowed him that when knowledge had come wisdom did
not linger.

He was never in any way led away by the temptations that no doubt
beset every boy in a village of hard-drinkers such as Bathgate was in
his youth. Alexander took pains to warn him--"Others may do this,
Jamie, but it would break all our hearts and blast all your prospects
were you to do it," he said. It was not necessary to make appeals to
James to work and fulfil the family predictions; he was as firmly
determined to be great as they were sure he would be: He never forgot
how much he owed to the loving help of his family, and to the fact
that he was the youngest son growing up at a time when the family
struggles were fairly over; when instead of its being an effort for
the parents to provide the necessary funds for his education, the
shop-till was well filled and the elder brothers and the loving sister
were at hand eagerly willing to help. In student days when struggles
came and the path seemed dark and beset with dangers, the knowledge of
the firm faith in his powers of the family at home and of the scarcely
smaller faith of the weavers, was a powerful incentive in the moments
when he required any other than that of the spirit within him.

We cannot feel otherwise than thankful that up to the age of fourteen,
when his schooldays ended, he had access to but a limited stock of
literature wherewith to gratify his hunger for knowledge. To satisfy
his appetite he was driven into the fields and the forests; every
sense was stimulated, and became developed through repeated use. Thus
he laid the foundation of his phenomenal faculty of rapid and accurate
observation, and of his no less phenomenal memory.

His imagination was fed with the legends of the district and tales of
his remote moss-trooper ancestors told to him of an evening by his
father. Though happily saved from being a bookworm to the exclusion of
sounder means for acquiring knowledge, he devoured and digested every
scrap of literature which came in his way. Like all Scots children of
his class he learnt his Bible thoroughly from end to end--a knowledge
which served him well in later years. Shakespeare followed the Bible
in his own review of his favourite reading as a boy; but a gazetteer
or an almanac was quite as acceptable. His taste was for solid
fact--fact which he could learn and put to the test; thus the great
open book of Nature was the attraction he most readily yielded to. But
nothing in book form ever came amiss to him; if between the covers
there was useful information to be had, Simpson extracted it and
stored it away in his capacious brain.

The unusually large size of his head, a source of admiration in
manhood, was in childhood an object of wonder to observers. In manhood
he wore his hair in long locks, and this was apparently his habit in
boyhood. Once a strange barber cut his hair so close that his brother
took upon himself to go and rebuke the man. "The callant had suck a
muckle head," was the retort, "I was doin' my best to mak' it look
respectable." A close-cropped head gave altogether a too sportive
appearance to the "young philosopher" in the eyes of the watchful
elder brother.

There is no evidence that Simpson displayed in his schooldays any
special leaning towards the medical profession; it cannot be
reasonably urged that his grandfather's rough skill in the treatment
of animals fostered any medical tendency in him, for James was but
five years old when the old man died. Even had he been of an age to
understand them, the methods employed would have scarcely recommended
themselves to a youth of Simpson's nature, sufficiently to raise a
spirit of emulation within him. It is also not recorded that the
village doctor took any special interest in the boy or brought any
influence to bear upon him; although his note-book thus gives the
earliest record of the future prince of obstetricians:--

  275.--June 7. Simpson, David, baker, Bathgate. Wife, Mary Jarvie.
  Æ. 40. 8th child, son. _Natus_ 8 o'clock. _Uti veniebam natus._
  Paid 10s. 6d.

James displayed his superiority so decidedly in the village school
that when he reached the age of fourteen it was decided to send him to
Edinburgh University without further waste of time. It was no unusual
age for boys to commence their University career in Scotland. There
was no secondary education in the Scots provinces, but instruction
intermediate between that of the parish school and what is ordinarily
known as University education was given within the walls of the
University itself. Boys of humble rank who aspired to a profession
were sent up, as indeed many still are, at the age of fourteen or
fifteen, to attend these junior Arts classes in which this instruction
was, and still is, imparted. The University was crowded with
schoolboys of all ranks of life gathered together from town and
country, and consisted of nothing more than a collection of
class-rooms devoted to the giving of instruction in lecture form. This
stepping-stone of junior classes threw open the higher education to
hundreds of youths whose equals in England had no such advantage at
that time. Scots University education besides being thorough was
decidedly cheap, so that the church, law, and medicine received many
recruits from the class out of which Simpson was drawn.

His environment up to the age of fourteen was well calculated to train
him for the great work that lay before him. The legends of the
district, and the sight of the objects of archæological interest which
he came across in his rambles out of school hours, were powerful
stimuli to his sensations; whilst the accurate observation of natural
phenomena in field and hedge which the kindly interested weavers
helped him to, was also a valuable educative influence. It is probable
that his senses received much of the training which was to lead to his
ultimately being the greatest physician of his day by these means,
rather than from the instruction imparted to him in the village
school, or derived by him independently from the books that came in
his way. It was undoubtedly a fortunate circumstance that he was born
and bred in an out-of-the-way country district, where he drew his
lessons from Nature and the phenomena which lay round him, rather than
in a great city where he would have been educated on the stereotyped
orthodox system. When we look further back, asking why he saw sermons
in stones and books in the running brooks, to which the bulk of his
schoolfellows were entirely blind, we are bound to confess that we
find no satisfactory answer in his family history, to which it is
customary to look for an explanation of such tendencies. Heredity
played no great part in making Simpson great; from the paternal side
there was imparted to him a vigorous physique; from his mother he
received the bright, happy, sympathetic, and alert disposition, which
descended through her from his French ancestors. He was provided with
a brain of marvellous quality and phenomenal size. But it was the
environment which acted upon this brain and brought out the capacities
born in him without any apparent hereditary bias, and which might have
remained entirely latent under less favourable circumstances. No small
part of the development was due to the people among whom he lived; a
race of men accustomed to rely upon their senses which were always
with them, rather than upon books which they seldom saw, even if they
were able to read them; and to observe not only all that lay around
them, but also the characteristics of their fellowmen with whom they
were brought into contact--the close contact of different classes
which obtains in village and rural life. Simpson was taught to study
Nature whether in field or fellow-creature first, and the knowledge
and opinions of men as expressed in books afterwards.




CHAPTER II.

STUDENT DAYS. 1825-1830.

  Visit to Edinburgh--Sent to the University--Takes the Arts
  classes--Gains a bursary--Influence of MacArthur and Reid--Robert
  Knox the anatomist--The Burke and Hare murders--Superiority of the
  extra-mural teachers of the day--Edinburgh an intellectual
  centre--University life--His mode of living as a student--Apprenticed
  to a chemist--Studies surgery under Liston--Regularly falls asleep
  in the obstetric class--Influence of his teachers--Verse
  writing--Description of the medical student of the day--Vacation
  work--Death of his father--Obtains qualification to practice at
  the age of eighteen.


Although Edinburgh was only eighteen miles from Bathgate, Simpson
visited it only once as a schoolboy; probably he walked all the way,
for railroads were as yet unknown and it was not a long walk for a
country-bred vigorous youth. He exercised his already formed habit of
noting objects of interest during this great event in his boyhood, and
in his journal there are copies of old inscriptions from tombs in the
famous Greyfriars' Churchyard to which he made his pilgrimage.

The boy's nearest and dearest ambition was to become a student at "the
College," as Edinburgh University was familiarly termed. It received
encouragement in the periodical return to the village of elder boys
who had gone up before him. He was specially struck, and afterwards
stimulated, by the appearance of one John Reid, his senior by two
years, and his former companion in many a country ramble, who came
back for the vacations smartened up both physically and mentally by
the new life.

Although the collegiate life characteristic of Oxford was unknown in
Scots Universities, there was social intercourse amongst the boys very
different from that of the village. The ancient Edinburgh University
attracted students from all parts of the world, mostly for the medical
curriculum, but many preceded the professional course with a year or
two's attendance on the Arts classes; and it was usual for young
Englishmen of good family to spend a session at Edinburgh before going
to Oxford or Cambridge. Prob or Cambridge. Probably before he entered the medical
classes, Simpson rubbed shoulders with lads of all ranks from home and
abroad. Pillans was at this time the Professor of Humanity, Wallace
held the chair of Mathematics, John Wilson--better known as
Christopher North--that of Moral Philosophy, and Dunbar was Professor
of Greek. Wallace had begun life as a bookbinder's apprentice, and
Dunbar had risen from being a gardener; the example of these men under
whose influence he was brought encouraged the baker's son to go and
do likewise.

The family had sent him off to the College with the mission to be
famous, and he was beginning only in an orthodox fashion when he
entered himself for the curriculum in Arts. It had been easy for him,
with his magnificent brain power, to stand _dux_ of the village school
over the ordinary village youth; but here, in Edinburgh, he was
brought into competition with the picked boys from other country
schools, and intellectually eager youths from town schools where the
course of instruction was such as more easily to lead to early
University success than that of the Bathgate parish school. At first
he found difficulty and desponded. The keen observer with senses all
alert was dashed to find so much of the College life to which he had
so eagerly looked forward only a magnified repetition of the dull
school routine. But he was too intent on ultimate success to be
repulsed by his initial disappointment, and soon brought his mind into
adjustment with the circumstances he found himself in, reserving
leisure time and vacations for the exercise of his faculties as he
most loved to exercise them. He did not persevere in the Arts course
after he found his tastes led him to other studies; he did not trouble
to obtain the Master of Arts degree, which was then conferred in a
very lax manner; probably he saw its worthlessness, for it was not
until the passing of the Scots Universities Act in 1858 that this
degree became really valuable. He recognised, however, the value of
laying a good foundation of general knowledge; without straining after
any distinction he acquitted himself creditably in all his classes. In
the second year of the curriculum he won one of the numerous small
bursaries of the value of £10 a year, for which logic was one of the
chief subjects of examination; but as candidates were restricted to
those who possessed either the name of the founder, Stewart, or that
of his wife, Simpson, the competition was not particularly severe. His
individuality and natural straightforwardness attracted the attention
of some of his professors. The boldness of his original essays
provided them with food for comment in a manner dear to the
professorial heart.

The Arts curriculum served him usefully in helping to develop a
literary style and in teaching him how best to express his vigorous
thoughts, as well as in strengthening his knowledge of Latin and
Greek. According to the record preserved on his class certificates he
worked attentively and diligently; but the mere fact that he did not
excel is sufficient proof that he did not make an attempt.

During his Arts course Simpson lodged at No. 1, Adam Street, along
with the John Reid already mentioned, who was now a medical student,
and with a Mr. MacArthur, who had been a junior master at the Bathgate
school, but had now also commenced to study medicine. MacArthur was a
man of dogged determination; he urged Simpson to persist with his
Arts course when his spirit seemed to rebel against it, and so long as
they were together seems to have maintained some of the authority of
the usher over both of the youths. The spirit of work was strong
within him. Soon after Simpson joined him he related that he could
then do with four hours' sleep, John Reid with six, but he had not
been able to break in James yet. What MacArthur and the Arts course
could not do, however, the attraction of medicine accomplished without
effort, and Simpson soon formed the habit of early rising.

It seems remarkable that so much study should have been required when,
compared with to-day, the science of the healing art was in but a
rudimentary condition. The teachers of the day had, in spite of
Sydenham, a great regard for authority, and burdened their students
with much that is utterly unknown to the present generation, and, if
known, would be regarded as worthless. A very large part of the
curriculum consisted of practical and bedside work, so that book study
was necessarily left to the evening or early morning. All three
students, moreover, were fired with ambition, and thirsted for
something more than mere professional knowledge. MacArthur constantly
urged on his two young friends, and foretold great things for them if
only they would work. When he afterwards heard of their successes he
used to say, "Yes, but _how_ they worked." Simpson became the
greatest living obstetrician, and Reid rose to be Professor of
Physiology in St. Andrew's University. MacArthur never became famous;
his name is known only because of the initial impetus which his
influence gave to the professional careers of his two young friends.

In his close association with two such men as MacArthur and Reid,
Simpson was again fortunate in his environment. The art of medicine
was also fortunate inasmuch as at the right moment the right
influences were at work to direct his mind towards it. While occupied
in mastering the laws of hexameter and iambic or in assimilating the
prescribed portion of Virgil and Tacitus, he happily now and then,
living with two such enthusiastic medical students, got a taste of the
more stimulating study of things scientific--food which was more
agreeable to his mental palate, more suited to his mental digestion.
By peeps into anatomical books, by little demonstrations of specimens
in their lodgings, and by occasional visits to some of the lecture
rooms or the wards of the Infirmary, his appetite was whetted for that
great study of nature which his youthful training at Bathgate had
prepared him for, and for which his mental constitution was specially
adapted. One can picture the eagerness with which he would cast aside
the finished Greek or Latin essay and urge the not unwilling embryo
professor to demonstrate a bone or lecture on an anatomical
preparation.

Sometimes as a special favour he was taken by Reid to hear one of the
lectures of the notorious Robert Knox, the extra-academical teacher of
anatomy, whose strong personality and unrivalled powers as a lecturer
were at that time attracting to Surgeon's Square hundreds of students,
while Munro (Tertius) was mechanically repeating his grandfather's
lectures from the University chair.

It was towards the end of 1828, when Simpson was just about commencing
his medical studies that Edinburgh, and in fact the whole of civilised
Europe, was horrified by the revelation of the doings of Burke and
Hare, when they were at last brought to justice for the long series of
crimes perpetrated for the purpose of selling the bodies of their
victims to the anatomical schools. Knox having a class of some four
hundred students had special difficulty in meeting the demand for
"subjects," and it was brought to light at the trial of Burke that the
majority of the bodies were disposed of to Knox. As was only natural,
a fierce indignation against Knox sprang up in the city. His residence
was assailed and his effigy burnt. His life was in danger at the hands
of the mob on more than one occasion.

Lord Cockburn in his "Memorials of His Time" says that all the
Edinburgh anatomists incurred an unjust and very alarming though not
an unnatural odium--Dr. Knox in particular, against whom not only the
anger of the populace but the condemnation of more intelligent
persons was directed. "But," he says, "tried in reference to the
invariable and the necessary practice of the profession our anatomists
were spotlessly correct and Knox the most correct of them all."

These were stirring times in Edinburgh medical circles. The strong,
cool demeanour of Knox under the persecutions to which he was
subjected, must have made an indelible impression on Simpson's mind,
and the memory of it may have served to strengthen him in later years
when himself subjected to the unjust accusations of thoughtless and
ignorant people.

One night when Knox had attracted a large class to hear him on a
favourite subject, the crowd in the street mustered in unusual force;
the yells and howls from outside were heard distinctly in the
class-room. The students got alarmed, and kept looking to the doors of
egress. Knox perceiving the restlessness and alarm of his audience
paused, and then addressed to them reassuring words, expressing his
contempt for the cowardly mob, and reminding them of the great men who
at different times had suffered persecution for the cause of their
science. His statement was received with such cheers as resounded
beyond the class-room walls and actually cowed the uproarious mob, so
loudly did the students applaud the words of the man who, they knew,
daily placed his life in danger in order to lecture to them, and whose
last hour seemed to have come, so great and threatening was the crowd
on this particular evening.

If Simpson did not actually witness such a scene as the foregoing--he
was not a member of Knox's class until the session 1830-31--he must at
least have known full well about it at the time, and shared with the
whole body of students the worship of the man as a hero. His fellow
lodger, Reid, was not only a distinguished pupil in Knox's class, but
became one of Knox's demonstrators in 1833, and was always a prominent
Knoxite. We know also that Knox went down to Bathgate to visit Reid's
relations there, so that it is justifiable to conclude that Simpson
came closely in contact with this remarkable teacher. That the
relationship between Reid and Simpson was most intimate we have the
former's own words for. At a public dinner given to him when appointed
to his professorship in 1841, he said, "In the croupier (Simpson) I
recognise my earliest friend, a native of the same village. We were
rivals at school and at college. We stood to each other from boyhood
upwards in every possible relation, whether of an educational,
warlike, delicate, or social character, which the warm and fitful
feelings peculiar to boyhood and youth can produce."

In the end Knox and Reid quarrelled over a scientific matter. Knox
never recovered from the effect of the Burke and Hare incident; in
spite of the favourable report of an influential committee appointed
to inquire into his share in the proceedings, and his own explicit
statements, the public never acquitted him of at least a wilful
shutting of his eyes to much that ought to have aroused his
suspicions. His crowded class-room gradually became empty during the
next few years, and the once brilliant, talented, and determined man
became demoralised and left Edinburgh. Christison says that Knox
finally died almost destitute in London, and that one of his last
occupations was that of showman to a party of travelling Ojibbeway
Indians.

However the strong personality and attractive lecturing of Knox may
have influenced him, it is undoubted that to the personal influence of
MacArthur and Reid, acting upon his constant hunger to know nature and
truth, stimulated as it was by what he saw of anatomy and physiology,
we owe the fact that Simpson decided to enter the medical profession.

Although the number of medical students in Edinburgh University
reached one of its highest points during the years that Simpson was a
student, it is remarkable that with one, or perhaps two, exceptions,
the University professors were men of no marked eminence in their
various subjects. On the other hand, the extra-mural teachers included
men of such wide reputation as Knox, Lizars, and Liston. Syme, who
reached the height of his fame as a surgeon about t
Simpson became renowned, had just resigned the teaching of anatomy to
take up surgery; shut out at first from the wards of the Royal
Infirmary by jealous colleagues, he was boldly establishing for
himself the little Minto House Hospital, which became the successful
nursery of his own unsurpassed system of clinical teaching, and
remains in the recollection to this day as the principal scene of Dr.
John Brown's pathetic story, "Rab and his Friends." It was chiefly
these extra-academical teachers who at that time made the medical
school famous, and were raising for it a reputation in surgery such as
it had acquired in physic in the days of Cullen. In certain subjects
the students would, according to the regulations for the degree, take
out their tickets of attendance on the professor's course of lectures,
but would put in only a sufficient number of appearances to entitle
them to the necessary certificates; the real study of the subject
being made under the more accomplished teacher outside the University
walls.

Edinburgh was at this period much more than the scene of the foremost
medical and surgical teaching of the day in the world. It was a
striking centre of intellectual activity. Sir Walter Scott,
Cockburn, and Jeffrey were famous in literature and politics; Chalmers
and Moncrieff in Church affairs; and Aytoun, John Wilson, Sir
William Hamilton, and Sir David Brewster were names that attracted
men from far and wide to the modern Athens. English and foreign
advocates, scholars, artists, squires, and noblemen mingled together
to hear or see some of these men. Lord John Russell, Henry
Temple--subsequently Lord Palmerston--and Lord Melbourne were
amongst the young Englishmen who attended university classes for a
session or two; and H.R.H. the Prince of Wales, and his brother the
Duke of Edinburgh, each matriculated in later days. When Simpson began
his studies Knox was the great lion, without a visit to whose
class-room no sojourn in Edinburgh was complete; just as in later
years Simpson's house in Queen Street was the resort of all sorts
and conditions of distinguished people.

The University had little control over her students once they were
outside the gates of the quadrangle. There were no residential
colleges; each youth found lodgings for himself suitable to his means,
and led a perfectly independent life. So long as he conducted himself
with propriety within her walls his Alma Mater cared little how he
conducted himself or how he fared outside. Before 1858, when the Town
Council controlled University affairs, there were sometimes attempts
to order the comings and goings of students. It is recorded that in
1635 the Town Council discovered that the scholars of the College were
much withdrawn from their studies by "invitations to burials," which
"prejudiced their advancement in learning," and they enacted that no
student was to be permitted to attend burials except those of
University or city worthies. This was at a time when some of the
students were provided with residences inside the University, but by
the beginning of the eighteenth century College residence had ceased.
From time to time attempts have been made to render the students
conspicuous in the city by the wearing of red gowns, but without
success; and those of all faculties continue to be their own masters,
in marked contrast to the mode of government in force at Oxford and
Cambridge. Recently, in the eighties, a batch of students who had
figured in the police-court after a riot in the gallery of a theatre
were surprised to find themselves summoned before the Senatus
Academicus and rusticated for varying periods; this, however, was but
a spasmodic exercise of power. The chief advantage claimed for this
custom of leaving the student to his own devices is that it encourages
independence and develops each man's individuality better than a
system of discipline and control. In men of Simpson's calibre it
certainly has had a good effect.

Although the family in Bathgate strained every nerve to keep James
well supplied with the necessary funds as a student, they were not
able to place him in such a pecuniary position as to make it
unnecessary for him to exercise economy: He appears to have been very
careful indeed of the money which he had; much more careful than when
he reckoned his income by thousands. He kept methodical accounts of
his expenses down to the most trivial items, and regularly submitted
them to his family. His cash-book opened with the following quotation
from a small book called the "Economy of Life," which figures at a
cost of ninepence:--"Let not thy recreations be expensive lest the
pain of purchasing them exceed the pleasure thou hast in their
enjoyment"; and to this he added:--

  "No trivial gain nor trivial loss despise;
  Mole-hills, if often heaped, to mountains rise.
  Weigh every small expense and nothing waste;
  Farthings long saved amount to pounds at last."

It is easy to see here the imprint of a well-known national
characteristic, from which, however, he completely shook himself free
when prosperity came to him.

His share of the rent of the Adam Street lodging amounted to only
three shillings a week. The entries in the cash-book show how frugally
he lived and how every spare sum was devoted to the purchase of books.
His library, the foundation of much of his encyclopedic knowledge, was
a curious mixture. Adam's "Antiquities," Milton's Poems, Byron's
"Giaour" and "Childe Harold," a Church Bible, Paley's "Natural
Theology," Fife's "Anatomy," and "The Fortunes of Nigel," were amongst
those entered as purchased. The daily entries were such as the
following:--"Subject (anatomical), £2; spoon, 6d.; bread and tart, 1s.
8d. Duncan's Therapeutics, 9d.; snuff; 1-1/2d.; Early Rising,
9-1/2d."

He followed out the usual student's custom of the day of learning
dispensing by serving for a time in a chemist's shop. The late Dr.
Keiller, of Edinburgh, used to relate how, while he himself was so
employed in a chemist's shop in Dundas Street, one day "a little
fellow with a big head" was brought in and entered as a pupil by a
relative. The little fellow was Simpson, and no sooner was he left in
the shop than he sat down with a book upon drugs, and turning to the
shelves took down drug after drug to read up. The prompt industry of
the big-headed fellow deeply impressed Keiller.

James attended most of the University classes, but studied surgery
under the great Robert Liston, the foremost extra-mural surgeon,
daring and skilful as an operator and of great repute as a lecturer,
who afterwards filled the post of Professor of Clinical Surgery in
University College Hospital, London. Liston was an abrupt-mannered but
sincere man, and a keen lover of truth. He was a warm advocate of
hospital reform, and was successful in introducing several needed
improvements into the Royal Infirmary after a fierce fight. Here again
Simpson was brought under the influence of a strong, self-reliant man
with a distinct tendency towards controversy; to whom he was also
attracted by the fact that Liston was a native of Linlithgowshire.
Liston and Syme, after being close colleagues, quarrelled most
fiercely, and were bitter rivals until Liston removed to London in
1835. Simpson attended Liston's lectures during three sessions.

There is no record of his having obtained great distinction in any of
the medical classes, but his certificates show that he worked with
pre-eminent diligence in them all, and obtained a characteristic
mastery of each subject. If any exception occurred it was in the very
subject in which he afterwards earned his greatest scientific
fame--that of obstetrics. He attended Professor James Hamilton's
course of lectures on that subject early in his career, and apparently
felt so little interest--the subject only became a compulsory one for
examination for qualification in 1830--that he regularly went to sleep
during the lecture. The excuse urged was that the lecture being a late
one, three to four in the afternoon, it found him tired out after a
long morning of study, lectures, and practical work. But had he been
keenly interested he would have been wide awake, for Hamilton was a
forcible, if plain, lecturer.

Hamilton was another of Simpson's teachers who exhibited the same
uncompromising fighting characteristics--eager and strenuous in his
efforts to obtain some object--which Simpson himself afterwards
displayed. He fought hard for fifteen years to gain recognition for
the subject which he taught, and to have it included in those
necessary for qualification. He succeeded in the end, but in the
course of the struggle had to bring two actions at law against
professional brethren. In one the defendant was Dr. Gregory, whose
teaching was mainly responsible for the British system of medical
practice in the early part of this century, viz., free purging,
free bleeding, and frequent blistering, and who was the inventor of
that well known household remedy, Gregory's powder. Gregory was also
a pugnacious man and could not abide the pretensions of the
representative of the despised art of midwifery; he administered a
public caning to him, and had to pay £100 in damages which, it is
said, he offered to pay over again for another opportunity of
thrashing the little obstetrician. This encounter occurred before
Simpson became a student, but the memory of it was frequently
revived in the subsequent disputes which Hamilton carried on.

The notes which Simpson took of the curriculum lectures were concisely
made and full of comments, criticisms, and queries. He by no means
bowed down to authority; he allowed nothing to pass which he did not
understand at the time, and specially noted points which it seemed to
him his teachers themselves did not understand.

Like most young men of his abilities and temperament, Simpson took
pleasure in rhyming, and some of his verses are preserved. They
indicate something of the rollicking spirit of the medical student's
life seventy years ago. The medical student at that date has been
described in a recent interesting sketch of Edinburgh student life as
wearing a white great-coat and talking loud; his hat was inclined
knowingly to one side of his head, and the bright hues of an Oriental
handkerchief decorated his neck. There was a great deal of acting in
his motions. He was first at the door of the theatre on a Saturday
night, and regardless of the damages sustained by the skirts of his
coat, secured the very middle seat of the fifth row of benches in the
pit. Simpson, however, hardly conformed to this description. He
enjoyed recreation as much as any man, and had a keen sense of humour
which made him popular among his fellow students, but he was saturated
with the love of study and was not led into extravagances of the Bob
Sawyer type, or the harmless inanities of Albert Smith's immortal
Medical Student.

During the long summer vacation he noted carefully his observations on
the botany, zoology, geology, and even the meteorology of the Bathgate
district. Dr. Duns, in his memoir, points out that he was much more at
home with the phenomena of organic than with those of inorganic forms.
His highest powers came into play when he had to do with the presence
of life and its varied manifestations. Even his antiquarian notes
illustrated this. He passed at once from the things to the thoughts
and feelings of the men associated with them.

In the holidays he also assisted the village doctor in visiting and
dispensing, and lent a willing hand in his father's shop when he was
wanted, often enough driving the baker's cart on the daily round of
bread delivery.

In January of the year 1830 his father was taken seriously ill, and
James hastily left Edinburgh and tended him till his death. On his
return he presented himself for the final examination at the College
of Surgeons. This he passed with ease and credit in April, and found
himself a fully qualified medical practitioner at the age of
eighteen.




CHAPTER III

FURTHER STUDIES. 1830-1835

  Applies for a village appointment--Disappointment--Brother's help
  to further studies--Dispensary assistant--Obtains University M.D.,
  1832--Thesis--Assistant to the Professor of Pathology--Turns to
  obstetrics--Attends Professor Hamilton's lectures again--Royal
  Medical and Royal Physical Societies--Edward Forbes--The
  Oineromathic Society--Foreign tour--Visits Liverpool and meets
  Miss Jessie Grindlay--His characteristics, principles, and
  methods, with extracts from addresses.


There now came the first crisis in Simpson's medical career. After
his father's death he felt that having obtained his qualification
to practise it was his duty to relieve his family of the burden of
supporting him through more extended studies. After due deliberation
he applied for a small appointment which would have served as a
nucleus for private practice, that of parish surgeon to a small
village on the banks of the Clyde. Those in whose hands the
appointment lay were not impressed with his fitness for the post,
and he was not elected, "I felt," he afterwards said, "a deeper
amount of chagrin and disappointment than I have ever experienced
since that date. If chosen, I would probably have been working there
as a village doctor still." Although such a commencement might have
delayed his ultimate rise to eminence, it cannot be agreed that it
could possibly have prevented it. It was at this crisis that what he
tenderly referred to as "the ceaseless love and kindness of a dear
elder brother" came to his rescue, and by Alexander's or, as he
affectionately called him, "Sandy's" help, he returned to Edinburgh
to resume his studies in the winter session, 1830-31. His other
brother, David, had started in business as a baker at Stockbridge,
close to Edinburgh, and James boarded with him there for a time.
His qualification enabled him to become assistant to a Dr. Gairdner
in dispensary practice, a class of work he had had some experience of
in the previous year while staying with Dr. Girdwood at Falkirk during
the summer. Dr. Gairdner was much struck with Simpson's abilities,
which he stated, "promised the most flattering expectations." In the
course of his first experiences of actual practice he became
impressed with the necessity for a knowledge of obstetrics, and
therefore attended lectures on the subject by Dr. Thatcher, an
extra-mural teacher of repute, who subsequently applied for the
University chair of midwifery when Simpson was the successful
candidate.

His chief object, however, was to qualify for the degree of Doctor
of Medicine of the University, and this he succeeded in doing in
1832. The regulations for this coveted degree were, for the times,
wonderfully complete; it was held in such high estimation and such
large numbers qualified annually--in 1827 there were one hundred and
sixty graduates--that the authorities felt justified in being
stringent. The length of the course of study necessary for graduation
had been fixed at four years, and required the candidate to have
attended classes in Anatomy, Surgery, Materia Medica, and Pharmacy,
the Theory and Practice of Medicine, Clinical Medicine, Midwifery,
Chemistry, and Botany, as well as a three months' course in any two
of the following:--Practical Anatomy, Natural History, Medical
Jurisprudence, Clinical Surgery, and Military Surgery. The first
step in examination took place at the house of one of the professors
where the candidate was questioned in literary subjects, chiefly
Latin, and in the different branches of Medicine and Surgery. If he
passed this satisfactorily he was examined more minutely by two
professors in the presence of the others, and was subsequently given
two Aphorisms of Hippocrates to explain and illustrate in writing and
to defend before the faculty, as well as two cases with questions
attached. The last step was the presenting of a thesis which was
read by one of the faculty and was publicly defended by the
candidate on the day of graduation. All this examination was
conducted in Latin. Simpson's thesis was entitled: "_De causa
mortis in quibusdam inflammationibus proxima_." He was amongst the
last graduates who were examined through the medium of Latin, for
after 1833 the language was optional, and English soon became the
only one used; at the same time the examinations were differently
arranged, and made to consist of more thorough and prolonged written
and oral stages. Being on a pathological subject, Simpson's thesis
was allotted to Thomson, the professor of Pathology, to examine,
who not only recommended the author for the degree, but was so
impressed by the ability displayed in the dissertation that he sought
him out and promptly offered him the post of assistant, which
Simpson as promptly accepted. This appointment was most welcome. Not
only did it give him a much desired opportunity for pathological work,
but the salary of £50 a year enabled him to free his family from
the immediate necessity of supporting him.

If to MacArthur and John Reid was due the credit of first directing
Simpson's thoughts to the study of medicine, to Professor John Thomson
belongs the credit of having made him an obstetrician. "At Dr.
Thomson's earnest suggestion and advice," says Simpson, "I first
turned more especially to the study of midwifery with the view of
becoming a teacher of this department of medical science." He lost no
time in throwing himself heartily into the work that was nearest to
him, and became almost indispensable to his chief. Most of his time
was spent in the Pathological Museum, busily engaged in arranging,
classifying, and describing the preparations, but he also assisted in
preparing the professor's lectures. He took up more readily than
Thomson the then new mode of study by the microscope, and it is
related that once he composed a lecture for his chief on this subject
which Thomson delivered without previous perusal. Several times as
Thompson read the lecture to the class he looked up to glare at his
assistant, and when they returned to the side room he shook his fist
in his face, saying, "I don't believe one d--d word of it."

Although Simpson was now earning enough by his salary as assistant to
meet his expenses at the time, his family maintained their loving
interest in his welfare. His sister told him he was working too hard
and hurting his health. "Well," he replied, "I am sure it is just to
please you all."

Sandy, who had married in 1832, watched his career carefully, and when
the cholera made its appearance in Scotland he made a will with a
provision for "my dear James" in the event of his death. "I daresay,"
he addressed his family therein, "every one of you has a pleasure in
doing him good by stealth as I have had myself."

By Thomson's advice Simpson attended Hamilton's lectures in the winter
session 1833-4, and this time with awakened interest. With the
definite object of devoting himself to Midwifery clearly in view
Simpson worked with all his phenomenal energy during the years from
1832 to 1835, studying the subject while he was helping Thomson. He
entered the front rank of the young graduates of his day, and was
elected a member of the Royal Medical and Royal Physical Societies in
the same year, 1833. Both these societies were for the encouragement
of scientific study and discussion among students and young graduates,
and to obtain the Presidential chair of either was a high honour. The
Royal Medical Society was the oldest Society in the University, having
been established in 1737 by the great Cullen and others; it had always
been of great account in the University, and the originality of the
utterances on professional matters which emanated from it made it then
a power to be reckoned with not only in Edinburgh, but throughout
European professional circles. For membership of the Royal Physical
Society he was proposed by Edward Forbes, a brilliant youth, who
subsequently distinguished himself in Natural History, and held the
University Chair in that subject for a brief period until cut down
prematurely at the age of thirty-nine. Forbes was the leader of a set
of able young students who have left a distinct mark in the history of
the University. John Reid was an intimate friend of Forbes, and
Simpson was probably as intimate with him. Forbes was the founder and
editor of the best of all the shortlived literary ventures of
Edinburgh undergraduates--_The University Maga_, which was issued
weekly in 1834; and he was also one of the founders of the
Oineromathic Society, "The brotherhood of the friends of Truth."
Forbes thus described the nature of this Society in song:--

  "Some love to stray through lands far away,
    Some love to roam on the sea,
  But an antique cell and a college bell,
    And a student's life for me.
  For palace or cot, for mead or grot
    I never would care or pine,
  But spend my days in twining lays
    To Learning, Love, and Wine."

"Wine, Love, and Learning" was the motto of this curious brotherhood,
and it numbered in its membership many men of the day, who afterwards
became eminent, such as Forbes himself, Reid, George Wilson, Goodsir,
and Bennet. Simpson must have been quite cognisant of this Society's
doings; he was closely associated with its leaders, but his name does
not appear in any of the lists of members still preserved. His
whole-hearted devotion to the ~MATHÊSIS~ probably prevented his
uniting with the brotherhood to worship the ~ERÔS~ and ~OINOS~. The
brotherhood was conspicuously united. In the great snowball riot of
1837, which was quelled only by the reading of the Riot Act and the
marching down at the double from the Castle of the Cameron Highlanders
into the University gates, they fought shoulder to shoulder.

In 1835 Simpson felt that the time had come to enter into serious
practice and turn his acquired knowledge to account. Fifty pounds a
year was no large income on which to satisfy his craving for
learning, and there was no surplus from which by any means to repay
his family for their assistance. Before taking any decided step,
however, he desired to pay a visit to the Continental centres of
medical science and teaching. The funds for the proposed tour were
promptly found by his brothers Alexander and John; by their assistance
he was enabled to visit Paris, Liége, and Brussels, as well as London
and Oxford. He was accompanied by Dr. (now Sir Douglas) Maclagan, and
kept a journal of the tour, which is an interesting example of his
lively powers of observation. In London he visited the leading
hospitals, and made the acquaintance of the leading physicians and
surgeons, amongst whom were many _alumni_ of his own _alma mater_. In
the journal he freely and concisely criticised the men, their methods,
and their hospitals. In Paris he followed the same plan, going the
round of all the hospitals, and searching for and grasping the
principle which guided each distinguished man's thought and teaching.
He took more than a medical interest in all that he saw, and noted the
appearance and habits of the people of each place that he visited. At
the end of his coach ride from London to Southampton, on the way to
Paris, he sat down to write:--"The ride as far as Windsor Park was
delightful, and from the top of the coach we had two or three most
lovely glimpses of English scenery. After passing Windsor the soil was
rather inferior in many parts, and we passed every now and then large
tracts of heath.... The neatness and cleanliness of the English
cottages is greatly superior to all that we have in Scotland; the
little patches of garden ground before, behind, and around them set
them off amazingly. I wish the Scottish peasantry could by some means
or other be excited to a little more love of cleanliness and
horticulture. I did not see above two or three dirty windows, men or
women along the whole line of road. The snow-white smock-frocks of the
Hampshire peasantry do actually look well in my opinion."

At Liége on June 13th he wrote:--"And is it possible that I here begin
a second volume of a journal?... I began my journal chiefly with some
distant prospect of teaching myself the important lesson of daily
notation. I am vain enough to flatter myself now that I have partly at
least succeeded. At all events that which was at first a sort of task,
at times rather an annoying task, has now become to me a pleasure. If
I had my first volume to write over again I think I would now write it
twenty times better. In writing a journal 'tis needless to think of
making no blunders in the way of blots and bad grammar or of crooked
sentences. We, or at least I, have occasionally felt so confoundedly
tired at night that if I had been obliged to attend to such minutiæ I
certainly would not have been able to advance above two sentences.

"This morning rose by half-past seven--dressed and breakfasted on
coffee and rolls, read the _Liége Courier_, and by nine o'clock called
on Professor Fohman with a copy of Dr. Reid's paper on the glands of
the whale, which I had promised him yesterday. The Professor kept us
until five minutes to ten, lecturing us on his discoveries upon the
original elementary tubular structure of animal tissues. Somebody has
remarked that no person ever entered into or at least came out of the
study of the Book of Revelation without being either mad before or mad
after it. I would not choose to say that Dr. F.'s case is perfectly
analogous, but has it not some analogy? He seems to run wild on
elementary tubular texture; ... he hates Lippi and his researches with
a perfect hatred. Lippi has been preferred to him by the Parisian
Academy. Is he not working against Lippi, and it may be against truth,
if they happen to go together, which I do not believe?

"We have taken our seats in the diligence to-morrow for Louvain, and
on leaving Liége I must confess that I leave one of the most lovely
places I have seen on the Continent. 'Tis rich, populous, busy; the
town in itself is old and good, though not so neat and clean as Mons;
its environs wild and romantic. Besides it seems full of good-natured
_gash_ old wives, and sonsy, laughing-faced, good-looking, nay, some
of them very good-looking girls."

The homeward journey was made _viâ_ Birmingham, Liverpool, and
Glasgow. In Liverpool he called upon a distant relative named
Grindlay, established there as a shipper, and laid the foundation of a
life-long friendship with the family. He also then for the first time
met Miss Jessie Grindlay who afterwards became his wife.

With the end of this tour, Simpson brought to a close the more
strictly student part of his career, although it remained true of
him, as of all eminent scientific men, that he was a student to the
end of his days. He felt himself now fully equipped to enter into
the professional battle, and he stepped into the arena, not only
full of vigorous life and hope, but possessed of highly trained
faculties, keen senses, and lofty ideals. It was his strong,
personal characteristics, apart from his accomplishments, which at
once placed him head and shoulders above his fellows. "He had a great
heart," says a recent writer, "and a marvellous personal influence,
calling forth, not only the sympathy and love of his fellowmen,
but capable of kindling enthusiasm in others almost at first
sight." It is impossible to overestimate this personal influence in
analysing the elements of his ultimate success, and it is more
impossible for those who did not feel it to realise its nature; but
that he became the beloved as well as the trusted physician is due to
this influence. "He had no acquaintances," says the writer already
quoted; "none could come into contact with him and stop short of
friendship." This was a powerful trait to possess; it cannot be
denied that he was fully aware of it and its value; and used it with
good effect in establishing himself as the greatest physician of his
day.

As a scientist he started with an eager desire for knowledge and
reverence for truth, to which was added the highly developed power of
mental concentration born of early self-training. When most men would
be waiting in what they would term enforced idleness, Simpson would be
busy with book or pen, deeply attentive to his occupation despite
surrounding distractions or temptations to frivolous idleness. He took
the full measure of the value of Time and handled his moments as
another would a precious metal. "At all times," he said himself, "on
all occasions, and amidst the numerous disturbing influences to which
the medical man is so constantly subjected, he should be able to
control and command his undivided mental attention to the case or
object that he may have before him.... In the power of concentrating
and keeping concentrated all the energies of attention and thought
upon any given subject, consists the power of thinking strongly and
successfully upon that subject. The possession or the want of this
quality of the mind constitutes the main distinction between the
possession or the want of what the world designates 'mental abilities
and talents.'"

His high ideals, his conception of the functions of the physician,
and the strivings of the scientist are best shown in his own
words:--"Other pursuits become insignificant in their objects when
placed in contrast with ours. The agriculturist bestows all his
professional care and study on the rearing of crops and cattle; the
merchant spends his energies and attention on his goods and his
commissions; the engineer upon his iron-wheels and rails; the sailor
upon his ships and freights; the banker upon his bills and his
bonds; and the manufacturer upon his spindles and their products. But
what after all are machinery and merchandise, shares and stocks,
consols and prices-current, or the rates of cargoes and cattle, of
corns and cottons, in comparison with the inestimable value and
importance of the very lives of these fellowmen who everywhere move
and breath and speak and act around us? What are any, or what are all
these objects when contrasted with the most precious and valued gift
of God--human life? And what would not the greatest and most
successful followers of such varied callings give out of their own
professional stores for the restoration of health and for the
prolongation of life--if the first were once lost to them, or if
the other were merely menaced by the dreaded and blighting finger of
disease?"

In one of his addresses of later years he urged upon his students the
objects and motives which had been his in early professional
life:--"The objects and powers of your art are alike great and
elevated," he said. "Your aim is as far as possible to alleviate
human suffering and lengthen out human existence. Your ambition is to
gladden as well as to prolong the course of human life by warding off
disease as the greatest of mortal evils; and restoring health, and
even at times reason itself, as the greatest of mortal blessings....
If you follow these, the noble objects of your profession, in a proper
spirit of love and kindness to your race, the pure light of
benevolence will shed around the path of your toils and labours the
brightness and beauty that will ever cheer you onwards and keep your
steps from being weary in well-doing; ... while if you practise the
art that you profess with a cold-hearted view to its results, merely
as a matter of lucre and trade, your course will be as dark and
miserable as that low and grovelling love that dictates it."

Simpson's method of study was simple, at the same time that it
involved immense labour. In entering upon a new work his first
proceeding was to ascertain conscientiously all that had already been
said or written by others upon the subject. He traced knowledge from
its earliest sources and was able, as he followed the mental workings
of those who had preceded him, to estimate the value of every vaunted
addition to the sum of knowledge; and to weigh the theories and new
opinions of men which had been evolved with the progress of time, and
which had sometimes obscured, instead of casting greater light upon
the truth. His antiquarian tastes added to his knowledge of Latin
helped him in this work and turned a tedious task into a real
pleasure. This preliminary accomplished, he plunged into the work of
adding to the knowledge of the subject by thought, research,
experiment, or invention.

In writing upon an abstract subject he would disentangle the confused
thoughts of his predecessors and restate their opinions in direct and
simplified language. But matters of opinion never had such an
attraction for him as matters of fact; in dealing with these latter he
would test by experiment the statements of authorities and correct or
add to them by his own researches. Most of his professional writings,
as well as his archæological works, are valuable for the historical
_résumé_ of the knowledge on the subject as well as for his additions.
His later writings show as careful an attention to the inductive
method with which he started, as those produced in the days of his
more youthful enthusiasm; when fame was attained and fortune secured,
when excessive work was sapping his physical strength, he never sank
into lazy or slovenly methods in scientific work, but ever threw his
whole vigour into the self-imposed task.

When studying Nature directly he was constantly asking her "why?"--just
as in his notes of his teacher's lectures the query was ever recurring.
He never felt himself beaten by an initial failure, but returned again
and again with his questions with renewed energy each time. He was not
to be denied, and in this manner he wrested from Nature some of
those precious secrets the knowledge of which has relieved suffering and
prolonged human life in every corner of the globe. "He never kept
anything secret," says his nephew and successor, Professor A. R.
Simpson, "that he thought could help his fellows, and it is hard to
say whether his delight was greater in finding some new means to cure
disease, or in demonstrating to others his methods of treatment."

He was indeed clothed in well-nigh impenetrable armour, and provided
with powerful weapons, when in the autumn of 1835 he returned from his
foreign tour to commence the serious fight in which his avowed object
was not only to obtain professional eminence, but to stand forth a
proud benefactor of the human race. Although he appealed always
directly to Nature and used his own well-trained eyes and ears in
preference to those of others, he did not completely brush aside
authority as Sydenham had done; he hesitated neither to extract all
that was valuable, nor to discard what appeared worthless from the
writings of past masters.




CHAPTER IV

EARLY PRACTICE AND PROFESSORSHIP. 1835-1840

  President of Royal Medical Society--Personal appearance--Practice
  among the poor--Corresponds with Miss Grindlay--Lecturer on
  obstetrics--Resignation of Professor Hamilton--Applies for
  vacancy--Active candidature--Strong opposition--Marriage--Account
  of the midwifery Chair--The medical professors at the time--Their
  opposition--Cost of candidature--Triumphant election.


In November, 1835, Simpson was elected one of the annual Presidents of
the Royal Medical Society; a position which has been occupied by many
young Edinburgh graduates, who have subsequently risen to fame. He
took pains to make his inaugural address worthy of the occasion, and
chose a subject connected with the pathology of obstetrics. It was a
great success, and contributed largely towards giving him a recognised
position as an authority in that branch of study. After appearing in
the _Edinburgh Medical and Surgical Journal_ for January, 1836, it was
translated into French, Italian, and German. It also obtained for him
his first foreign honour--one of a long list that was made up through
his lifetime--that of corresponding member of the Ghent Medical
Society; indeed, his early works received more attention and
appreciation abroad than at home. In 1836, in order to widen his
experience in his chosen subject, he filled the post of house-surgeon
to the Lying-in Hospital, and held it for twelve months. He was also
elected a Fellow of the Edinburgh College of Physicians. From this
time he became a profuse writer on professional subjects, and
developed an easy and convincing style; he carried on this work _pari
passu_ with practice amongst the poorer classes of the city and in
addition to his work in connection with the Pathology Chair, always
keeping in view his great object of becoming an obstetrician. It was
not until 1838 that he became an independent lecturer on Midwifery. He
had intended to do so earlier, but owing to Professor Thomson's
ill-health, he had been called upon to act as Deputy-Professor of
Pathology, a most valuable and useful employment.

Simpson's personal appearance at this time has been described by one
who visited a meeting of the Royal Medical Society on an evening when
he was in the chair:--"The chair was occupied," says the narrator, "by
a young man whose appearance was striking and peculiar. As we entered
the room his head was bent down, and little was seen but a mass of
long tangled hair, partially concealing what appeared to be a head of
very large size. He raised his head, and his countenance at once
impressed us. A pale, 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; a coarsish nose with
dilated nostrils, finely chiselled mouth which seemed the most
expressive feature of the face ... Then his peculiar rounded soft body
and limbs, as if he had retained the infantine form in adolescence,
presented a _tout ensemble_, which even if we had never seen it again
would have remained indelibly impressed on our memory."

In Simpson's youth physicians and surgeons made a habit of cultivating
peculiarities of appearances and behaviour, but he was so shaped by
nature as to attract attention without artificial aid. The growth of
long hair seemed a natural accompaniment to his massive head and broad
expressive countenance.

His practice at this time was scattered over the city, and he took
long tramps in the course of the day. In one of his letters to his
brothers, who were still loyally supporting him in his increasingly
successful endeavours to establish himself after his heart's desire,
he says:--"The patients are mostly poor it is true, but still they are
patients; ... if my health is spared me, I do hope I may get into
practice sufficient to keep me respectable after the lapse of years;
but I know years must pass before that. At present I enjoy the best
possible spirits and health, and with all my toils was never happier
or healthier."

_Tout vient à point à qui sait attendre._ Simpson knew how to wait; he
knew that waiting did not mean inactivity. Every opportunity that
arose for advancement found him prepared to take full advantage of
it.

That his lectures on pathology were acceptable was made manifest by
the address presented to him by the students of the class at the end
of his temporary term of office, testifying to his zeal, fidelity, and
success, their admiration of his high talents, of the varied and
extensive research which he displayed, and of his uniform and kind
affability which, while it exalted him in the eyes of all as a
teacher, endeared him to each as a friend.

During this period he kept up a correspondence with the Miss Grindlay,
of Liverpool, whose appearance he had been struck with when he visited
the family, and towards the end of 1837 he found time to visit there
again accompanied by Dr. John Reid.

The way for his appearance as an extra-academical lecturer on
midwifery was made clear at the end of 1837 by the death of Dr.
Macintosh, a successful teacher of that subject. He had been in
negotiation, without success, with this Dr. Macintosh for the taking
over of the part or whole of his lectures, and found it easy to step
at once into his place at his death. He was firmly determined to
succeed ultimately to the University Chair of Midwifery. On one
occasion he pointed out to some friends the then holder of the Chair,
Professor Hamilton, thus:--"Do you see that old gentleman? Well,
that's my gown!"

The good luck which had been his during his boyhood did not desert him
when he began his course of lectures; for not only did he speedily
attain a reputation for teaching, science, and practical skill,
wonderful for one so young, but he had not two years to wait after
thus establishing himself before the chair of his ambition fell vacant
owing to the resignation in 1839 of Professor Hamilton, who died soon
afterwards at the age of seventy-two.

It was a bold step for so young a man--for Simpson was only
twenty-eight--to apply for the professorship. He was, however, not
without his precedent. The second Monro obtained the Anatomy Chair at
twenty-five, Alison filled that of Physic at thirty, and Thomas Hope
and Alexander Christison were Professors of Chemistry and Medical
Jurisprudence respectively each at the age of twenty-four. But this
subject was one which was popularly thought to require a man of
experience and especially a married man. Simpson had devoted his
energies but partially to midwifery for only four or five years, and
except for his short hospital appointment and recent experience as a
lecturer on the subject had in the eyes of many no greater claim to
the post than any other general practitioner, except in the fact that
he had obtained a wide reputation in the science of the subject by
his contribution to its literature and his researches. This last was
the point on which he himself most relied; for his age he had done
more scientifically than any of his opponents. Those who had watched
his career knew that he possessed in addition to zeal and ability,
brilliant teaching and practical powers. The objection of his youth
was less easily got over than that of his unmarried state. With
characteristic promptness, as soon as he had determined to apply for
the Chair and found that as a bachelor his chances would be small, he
disappeared for a time from Edinburgh, and returned triumphantly with
Miss Jessie Grindlay, of Liverpool, as his wife. It was a bold stroke
which delighted his supporters, discomfited his opponents, who saw
therein the removal of a barrier to his success and a weapon from
their hands, and astonished the worthy town councillors in whose gift
the appointment lay.

The Edinburgh Chair of Midwifery was established in 1726, and was
indisputably the first Chair of its kind in the British Islands, and
probably in the world. It was in that year that the Town Council first
established the medical faculty, by appointing two Professors of the
Theory and Practice of Medicine and two of Medicine and Chemistry. A
Chair of Anatomy had been instituted six years earlier through the
instrumentality of the first Monro who became its first occupant.
These five chairs were considered sufficient wherewith to teach all
the medical knowledge of the day, and although appointed _ad vitam
aut culpam_ the professors received no remuneration out of the city
revenues. The Chair was not reckoned at first as a faculty Chair, but
was termed a city professorship. The newly created medical faculty
would have no midwifery within the precincts of the University; and
this is scarcely surprising when we remember that at first the only
persons lectured to by the city professor were women of an inferior
class in whose hands the practice of the art almost entirely lay.

Along with this appointment the Town Council established a system of
regulation for midwifery practice within the city. It ordered that all
midwives already in practice should at once be registered, and that no
persons should thereafter enter on the practice within the city until
they had presented to the magistrate a certificate under the hands of
at least one doctor and one surgeon who were at the same time members
of the College of Physicians or of the Incorporation of Chirurgeons,
bearing that they had so much of the knowledge and principles of this
art as warranted their entering on the practice of it; whereupon a
licence should be given them signed by four magistrates at least
entitling them to practise. It was further enacted that certain pains
and penalties were to be inflicted upon ignorant persons for
practising without this licence whereby their "want of skill might be
of such dangerous consequences to the lives of so many people." It is
to be presumed that as qualified medical men granted them these
certificates and that these women had extensive practices, they
possessed also a fair amount of skill. But slowly and gradually they
had to give way and retire to the rank of nurses before the rise and
growing public tolerance of the qualified male practitioner of
obstetrics.

The second occupant of the chair, appointed in 1739, was elevated to a
place in the medical faculty, but Professor Thomas Young, who occupied
it in 1756, was the first to teach the subject to medical students by
means of lectures and clinical instruction. As already noted, it was
left for James Hamilton to obtain the recognition of midwifery as a
subject, a knowledge of which was necessary for the obtaining of the
University medical degree.

At the time when Simpson was straining every nerve to gain the post he
coveted, the medical faculty of the University comprised the following
professors of the following subjects:--Botany, Robert Graham, who
established the Edinburgh and Glasgow Botanical Gardens; Anatomy,
Monro the third; Chemistry, Hope, who discovered strontium in the lead
mines of Argyleshire; Institutes of Medicine, Alison, an eminent
physician and philanthropist who first pointed out the connection
between destitution and epidemics of disease, and secured improved
Poor Laws for his country; Practice of Physic, James Home; Materia
Medica, Christison, the world-reputed toxicologist; Natural History,
Robert Jameson; Clinical Surgery, James Syme, the wonderful operator
and teacher, and inventor of the "macintosh" waterproof; Military
Surgery, Ballingall; Medical Jurisprudence, Traill; Pathology,
Thomson; and Surgery, Charles Bell, the discoverer of the double
function of the nerves, who was ranked in his day on the Continent as
greater than Harvey. It was thus not an undistinguished body that
Simpson strove to enter; several of the best-known members were
comparatively young men, recently appointed to their posts, and full
of the rising scientific spirit. It is little to their credit that
they were practically unanimous in opposing the candidature of this
young and enthusiastic scientist, who afterwards shed such lustre on
the University from the chair which they would have denied him for no
reasons other than his youth and his humble origin.

Fortunately for Simpson and for the University, the appointment did
not lie in the gift of the professors, but was entirely in the hands
of the Town Council, comprising thirty-three citizens.

Such an election was always a matter of keen interest to the
inhabitants of Edinburgh, and each candidate brought all the direct
and indirect influence within his power to bear on every councillor
whom he could reach. The Professors in the various faculties had no
doubt great influence; they openly canvassed for the candidate they
favoured, and did not hesitate to decry those they did not approve of.
Shortsighted as this professorial opposition was, it proved no small
difficulty in Simpson's way. Foremost amongst his opponents was Syme,
who commenced a long feud with him by supporting his chief rival, Dr.
Kennedy; "I feel no hesitation in stating," he wrote purposely for
publication, "that of all the candidates in the field, he (Kennedy) is
out of all question, according to my judgment, the one that ought to
be elected." Sir Charles Bell was equally emphatic, and characterised
Simpson's testimonials, in a note which Kennedy circulated, as given
by "good-natured people merely to do a civil thing to a friend"--which
was his mode of describing the declarations of some of the most
eminent men of the day.

Each candidate also brought political influence to bear, and Whig and
Tory grew agitated as the contest became keener. Simpson seems to have
thought that both political parties were in opposition to him, but he
certainly had the strong support of Ritchie of _Scotsman_ fame, and
the no less important influence of Mr. Duncan Maclaren.

When writing to ask Mr. Grindlay for his daughter's hand, Simpson
candidly confessed his pecuniary position at the time. He referred to
a debt of £200 already owing to his brother Sandy, and added:--"Again
he gave me a bill for £120 to assist me in furnishing my house. This
has been renewed and becomes due in January. He hopes to be able to
pay it, and I fondly imagined I would have paid the half, but this
canvass has involved me in new difficulties, and besides, I have
endeavoured to assist my sister to go out to Van Diemen's Land. As it
is now I am self-sufficient enough to think that I am as well off as
regards station in my profession as any who started here in the race
of life with me. They have all, I believe, been aided by friends or by
private wealth. They have almost all been fortunate enough to have the
protection of a father's roof during the first years of practice. I
have had no such advantages, but have worked and stood alone. I have
accumulated for myself a library and museum, worth £200 at least,
amidst these difficulties. These I have won by my pen and my lancet,
and these are my only fortune. And now could you trust her future
happiness to me under such circumstances? I did not intend to ask her
hand at present. I fondly hoped I might have _first_ cleared myself of
my debts."

Grindlay did not hesitate, but willingly gave his daughter, as she was
willingly given, for better or worse.

The expenses of the canvass amounted to about £500, an amazingly large
sum; he spared no expense in printing and posting his testimonials and
letters to every one who had any influence with the Council, however
small; but taking into consideration the cost of printing and postage
in 1839, it is difficult to realise how the money was expended. His
aim was to make known his scientific attainments, powers as a
teacher, and personal qualifications which he felt, if duly realised,
would outweigh the disadvantages of his youth and comparative
inexperience. His testimonials spoke in strong terms of his abilities
and characteristics; they were a good deal more numerous and elaborate
than is customary to-day, but Kennedy's also made a fat volume of 150
octavo pages.

As the day of election drew near the excitement amongst citizens,
professors, and students grew intense. Of the five candidates in the
field, three, including his former teacher Thatcher, speedily fell out
of the running. Dr. Evory Kennedy, of Dublin, and Simpson stood face
to face as rivals. Kennedy was no mean opponent, and his supporters
honestly considered him the better man of the two; his attainments
certainly merited warm support. The prophets foretold a close
struggle, and the event proved them correct. So keen was public
interest that when a report was circulated that Kennedy was a bad
lecturer, his friends brought him over from Dublin a few days before
the election, hired a public room, and made him lecture to a crowded
and enthusiastic audience to dispel that illusion. In spite of this
the popular vote was decidedly in Simpson's favour; if the citizens
had had votes Simpson would have been returned at the head of the poll
by a large majority.

On Tuesday, February 4, 1840, at a Council meeting, at which all
thirty-three members were present, the Provost himself proposed
Kennedy, while Baillie Ramsay proposed Simpson. The result was
awaited with breathless suspense, the chamber being crowded by anxious
spectators. Simpson's enthusiasm had infected his supporters; he had
kindled the first sparks of that enthusiastic affection with which the
citizens of Edinburgh ever after regarded him; when his triumph, by
the narrowest majority, was announced, the cheers resounded loud and
long.

The same evening he was able to write to Liverpool:--

  "1, DEAN TERRACE.

  "I was this day elected Professor. My opponent had sixteen and I
  had seventeen votes. All the political influence of both the
  leading Whigs and Tories here was employed against me; but never
  mind, I have got the chair in despite of them, Professors and all.
  Jessie's honeymoon and mine is to commence to-morrow."

It was the man's strong individuality which carried the day. The town
councillors threw aside the political and academic bias of those who
endeavoured to lead them, and elected the man who had boldly said,
"Did I not feel I am the best man for the Chair I would not go in for
it"; and had more boldly gone on showing them how thoroughly he felt
what he said until they themselves came to believe it.

The gift of this Chair, as of many others in the University, has now
passed from the hands of the Town Council into those of a body of
curators, seven in number, three nominated by the University Court
and four by the Town Council; such a body might have made a more
cautious choice, but never a more fortunate one both for the city
and the University than this of their long-headed and far-sighted
predecessors.




CHAPTER V

PROFESSOR AND PHYSICIAN. 1840-1847

  Success as a lecturer--Increased practice--Generosity--Fashionable
  patients--Memoir on Leprosy--Controversy concerning the Pathology
  Chair--Address to the Graduates, 1842--Squabbles--Purchases 52,
  Queen Street--A great and good physician--Called to London--Visit
  to Erskine House--The daily scene at 52, Queen Street--Rangoon
  petroleum and Christison--The disruption--His family--Appointed
  Physician-Accoucheur to the Queen for Scotland.


Simpson had not long been engaged upon his new duties before the town
councillors gladly saw, and his brother professors were obliged to
admit, that the baker's son was bringing a mighty genius to bear upon
the subject of his choice from the chair of his ambition. He cherished
no ill-feeling against those _confrères_ who had actively opposed his
candidature, but set to work amidst his new surroundings conscious
that the best way to obliterate bitter feelings was by gradually
creating a stronger feeling--that of respect for him as a man and a
worker. He had dealt heavy blows himself during the conflict--blows
not easily forgotten. The position demanded tact and patience, and he
was not found wanting in either. He converted many who had worked
against him into adherents, admirers, and even friends.

His lectures speedily attracted students. Besides those who were
entering the profession, grey-headed and grey-bearded men, whose
student days had long since passed away, came to sit at the feet of
this remarkable young man and hear the so recently despised subject
dealt with in his own masterly, scientific manner. Conciseness,
clearness, and directness characterised his delivery; while with
illustration and anecdote he made his dull subject fascinatingly
interesting. It was his custom to write out on a black-board notes of
the subject on which he was about to speak--concise, pithy headings,
which were hung up in the theatre and which he proceeded methodically
to explain and enlarge upon. So successful were his efforts that even
in the first session he was able to make the proud boast that his
class was for the first time in its history the largest in the
University, and this in spite of the fact that one of the leading
professors altered his lecture hour to the same hour as Simpson's,
with the purpose of injuring the attendance at Simpson's class.

A direct result of the reputation obtained through his course of
lectures and improved professional position was the rapid increase of
his practice and the improvement of the class of his patients, so that
pecuniary profit came within his reach. He continued to be a general
practitioner, however, attending to all classes of cases that came to
him; but his zeal for midwifery and the diseases of women, together
with his renown in those subjects, brought mostly patients of the
female sex to his consulting-room. With the improved position there
came necessarily increased expenditure, which at first exceeded the
income; he never stopped to consider the patients' circumstances or
whether he was likely to be paid for his services. "I prefer to have
my reward in the gratitude of my patients," he said. He treated all
that came to him, and his generous nature was oftentimes taken
advantage of by persons very well able to remunerate him; moreover, at
this time, when his pecuniary profit did not equal his professional
reputation, he cheerfully helped many who appealed to him with amounts
he could ill spare.

His father-in-law generously and willingly stood by him until the fees
began to come in more freely--his brother Sandy, who had supported him
hitherto, having now other claims upon his purse. He found two
ordinary but costly steps advisable--first, to move into a better and
more centrally situated house; and, secondly, to obtain a carriage,
"both to support my rank among my wealthier compeers and to save my
body from excess of work." The outlay was justified in the result; the
fees from students and from his private practice very soon enabled him
to repay the debts to his brothers and his father-in-law without
inconvenience and with grateful pleasure. Once and for ever within
the first few years of his professorship he placed himself in a safe
position, free from all pecuniary anxiety.

If he had laboured hard to fit himself for the front rank of his
profession, his work on attaining that position showed increase rather
than abatement. His private practice alone was the work of more than
one ordinary individual, and his professorial duties took up some of
the best hours of his day. In the evenings and at all odd times he
busied himself with absorbing current or ancient literature, or in
preparing his own contributions to both professional and general
knowledge either with the pen or by experiment. "Oh that there were
double twenty-four hours in the day," he sighed at a time when he was
working at highest pressure, practising amongst peers, commoners, and
cottagers alike, who all flocked to his residence or sent long
distances for him. When Princess Marie of Baden, wife of the Duke of
Hamilton, came under his special care in 1843 he felt that he was
placed at the top of his profession in Scotland, and must have
smilingly recalled the words of old Dr. Dawson, of Bathgate, when he
heard of the successful contest for the Chair. "It's all very well,"
he had said, "to have got the Chair! But he can never have such a
practice as Professor Hamilton. Why, ladies have been known to come
from England to consult him!"

They came from the furthest parts of Greater Britain to consult
Hamilton's successor, in spite of the old doctor's prognostication!

The energy as well as the versatility of the man is well shown in the
works which he found time to carry on while he was thus establishing
himself as a teacher and as a practitioner, during the years from 1840
to 1845. One of his first literary efforts, not wholly professional,
the Memoir on "Leprosy and Leper-Houses," was produced at that time.
It was a work of relaxation and pleasure, for it carried him deeply
into his favourite archæology. The fascination which this subject
always had for him sprang from his love of nature, and of the greatest
work of nature--man. "The leading object and intent of all the
antiquarian's pursuit is MAN," he said, "and man's ways and works, his
habits and thoughts, from the earliest dates at which we can find his
traces and tracks upon the earth, onwards and forwards along the
journey of past time. During this long journey he has everywhere left
scattered behind him and around him innumerable relics forming so many
permanent impressions and evidences of his march and progress."

The quantity and quality of the information concerning leper hospitals
which he collected and embodied in his memoir, contributed to the
Edinburgh Medico-Chirurgical Society in March, 1841, was phenomenal.
He had consulted old manuscripts and registers, monastic chronicles,
burgh records, and Acts of Parliament, as well as works of antiquity,
travel, and history. He gave close upon five hundred references, as
well as a list of one hundred and nineteen leper-houses, whose
existence in Britain and whose history he had traced. The work
illustrates the objects and proper methods of antiquarian research,
which twenty years afterwards he dilated upon in his address from the
Chair of the Scottish Society of Antiquaries. In the course of it he
pointed out how vigorously our ancestors had set to work to stamp out
the disease when it spread through Europe during the period from the
tenth to the sixteenth century. The method adopted was that still
employed--segregation; about the twelfth century scarcely a town or
burgh in France and Britain was without its leper-hospital. Although
we in Britain are happily now freed from its ravages, other parts of
the world are not so fortunate. It is still regarded popularly as an
incurable disease, as it was in 1597, when one Catherine Livingstone
was gravely brought to trial for witchcraft, one instance of which had
been that she dared to state her ability to cure "leprosie, which the
maist expert men in medicine are not abil to do." The indictment set
forth that she "took a reid cock, slew it, baked a bannock with the
blude of it, and gaf the samyn to the leper to eat." The witch's
remedy is scarcely more curious and certainly no less useful than
those recommended two centuries later by John Wesley in his "Primitive
Physic," where, moreover, he cheerfully, if somewhat too briefly to
satisfy the modern inquirer, reports the cure "of a most desperate
case" by the drinking of a half-pint of celery-whey morning and
evening.

Scotland was severely smitten by leprosy in the centuries when it
overspread Europe; Robert Bruce fell a victim to it in 1339, and the
disease seems to have lingered in the North after it had almost
vanished from England.

Simpson's paper was published in the _Edinburgh Medical and Surgical
Journal_ in three parts in 1841 and 1842, and to this day is the most
valuable contribution to the interesting and important history of the
disease. Some of the information had been collected in his student
days. In his antiquarian researches he had frequently met with
references to the dirty and unwholesome habits and surroundings of
Scots towns in early days. The thought that dirt and disease were
directly connected--a new thought even so recently as fifty years
ago--led to his investigations. He found that leprosy was most
prevalent at the time when his country was most dirty; but he was not
able to establish his supposition that the cause of the disease lay in
the insanitary surroundings of the people; indeed his researches
proved that, on the contrary, leprosy had declined and practically
disappeared from the country long before any material improvement in
sanitary conditions took place.

Simpson's conduct when Professor Thomson resigned the Chair of
Pathology illustrates the vigour with which he entered into quite
casually arising incidents where he saw that strength and a fight were
necessary to conquer an evil or prevent an abuse. Thomson resigned in
1841 owing to ill-health. The Chair had been established by William
IV. in 1831 on the representations of Thomson himself, who succeeded
in satisfying Lord Melbourne that the subject was worthy of the
dignity of a separate Chair, in spite of the protests of the Senatus
Academicus, who throughout the history of the medical faculty
generally appear to have been actuated more by personal considerations
and professional jealousies, where new developments were in process,
than by zeal for their _Alma Mater_. Professors Syme and Alison
actively led an agitation that with Thomson's resignation the separate
teaching of pathology should be brought to an end. Without a moment's
hesitation, in the midst of his hard work, and suffering from
indifferent health, Simpson plunged into a controversy with these
colleagues, in which he silenced at once and for ever the detractors
who had sneered at him as an ignorant, uncultured man-midwife. The
controversy as usual was followed with intense interest by Edinburgh
folks, and Simpson received a first taste of that popular approval
which undoubtedly was one of the enjoyments of his life. The Crown
avoided the difficulty of deciding between the rival petitioners for
and against the Chair by transferring its patronage to the Town
Council, who showed the same foresight which had led them to appoint
Simpson, in deciding to maintain its existence. Unfortunately their
wisdom failed when they elected as Thomson's successor a man who,
although of brilliant attainments, subsequently brought discredit upon
his University and himself by becoming a convert to homoeopathy.
Simpson, who was indirectly instrumental in securing the Chair of
Pathology for this man became his bitterest opponent when he declared
himself a follower of Hahnemann's unorthodox and mistaken doctrines.

In 1842 it fell to Simpson's lot to deliver the customary address to
the medical graduates after they had received their degrees at the
annual ceremonial on the 1st of August. He treated his listeners to a
discourse on the duties of young physicians. When we remember that he
had attained to his then high professional position while he was no
more than a young physician himself, we recognise that he was but
setting forth the ideals and principles which had been and still were
his guides in life and conduct.

After warning his audience against regarding the gaining of the
coveted degree as the end of their student career, instead of as in
reality the opening up of a lifetime of observation and study, he
pointed out that self-patronage was the best of all patronage. "Place
from the first," he said, "all your hopes of advancement upon the
breadth and extent of your medical abilities alone.... Rather walk by
the steady light of your own lamp than by the more dazzling, but to
you more uncertain, lustre borrowed from that of others ... Young
physicians often dream that by extending the circle of their private
acquaintances they thus afford themselves the best chance of extending
the circle of their private patients.... No man will in any case of
doubt and danger entrust to your professional care the guardianship of
his own life or of the life of those who are near and dear to his
heart, merely because you happen to be on terms of intimacy with him.
The self-interest of human nature forbids it.... The accomplishments
which render you acceptable in the drawing-room are not always those
that would make your visits longed for or valued in the chamber of
sickness and sorrow.... Give therefore your whole energies to
medicine; and in its multiplied departments you will find 'ample room
and verge enough' for the most energetic as well as the most
comprehensive mind. Place your faith in no extrinsic influences. Let
your own professional character be the one great patron to whom you
ever look for your professional advancement." He exhorted the young
practitioners above all to save and economise their time, and to
regard it as a property to be avaricious of and of every item of which
they were to render a proper account to themselves. "It is by
carefully preserving, confirming, and making diligent use of these
broken and disjointed portions of it, which others thoughtlessly waste
and destroy, that almost all the highest reputations in the medical
profession have been formed." He strongly urged the value of a "proper
covetousness of time." "Look around, and you will find that those who
have the most to do in the way of business as practitioners have also
apparently the most time to spare as observers and writers.... And
why? Because they have all their daily duties perfectly assorted and
arrayed; they save from loss and destruction every possible fragment
of time and this very industry and precision procures them more true
leisure than indolence can boast of."

In referring to the relation of practitioner to patient, he
spoke on a subject which has been much discussed in recent years
without altering the principle originally laid down in the oath of
Hippocrates:--"Whatever," said Simpson, "is communicated to you
as a matter of professional confidence, must ever remain buried
within your own breasts in all the silence and secrecy of the
grave." He concluded his address with well-judged remarks on the
relation of the physician to his professional brethren, counselling
his hearers to observe the Golden Rule, and, moreover, "if it be
possible, as much as lieth in you, live peaceably with all men;
never allow the darker part of your nature to persuade you to
the attempt of over-taking him who has distanced you in the race
of life by any unjust efforts to lame the character, and thus
diminish the speed, of your adversary. And if such attempts are
made upon you by others, have no dread of them--if you are armed
strong in honesty, if you have pursued a line of irreproachable
truth and unbending rectitude of conduct. 'Be thou as pure as
snow thou shalt not escape calumny.'... Your future career is a
matter of your own selection, and will be regulated by the conduct
which you choose to follow. That career may be one of happiness or
self-regret, one of honour or of obscurity, one of wealth or of
poverty. The one or other result is not a matter of _chance_, but
a matter of choice on your part. Your diligence and industry for
the next few years will almost inevitably secure for you the one;
your apathy and indolence will almost inevitably entail upon you
the other. May God, in His infinite goodness, enable you to
select the wiser and the better path."

In this address, as in that previously quoted, we hear him exhorting
his young listeners to a line of conduct which we know to have been
broadly his own in practice as well as in ideal. During these early
years as professor, Simpson had to ward off many ill-disposed
adversaries, and he met their attack with the determination and
powerful preparedness that characterised his attitude in later years,
when he experienced the hostility so constantly opposed to genuine
reformers, and men who have lived ahead of their times. He sometimes
regarded these encounters regretfully himself; but none the less
remembered to

  "Bear't that the opposed may beware."

The correspondence pertaining to some of these disputes was filed and
ticketed, with brief contempt, "Squabbles." His controversy with
Professor Syme over a personal matter in 1845 was not to the credit of
either of these great men, and, as Simpson himself confessed, was
equally discreditable to their profession. Simpson had seen, as has
been pointed out, several of his teachers fighting long and strongly
for their own cherished objects; and he doubtless then, in his student
days, learnt the lesson that vigorous persistence had the power to
gain much that at first seemed hopeless; he fought with such energy,
that he accomplished in his own lifetime what the example of others
might have led him to think would have been accomplished only by his
successors.

The growth of his practice up to 1847 was little short of phenomenal.
In 1845 he purchased No. 52, Queen-street, the house which he
inhabited up to his death, and which became the Mecca of hundreds upon
hundreds of pilgrims from all quarters of the globe. Here, in those
years, he was sought and consulted by unceasing crowds; in the public
mind he was undoubtedly endowed with more than human powers, and
regarded as a magician, at the wave of whose wand pain and disease
would vanish. This caused him much embarrassment, and brought upon him
the abuse of ignorant persons, irritated to find that, after all, even
in Simpson's person, there was a limit to human powers; or of others
with unimportant ailments who were disappointed to find that, once
having made his diagnosis of their condition, he would have no more of
them, preferring to place his time at the disposal of those whose
sufferings were real and capable of relief, or whose cases were
complicated and interesting. The question of remuneration was always
secondary, and so careless was he in pecuniary matters that it is
related that he would wrap up interesting specimens, professional or
antiquarian, in bank notes; and his trusted valet was in the habit of
emptying his pockets at night of the money earned in the day, to
prevent its being lost, mislaid, or given away to undeserving persons.
With him work was first and fee second. Like a great modern teacher he
was able to say, "Work first--you are God's servant; fee first--you
are the fiend's." To Simpson "work was master and the Lord of Work,
who is God."

The personal power and attractiveness of the man were large factors in
gaining the practice which he now enjoyed. But he did not depend for
success on these alone, by any means. His professional reputation was
fully won by great work in obstetrics and gynæcology, and by the
introduction of methods and instruments which contributed to the
saving of countless lives. It has been said that he gave a new life to
the obstetric art, and presided at the birth of gynæcology. He had
done this before the great deed was dreamt of which hands his name
down to posterity, before his discovery of the anæsthetic power of
chloroform. Simpson was a great physician, the leading practitioner
of the art and exponent of the science with which his name will always
be connected. But many great physicians have failed to fulfil as
Simpson did, Robert Louis Stevenson's description of the physician:--

"Generosity he has such as is possible to those who practise an art,
never to those who drive a trade; discretion tested by a hundred
secrets; tact tried in a thousand embarrassments; and what are more
Heraclean cheerfulness and courage. So it is that he brings air and
cheer into the sick room, and often enough, though not so often as he
wishes, brings healing."

Great as a man and great as a physician, Simpson was actually run after
by the greatest in the land. In 1845 he was summoned professionally
to London, and gave an interesting description of his kindly reception
by the Duchess of Sutherland and her family in a letter written from
Stafford House. His advent to London was a matter of notoriety, and
he noted that he bought in the street a life of himself which
mightily diverted him and made him laugh until he was sore. A year or
more later he was invited for rest and change to Erskine House by
Lord Blantyre, where he says, "the Duchess of Sutherland, the Marquis
and Marchioness of Lorne, and two Ladies Gower have made up with myself
all the strangers." "Tell Janet," he wrote to his brother, "I think now
artificial flowers very ungenteel. The ladies here wear nothing but
real flowers in their hair, and every day they come down with
something new and for us males to guess at. Often the Duchess wears a
simple chaplet of ivy leaves, sometimes a bracken leaf is all she sports
in her head ornaments, and beautiful it looks. Rowans and 'haws' are
often worn beaded into crowns or flowers or chaplets. Heather is also
a favourite. On Thursday Lady Lorne came down with a most beautiful
chaplet tying round and keeping down her braided hair. It was a long
bunch of bramble leaves and half-ripe bramble berries--actual true
brambles. They have been all exceedingly kind to me, and I really
feel quite at home among them though the only untitled personage at
table."

The daily scene at 52, Queen Street was now unique. Those who had the
fortune to lunch or breakfast in that hospitable house never forgot
it. Statesmen, noblemen, artists, scientists, clergymen, and
politicians from various countries sat down together and entertained
each other or attempted to do so in their different languages. The
host guided the conversation while he still glanced over the newspaper
or some newly published book, and never failed by skilful leading to
entice out of every one the best knowledge that they possessed. With
his quick insight he rarely failed in his estimate of character, but
rapidly perceived even in a stranger where the conventional ceased and
the real man began.

No stranger to Edinburgh omitted to bring or obtain an introduction
to the genial professor; all were welcome, and an open table was kept.
The scene has been described from intimate knowledge in the columns of
the _Scots Observer_ as follows:--"Luncheon is set on the table, and
some ten, twenty, or even fifty people wait the appearance of their
host, who is on his rounds maybe, or in another room ministers to an
urgent case. A stranger who has not learnt that the great Simpson was
only in the broadest sense a punctual man--of minutes, hours, he knew
nothing, but none more reliably punctual, few so unsparingly regular
in working while 'tis called to-day--might be prompted by hungry
discontent to suggest that none but the wealthiest can keep the doctor
from his guests. The mere suggestion would be infamous, for rich and
ragged alike pay fees or not exactly as it pleases them. Whatever the
cause, the host still lingers, and the impatient stranger has time to
wonder how it is that so odd an assortment of human beings should be
met together in one room. Lords and Commons rub shoulders at his
table; the salt of the earth sit down side by side with the
savourless; tweed jostles broadcloth; the town-bred Briton looks
askance at his country-bred compatriot, and both unconsciously shudder
at the Briton with no breeding at all. In one room are assembled
together the American of bluest blood; the Yankee bagman; the
slave-owning Southerner, and even the man of colour hateful to both
alike. The atmosphere is chill like the grave, each guest, eyeing his
neighbour suspiciously, shrinks into his own social shell; on each
face the meanness and snobbery of humankind is, if not aggressively
expressed, at least clearly legible; when all at once Simpson bustles
in. In a few minutes, under the genial influence of his presence, all
tongues are set a-wagging, and well may you ask whether the men who
leave his house after luncheon are those who half-an-hour ago regarded
each other with cold disdain. For now they are cordial, kindly,
sympathetic; each has been induced to show whatever was attractive in
his nature, or to give the fruits of his experience. If in one short
hour Simpson could thus transform a crowd of frigid, haughty strangers
into an assemblage of decent, amiable human beings, what could he not
achieve in a day, a year, or a life?"

His reception of members of his own profession was specially cordial,
and if those from any one country were more welcome than others, it
was the many who crossed the Atlantic to see and hear him. America had
the greatest share in the birth of anæsthetics, and Simpson's intimacy
with so many of the profession in the United States made it easy for
them to welcome his assistance in that great event. Gynæcology, too,
was eagerly taken up in America, and many were Simpson's admirers from
that country who returned home fired by his influence to work out for
themselves valuable additions to that science.

Simpson paid close attention to current events in other branches of
science, in politics, and in religion. Sir Robert Christison and he
were at one time associated in an enterprise which narrowly escaped
being the source of a fortune to him. Rangoon petroleum which was
obtained from pits dug on the banks of the Irawaddy had been
chemically investigated by Christison, and he had isolated from it a
substance which he named petroline; unfortunately, unknown to him, a
German chemist had independently made the same discovery a few months
earlier, and christened the substance paraffin. When, a few years
later, it occurred to Simpson that the crude Rangoon petroleum might
serve as a lubricant for machinery and prove cheaper than those in
general use, he applied to Christison. He met with willing assistance,
but a refusal on principle to have anything to do with a patent, which
Christison laughingly suggested, might be called "Simpson's
incomparable antifriction lubricant!"

"When I called for Simpson," says Christison, in his Recollections,
"his two reception rooms were as usual full of patients, more were
seated in the lobby, female faces stared from all the windows in
vacant expectancy, and a lady was ringing the door bell. But the
doctor brushed through the crowd to join me, and left them all kicking
their heels for the next two hours."

Their experiments proved that petroleum was vastly superior to sperm
oil, the best known and most commonly used lubricant. Simpson
proceeded to take out a patent, having no such scruples as Christison;
but to his chagrin found that he had been forestalled by others, and
had to abandon the subject.

About the period now referred to Scotland was stirred from end to end
by the ecclesiastical movement which culminated in the crisis known as
the Disruption, when, for reasons connected with the jurisdiction of
the National Church, a majority of its members severed their
connection therewith in a public and dramatic fashion, and "came out"
to found the now strong and vigorous Free Kirk. Simpson at first
steered clear of all the squabbles and discussions which the movement
gave rise to, but when affairs approached a crisis he threw his lot in
with the leaders of the new movement, and became a staunch Free
Churchman.

Busy as he was, Simpson fully enjoyed his home and all the inner
domestic life. He was a cheery and hearty host to his intimate
friends, and took a pleasure in impromptu entertainments got up by
himself in his own house, when he found time at his disposal for such
amusement. His first child--a daughter--of whom he was mightily proud,
was born in 1840; his first son, David, in 1842; and the second,
Walter, in 1843. In 1844 the young couple, in the midst of their
rising prosperity, suffered the loss of their daughter, who died after
a brief illness. Simpson felt the loss keenly, and wrote pathetically
on the subject to his relations; long afterwards he loved to talk of
her and her winning ways.

By 1846 the vast majority of his work lay in obstetrics and
gynæcology, although he himself would no doubt have indignantly
repelled the suggestion that he was a specialist; his mind recognised
the interdependence of all the great branches of the healing art, and
the necessity for any who wished to excel or be useful practitioners
to be _au courant_ with each and every branch. He had early shown that
as a pathologist alone he was worthy of a niche in the temple of fame;
and in later days he was urged to apply for the vacant chair of Physic
in his own University; while Professor A. R. Simpson tells us that
foreigners working in the sphere of surgery sometimes spoke of him as
a surgeon.

Early in 1847 his good friend, the Duchess of Sutherland, wrote to
inform him that the Queen had much pleasure in conferring upon him the
vacant post of Physician to Her Majesty. In the Queen's own words,
"His high character and abilities made him very fit for the post." He
held this post until his death, under the title of Physician
Accoucheur to the Queen for Scotland.

Thus in his thirty-sixth year, to the pride of his family and of the
whole village community in which he had been born and received his
early training, to the admiration of patients and friends, as well as
to his own conscious satisfaction, the Bathgate baker's son had risen
by his own efforts to the highest attainable position in his native
land. But the work which was to make him one of the most conspicuous
figures in the history of medicine, and raise him to a place of honour
in the grateful estimation of humanity, was scarcely begun.




CHAPTER VI

THE DISCOVERY OF ANÆSTHETICS. 1844-1847

  His early sympathy for suffering--Surgical methods before the
  discovery of anæsthetics--His mental struggle caused by the
  sickening sights of the operating theatre--His researches into the
  history of anæsthesia--Indian hemp--Mandrake--Alcohol--Hypnotism and
  other methods--Inhalation of drugs--Sir Humphry Davy--Anæsthetics
  discovered in America--Horace Wells and laughing-gas--Morton and
  ether--Ether in Great Britain--He uses it in midwifery
  practice--Search for a better-anæsthetic--Discovery of anæsthetic
  power of chloroform.


From his earliest student days the desire had ever been present in
Simpson's mind to see some means devised for preventing the sufferings
endured by patients on the operating table, without, as he put it,
"interfering with the free and healthy play of the natural functions."
It is difficult for us at the close of the nineteenth century to
understand, without an effort of the imagination, the strong
incentives which he had for such a wish. Even to-day, when operations
are conducted without the infliction of pain, young students are not
unfrequently overcome by the sight and the thought of what is in front
of them. At the commencement of a winter session the theatre is
crowded with those students who are entering upon surgical study, and
with others, not so far advanced, who have come to get a preliminary
peep at the practice of this fascinatingly interesting art. Many of
these at first succumb and faint even before the surgeon has begun his
work, and sometimes are only persuaded to pursue their studies by the
encouragement of kindly teachers.

Simpson also went through this trying experience, but it must have
been a greater struggle to him to persist. The surroundings of the
surgeon at the commencement of the century were vastly more repugnant
to a youth of sensitive nature than to-day. The operating theatre then
has been compared to a butcher's shambles; cleanliness was not
considered necessary, and little attention was paid to the feelings of
the patient. He was held down by three or four pairs of powerful arms
as the surgeon boldly and rapidly did his work, despite the screams,
stopping, perhaps, only to roughly abuse the patient for some agonised
movement which had interfered with the course of action. The poor
wretch saw the instruments handed one by one by the assistant, and
heard the surgeon's calm directions and his remarks on the case. The
barbarous practice of arresting bleeding by the application of red-hot
irons to the surface of the wound had indeed ceased three centuries
before, when that humane reformer, Paré, displaced it with the method
of tying the open blood-vessel, but the patient's blood gushed forth
before him until arrested, into the sawdust spread to receive it, and
the sight and the hot odour of it oftentimes mercifully caused him to
faint. The spirit of Paré who, when relating a successful operation,
would humbly add at the end, "I dressed him; God healed him," had not
descended to those who practised in Simpson's day the art for which
Paré did so much. It had grown to be necessary for a surgeon to be
rough and callous; it was expected of him by the public; he was a man
to be pointed at in the street, and shuddered at when he passed, by
all who devoutly prayed they might escape his clutches. Much of this
conduct was mere mannerism; it had become the custom, and had to be
maintained in order to preserve the dignity and stamp the identity of
the surgeon. Much of it arose from the haste with which the surgeon
had to work; the quicker the operation the better chance had the
patient; it was no uncommon thing to see a bystander timing the
surgeon's work, as the professional time-keeper carefully times a
race; and the rapidity of each surgeon's performances was a subject of
comparison and admiration amongst the students of his day. Much of it
also arose from the effect of the hideous scenes in the operating room
upon the surgeon himself; his nerve had to become of iron if he
desired to succeed, and with the nerve the face and the manner, but
not necessarily always the heart hardened also. Tennyson possibly
recollected these days, when he wrote of the surgeon who

  "Sent a chill to my heart when I saw him come in at the door,
  Fresh from the surgery schools of France, and of other lands;
  Harsh red hair, big voice, big chest, big merciless hands."

When Simpson first saw Liston raise his knife to operate on a poor
Highland woman, he actually felt so repelled that he contemplated
abandoning his studies, and made a serious attempt to enter upon legal
work instead. But the mental struggle with which medical men of all
countries, and in all times, can sympathise out of their own
knowledge, ended in a victory for medicine, and a triumphant return to
his studies with the question permanently engraved on the tablets of
his mind, "Can nothing be done to prevent this suffering?"

It is necessary and it is certainly beneficial that we should thus
remind ourselves of the horrors which surrounded the surgeon so
recently as sixty years ago. "Before the days of anæsthetics," wrote
an old patient to Simpson, in a letter which he treasured with
pride--the writer was himself a medical man--"a patient preparing for
an operation was like a condemned criminal preparing for execution. He
counted the days till the appointed day came. He counted the hours of
that day till the appointed hour came. He listened for the echo in the
street of the surgeon's carriage. He watched for his pull at the door
bell; for his foot on the stair; for his step in the room; for the
production of his dreaded instruments; for his few grave words, and
his last preparations before beginning. And then he surrendered his
liberty and, revolting at the necessity, submitted to be held or
bound, and helplessly gave himself up to the cruel knife.".

It was, indeed, a monstrous ogre this giant Pain, holding the poor
weak human creature in its merciless clutches, which Simpson even in
his youthful days bethought himself to attack. It is well that we who
are the heirs, should know how Simpson and those others whose names
are ever associated with his, slew the monster, won the victory, and
championed the human race forward into a land where further victories
undreamt of by themselves are now being daily won.

Simpson searched into ancient history in order to ascertain the
methods, if any, by which in remote and mediæval times surgeons sought
to prevent the pain of operations. The most time-honoured method seems
to have been by the internal administration of drugs, the chief one
used being Indian hemp, which was well known in the East, and under
one of its names _haschish_ gave origin to the term assassin (strictly
eater of haschish). A certain Arab Sheikh got together a band of
followers to whom he administered haschish, which produced in them its
usual effect--beautiful dreams of a delightful paradise. He induced
them to believe so thoroughly in his power to gain for them at death
permanent entrance to this paradise that they obeyed all his ferocious
and bloodthirsty behests. Thus these assassins became known as men
obedient to their leader in any murderous enterprise. Indian hemp was,
and still is, used as a luxury all over the East, as well as to annul
pain, and was used by criminals doomed to torture or execution.
Simpson thought the _nepenthe_ of Homer was a preparation of this
drug; he also refers to the fact that Herodotus relates that the
Massagetæ inhaled the vapour of burning hemp to produce intoxication
and pleasurable excitement.

Mandrake was used in a similar manner and for similar purposes as
Indian hemp in the Middle Ages, but it fell into disuse on account of
the fatal results that often followed. It is frequently referred to by
Shakspeare both for its narcotic properties and for its fabulous power
of uttering a scream when torn up by the roots, to hear which meant
death or madness. Simpson cited also well-known passages from
Shakspeare to prove that the practice of "locking up the spirits a
time" was known to that poet.

In later days the intoxication produced by alcohol was taken advantage
of, and instances of its use have been known in quite recent years in
the Colonies, where both a surgeon and chloroform were out of reach.

No drug, however, was known to be of such value in producing
anæsthesia as to be constantly used, and many trials were made of
other means, notably that of compressing the nerves supplying the part
to be operated upon, but this was found to be too painful in itself.
The stupor produced by compressing the carotid arteries--a method
taken advantage of by the ruffians known as garotters--was also put in
practice for a time during the sixteenth and seventeenth centuries,
but it was found too barbarous a method even for those days.

Hypnotism was known to the Indians, Egyptians, and Persians at a very
remote period, and may possibly have been used by them sometimes to
produce anæsthesia for surgical purposes. Simpson was attracted by the
words of the poet Middleton in his tragedy "Women, beware Women"
(1617) where he says--

  "I'll imitate the pities of old surgeons
  To this lost limb--who ere they show their art
  Cast me asleep, then cut the diseased part."

When hypnotism made one of its periodic re-appearances in 1837, this
time under the name of mesmerism, after that extraordinary exponent of
its powers Mesmer, Simpson recognised in it a possible method for
"casting the patient asleep" before operation and set to work to
investigate its phenomena. A Frenchman named Du Potet, disheartened by
the prejudice against mesmerism in his own country, came to London in
1837, and was fortunate enough to receive the support of Dr. John
Elliotson, physician to University College Hospital. Elliotson's
advocacy of the new practice was received with ridicule by the
profession, and was treated with such scathing contempt by the
_Lancet_ and other journals, that he was completely ruined.

Simpson was very successful in his experiments with mesmerism,
conducted on the lines suggested by Elliotson, but he recognised that,
after all, it was not the agent for which he was seeking, and dropped
his researches.

He did not resume them even when Liston, a few years later, stimulated
by the advocacy of the Manchester surgeon Braid, who met with a better
reception than Elliotson, and by the relation of a long series of
successful cases by a surgeon named Esdaile, in Calcutta, actually
performed operations with success on patients brought under its
influence.

The first suggestion to produce anæsthesia by the _inhalation_ of
drugs was made by Sir Humphry Davy in 1800. He discovered by
experiment upon himself that the inhalation of _nitrous oxide_
gas--commonly known as a _laughing gas_--had the power of relieving
toothache and other pains; he described the effect as that of
"uneasiness being swallowed up for a few minutes by pleasures."
Although he stopped short at this stage, and does not seem to have
used the inhalation to produce actual loss of consciousness, he,
nevertheless, forecast the future by suggesting that nitrous oxide
might be used as an inhalation in the performance of surgical
operations, in which "no great effusion of blood" took place.

Some thirty years later Faraday pointed out that _ether_ had
effects upon the nervous system when inhaled, similar to those of
laughing-gas. These two drugs came to be inhaled more in jest than
in earnest; more as an amusing scientific experiment for the sake of
the pleasure-giving excitement they set up, than for the purpose
Davy had suggested. Ether, it is true, was recommended even before
Davy's day for the relief of the suffering in asthma, but until the
fifth decade of the century no one had attempted to prevent
suffering as inflicted by the surgeon or the dentist, by producing
the state of unconsciousness brought about by the inhalation of such
drugs as ether--a process now known to the world as anæsthesia.

The persons who first made the bold experiments which resulted in the
discovery of how to produce anæsthesia were Americans; and two men
were prominently concerned in the discovery. Several others made
isolated and successful efforts with both ether and nitrous oxide, but
they lacked the confidence and the courage to make their success
public and to persist in their experiments. Of these, Dr. Long, of
Athens, Georgia, was one of the earliest; he is said to have
successfully removed a tumour from a patient under the influence of
ether in 1842, and in the Southern States he is regarded as the
discoverer of anæsthesia. Dr. Jackson, of Boston--a scientific
chemist--laid claim to the honour of the discovery after others had
fought the fight and established the practice of anæsthesia. Neither
of these men, for the reason already given, deserves the honour which
is now universally attributed to their fellow-countrymen, Wells and
Morton.

Horace Wells was born at Hartford, Connecticut, in 1815, and was
educated to the profession of dental surgeon. He gave much attention
to the desire present in the minds of many men at that time to render
dental operations painless. On December 10, 1844, he witnessed at a
popular lecture the experiment of administering laughing-gas, and
noticed that a Mr. Cooley, while still under the influence of the gas,
struck and injured his limb against a bench without suffering pain.
The idea at once occurred to Wells that here was the agent he was in
search of, and the very next day he experimented upon himself. If it
has ever been fortunate to have toothache it was so for Wells that
day; he was troubled by an aching molar which was removed by a
colleague named Rigg, whilst he was fully under the influence of
nitrous oxide; and thus he began what he himself at once called on
recovering consciousness, "a new era in tooth-pulling." He proceeded
promptly to test the experiment upon others and with complete success;
and then making his success known, he proceeded with his former pupil
Morton to Boston, and gave a public demonstration of his method which
unfortunately was so imperfectly carried out that he was laughed at
for his pains and stigmatised an impostor. Wells himself stated that
the failure was due to the premature withdrawal of the bag containing
the gas, so that the patient was but partially under its influence
when the tooth was extracted. Wells and Morton were ignominiously
hissed by the crowd of practitioners and students gathered to see the
operation. Wells never recovered from the disappointment and the
illness which resulted, and although he was able to explain his
discovery to the French Academy of Science in 1846, he unfortunately
died insane in New York two years later. Undoubtedly he was the first
to discover the practicability of nitrous oxide anæsthesia, and to
proclaim the discovery with a discoverer's zeal. Although his career
ended so sadly, his efforts had, nevertheless, inspired to greater
endeavour his colleague Morton, who had not only been associated in
his experiments, but had been deeply interested in the subject for
many years.

William Thomas Green Morton was born in 1819; his father was a farmer
at Charlton, Massachusetts. He qualified as a dentist at Baltimore,
and entered into successful practice at Boston. Fired with the same
ambition as Wells, he made attempts to extract teeth painlessly with
the assistance of drugs administered, or sometimes of hypnotism. In
December, 1844, after Wells's failure with nitrous oxide gas, he
wisely abandoned that agent and investigated another which promised
better results. He experimented first with a drug known as _chloric
ether_, but failing to get the desired effect, and at the suggestion
of the aforementioned Dr. Jackson, he proceeded to investigate the
effect of ordinary ether. The first experiments were made on animals,
and were so encouraging that he believed he had at last found the
desired agent, provided the effect on human beings corresponded with
that upon dumb creatures. Boldly and heroically he made the necessary
experiment upon himself, and on September 30, 1846, inhaled ether from
a handkerchief while shut up in his room and seated in his own
operating-chair. He speedily lost consciousness, and in seven or eight
minutes awoke in possession of the greatest discovery that had ever
been revealed to suffering humanity. We can picture the man gradually
awakening in his chair first, to the consciousness of his surroundings
and then to the consciousness of his great achievement; sitting with
his physical frame excited by the influence of the drug which he had
inhaled, and his soul stirred to its deepest depth by the expanding
thought of the far-reaching effects of what he had done.

"Twilight came on," he said, in subsequently relating the event. "The
hour had long passed when it was usual for patients to call. I had
just resolved to inhale the ether again and have a tooth extracted
under its influence, when a feeble ring was heard at the door. Making
a motion to one of my assistants who started to answer the bell, I
hastened myself to the door, where I found a man with his face bound
up, who seemed to be suffering extremely. 'Doctor,' said he, 'I have a
dreadful tooth, but it is so sore I cannot summon courage to have it
pulled; can't you mesmerise me?' I need not say that my heart bounded
at this question, and that I found it difficult to control my
feelings, but putting a great constraint upon myself I expressed my
sympathy, and invited him to walk into the office. I examined the
tooth, and in the most encouraging manner told the poor sufferer that
I had something better than mesmerism, by means of which I could take
out his tooth, without giving him pain. He gladly consented, and
saturating my handkerchief with ether I gave it to him to inhale. He
became unconscious almost immediately. It was dark. Dr. Haydon held
the lamp. My assistants were trembling with excitement, apprehending
the usual prolonged scream from the patient, while I extracted the
firmly-rooted bicuspid tooth. I was so much agitated that I came near
throwing the instrument out of the window. But now came a terrible
reaction. The wrenching of the tooth had failed to rouse him in the
slightest degree; he remained still and motionless as if already in
the embrace of death. The terrible thought flashed through my mind
that he might be dead--that in my zeal to test my new theory, I might
have gone too far, and sacrificed a human life. I trembled under the
sense of my responsibility to my Maker, and to my fellowmen. I seized
a glass of water and dashed it in the man's face. The result proved
most happy. He recovered in a minute, and knew nothing of what had
occurred. Seeing us all stand around he appeared bewildered. I
instantly, in as calm a tone as I could command, asked, 'Are you ready
to have your tooth extracted?' 'Yes,' he answered, in a hesitating
voice. 'It is all over,' I said, pointing to a decayed tooth on the
floor. 'No,' he shouted, leaping from his chair. The name of the man
who thus for the first time underwent an operation under anæsthesia
induced by ether was Eben Frost."

The nature of the agent used by Morton was kept secret only a short
period; the steps he took to bring his discovery before the medical
profession would have rendered it difficult if not impossible, even if
ether had not a penetrating tell-tale odour. Morton laid his method
before one of the surgical staff of the Massachusetts General
Hospital, Boston, the same institution where Wells's ill-managed
demonstration had taken place two years before; he requested, with
complete confidence, to be allowed to exhibit the powers of his agent.
The surgeon was sceptical, but wisely consented, after having
satisfied himself that there was no risk to life. A patient suffering
from a tumour was chosen, and readily consented to act as a subject
for demonstration. A large crowd of professional men and students
assembled in the surgical theatre on the morning of October 16, 1846,
the day chosen for the trial. The senior hospital surgeon, Dr. J.
Collins Warren, was to perform the operation. The spectators, many of
whom no doubt recollected the failure with laughing-gas, were disposed
to deride when the appointed hour passed and Morton did not appear;
but the delay was due only to the desire of the dentist to bring a
proper inhaler, and although the crowd received him with a chilling
reserve, and the occasion was one fit to try the nerve of the
strongest, Morton did not lose his presence of mind. He promptly
anæsthetised the patient, and as unconcernedly as does the modern
administrator, nodded to the surgeon that the patient was ready. From
the first moment that the knife touched the patient, until the
operation was concluded, no sound, no movement indicated that he was
suffering. The men who had scoffed once and had come, even the surgeon
himself, prepared to scoff again, realised the success and the wonder
of it, and remained to admire. "Gentlemen, this is no humbug,"
exclaimed Dr. Warren, as he finished his handiwork. When the patient
recovered he was questioned again and again, but stoutly maintained
that he had felt no pain--absolutely none. "Gilbert Abbott, aged
twenty, painter, single," was the description of the man on whom was
performed the first surgical operation under the influence of ether.

News of the great success rapidly spread, and the experiment was
repeated by Morton and others in America, and similar work was taken
up throughout Europe. It cannot be said that Morton derived much
benefit from his discovery. Although the greatness of it was
recognised in his lifetime, and he received several honours and
presents, he entered into prolonged squabbles concerning the discovery
which worried him into a state of ill-health, ending in his death in
1868. A monument was erected over his grave by the citizens of Boston,
bearing the following concise description of his achievement:--

          "WILLIAM T. G. MORTON,

  "Inventor and revealer of anæsthetic inhalation,
  By whom pain in surgery was averted and annulled;
  Before whom in all time surgery was agony,
  Since whom Science has control of Pain."

Whilst the discoverer of nitrous-oxide anæsthesia was dying from
chagrin and inaction, and the revealer of anæsthetic inhalation by
ether was wasting time in unworthy disputes concerning priority, and
fruitless endeavours to gain pecuniary reward, a bolder than either
had taken up the work where they had left it, with the high object of
pursuing it until he had for ever established the benefit to humanity
which he recognised in it. He went straight forwards and onwards,
strong in his endeavour; undeterred by the jeers of the ignorant, the
opposition of the prejudiced or the attacks of the jealous, with no
thought of or wish for reward except that which was to come daily from
the depth of sufferers' hearts.

During the Christmas holidays of 1846 Simpson was in London, and
discussed the new discovery with Liston, who was one of the first to
operate under ether in Great Britain at University College Hospital.
The great surgeon thought that the chief application of the process
would be in the practice of rapidly operating surgeons; it was at
first generally believed that the inhalation could be borne for only a
brief period. Simpson speedily showed that no evil resulted if the
patient remained under the influence of the vapour for hours. In the
month of January, 1847, he gained for the Edinburgh Medical School the
proud honour of being the scene of the first use of anæsthetics in
obstetric practice. In March of the same year he published a record of
cases of parturition in which he had used ether with success; and had
a large number of copies of his paper printed and distributed far and
wide at home and abroad, so eager was he to popularise amongst the
members of his profession the revolutionary practice which he
introduced. From the day on which he first used ether in midwifery
until the end of his career he constantly used anæsthetics in his
practice. He quickly perceived, however, the short-comings of ether,
and having satisfied himself that they were unavoidable, he set about
his next great step, namely, to discover some substance possessing the
advantages without the disadvantages of ether. In the midst of his now
immense daily work he gave all his spare time, often only the midnight
hours, to testing upon himself the effect of numerous drugs. With the
same courage that had filled Morton he sat down alone, or with Dr.
George Keith and Dr. Matthews Duncan, his assistants, to inhale
substance after substance, often to the real alarm of the household at
52, Queen Street. Appeal was made to scientific chemists to provide
drugs hitherto known only as curiosities of the laboratory, and for
others that their special knowledge might be able to suggest. The
experiments usually took place in the dining-room in the quiet of the
evening or the dead of night. The enthusiasts sat at the table and
inhaled the particular substance under trial from tumblers or saucers;
but the summer of 1847 passed away, and the autumn was commenced
before he succeeded in finding any substance which at all fulfilled
his requirements. All this time he was battling for anæsthesia, which,
particularly in its application to midwifery, was meeting with what
appears now as an astonishing amount of opposition, on varying grounds
from all sorts and conditions of persons; but the vigour and power of
his advocacy and defence of the practice in the days when laughing-gas
and ether were the only known agents, were as nothing to that which he
exerted after his own discovery at the end of 1847.

The suggestion to try chloroform first came from a Mr. Waldie, a
native of Linlithgowshire, settled in Liverpool as a chemist. It was a
"curious liquid," discovered and described in 1831 by two chemists,
Soubeiran and Liebig, simultaneously but independently. In 1835 its
chemical composition was first accurately ascertained by Dumas, the
famous French chemist. Simpson was apparently not aware that early in
1847 another French chemist, Flourens, had drawn attention to the
effect of chloroform upon animals, or he would probably have hastened
to use it upon himself experimentally, instead of putting away the
first specimen obtained as unlikely; it was heavy and not volatile
looking, and less attractive to him than other substances. How it
finally came to be tried is best described in the words of Simpson's
colleague and neighbour, Professor Miller, who used to look in every
morning at nine o'clock to see how the enthusiasts had fared in the
experiments of the previous evening.

"Late one evening, it was the 4th of November, 1847, on returning
home after a weary day's labour, Dr. Simpson with his two friends
and assistants, Drs. Keith and Duncan, sat down to their somewhat
hazardous work in Dr. Simpson's dining-room. Having inhaled several
substances, but without much effect, it occurred to Dr. Simpson to
try a ponderous material which he had formerly set aside on a
lumber-table, and which on account of its great weight he had
hitherto regarded as of no likelihood whatever; that happened to
be a small bottle of chloroform. It was searched for and recovered
from beneath a heap of waste paper. And with each tumbler newly
charged, the inhalers resumed their vocation. Immediately an
unwonted hilarity seized the party--they became brighteyed, very
happy, and very loquacious--expatiating on the delicious aroma of
the new fluid. The conversation was of unusual intelligence, and quite
charmed the listeners--some ladies of the family and a naval
officer, brother-in-law of Dr. Simpson. But suddenly there was a
talk of sounds being heard like those of a cotton mill louder and
louder; a moment more and then all was quiet--and then crash! On
awakening Dr. Simpson's first perception was mental--'This is far
stronger and better than ether,' said he to himself. His second was to
note that he was prostrate on the floor, and that among the friends
about him there was both confusion and alarm. Hearing a noise he
turned round and saw Dr. Duncan beneath a chair--his jaw dropped,
his eyes staring, his head bent half under him; quite unconscious, and
snoring in a most determined and alarming manner. More noise still
and much motion. And then his eyes overtook Dr. Keith's feet and legs
making valorous attempts to overturn the supper table, or more
probably to annihilate everything that was on it. By and by Dr.
Simpson having regained his seat, Dr. Duncan having finished his
uncomfortable and unrefreshing slumber, and Dr. Keith having come to
an arrangement with the table and its contents, the _sederunt_ was
resumed. Each expressed himself delighted with this new agent, and
its inhalation was repeated many times that night--one of the ladies
gallantly taking her place and turn at the table--until the supply of
chloroform was fairly exhausted."

The lady was Miss Petrie, a niece of Mrs. Simpson's; she folded her
arms across her breast as she inhaled the vapour, and fell asleep
crying, "I'm an angel! Oh, I'm an angel"! The party sat discussing
their sensations, and the merits of the substance long after it was
finished; they were unanimous in considering that at last something
had been found to surpass ether.

The following morning a manufacturing chemist was pressed into
service, and had to burn the midnight oil to meet Simpson's demand for
the new substance. So great was Simpson's midwifery practice that he
was able to make immediate trial of chloroform, and on November 10th
he read a paper to the Medico-Chirurgical Society, describing the
nature of his agent, and narrating cases in which he had already
successfully used it. "I have never had the pleasure," he said, "of
watching over a series of better and more rapid recoveries; nor once
witnessed any disagreeable results follow to either mother or child;
whilst I have now seen an immense amount of maternal pain and agony
saved by its employment. And I most conscientiously believe that the
proud mission of the physician is distinctly twofold--namely to
alleviate human suffering as well as preserve human life." In a
postscript to the same paper he states on November 15th that he had
already administered chloroform to about fifty individuals without
the slightest bad result, and gives an account of the first surgical
cases in which he gave the agent to patients of his friends, Professor
Miller and Dr. Duncan, in the Edinburgh Royal Infirmary. "A great
collection," he says, "of professional gentlemen and students
witnessed the results, and amongst them Professor Dumas, of Paris, the
chemist who first ascertained and established the chemical composition
of chloroform. He happened to be passing through Edinburgh, and was in
no small degree rejoiced to witness the wonderful physiological
effects of a substance with whose chemical history his own name was so
intimately connected." Four thousand copies of this paper were sold in
a few days, and many thousands afterwards.

It is worthy of mention that, according to a promise, Professor Miller
had sent for Simpson a few days after the discovery to give chloroform
to a patient on whom he was about to perform a major operation;
Simpson, however, was unavoidably prevented from attending, and Miller
began the operation without him--at the first cut of the knife the
patient fainted and died. It is easy to imagine what a blow to
Simpson, and to the cause of anæsthesia this would have been had it
happened while the patient was under chloroform.

Thus in little more than a year from the date of Morton's discovery of
the powers of ether, Simpson had crowned the achievement by the
discovery of the equally wonderful and beneficial powers of
chloroform. Already he had made two satisfactory answers to the
question he had early set himself--first, the application of
anæsthesia to midwifery practice; and, second, the discovery of the
properties of the more portable and manageable chloroform; the third,
and perhaps the greatest, the defence of the practice, and the beating
down of the powerful opposition to anæsthesia was yet required to
render his reply complete.




CHAPTER VII

THE FIGHT FOR ANÆSTHESIA. 1847 ONWARDS

  His faith in chloroform--Confused public opinion on the
  subject--Personal attacks--Opposition on professional
  grounds--His reply--Opposition on moral grounds--His
  reply--Opposition on religious grounds--His reply--Her Majesty
  the Queen anæsthetised--Indiscrete supporters--The Edinburgh
  teaching of anæsthesia administration--The far-reaching effects
  of the successful introduction of anæsthesia.


Professor Simpson firmly believed that he possessed now in chloroform
an anæsthetic agent "more portable, more manageable and powerful, more
agreeable to inhale, and less exciting" than ether, and one giving him
"greater control and command over the superinduction of the anæsthetic
state." Fortified by this belief, full of facts relating to the
subject, and fired with zeal and enthusiasm, he was prepared to meet
the opposition which from his knowledge of human nature he must have
anticipated. So bravely and so emphatically did he champion the cause
that he became identified with it in the public mind. The revelation
of anæsthesia, the discovery of chloroform, and the application of
anæsthetics to surgery as well as to midwifery were attributed to him
by all classes of the community, not even excepting many of his own
profession. Chloroform was spoken of as if ether had never existed;
and chloroform and chloroforming displaced the terms anæsthetic and
anæsthetising in ordinary talk--such unwieldy terms were naturally
abandoned when there was the excuse that chloroform was universally
considered the best substance of its class. Simpson made no attempt as
Morton had done to patent his discovery under a fanciful name for his
own pecuniary profit; but widely spread abroad every particle of
knowledge concerning it that he possessed, so that every practitioner
was forthwith enabled to avail himself thereof for the benefit of his
patients.

Partly owing to his own enthusiasm and his strong belief in the
superiority of chloroform over ether, and partly owing to the
confusion prevailing in general circles as to the history of
anæsthesia, no small number of attacks were directed against Simpson
personally by those who either were jealous of his achievements, or
who considered that the part taken by themselves or their friends in
the establishment of this new era in medical science had been slighted
or overlooked. Simpson took all these as part of the fight into which
he had entered. His nature was not sensitive to such personal
attacks; he replied to them, cast them off, and went on his way
unaffected. He handled some of these opponents somewhat severely when
they accused him of encouraging the public belief in him as the
discoverer of anæsthesia. It is clear to us to-day after anæsthesia
has been on its trial for fifty years that Simpson magnified the
superiority of chloroform over ether, and was led by that feeling to
look on the history of ether as but a stage in the history of the
greater chloroform. He regarded chloroform as the only anæsthetic; his
utterances betrayed this feeling, and offence was naturally taken by
the introducers and advocates of ether. His opinion of chloroform was
shared by the leading European surgeons to such an extent in his day
that shortly after his death Professor Gusserow, of Berlin, stated
that with a few exceptions almost all over the earth nothing else was
used to produce anæsthesia but chloroform.

The real fight for anæsthesia was against those who found in the
practice something which ran contrary to their beliefs or principles.
There were first those who objected on purely _medical_ grounds;
secondly, those who took exception to it from a _moral_ point of view;
and thirdly, those who found their _religious_ convictions seriously
offended by the new practice.

The _medical_ opponents were, perhaps, the most powerful; certainly it
was they who had first to be won over, for without the support of the
profession the cause was in danger. It was urged first of all that the
use of anæsthetics would increase the mortality, then very great, of
surgical operations, and those who took their stand upon this ground
were men who had at first denied the possibility of making operations
painless, and had been driven to abandon that opinion only by a clear
demonstration of the fact. To meet this form of opposition he
instituted a laborious and extensive statistical investigation in
order to compare the results obtained in hospitals where anæsthetics
were used with those where the operations were performed on patients
in the waking state. He took care that the reports dealt with the same
operations under, as nearly as possible, similar conditions in each
case. He obtained returns from close upon fifty hospitals in London,
Edinburgh, Dublin, and various provincial towns. One of the most fatal
operations in those days, and one dreaded by patient and surgeon
alike, was amputation of the thigh. In 1845 Professor Syme said that
the stern evidence of hospital statistics showed that the average
frequency of death after that operation was not less than 60 to 70 per
cent., or above one in every two operated upon. Simpson fearlessly
collated statistics of this operation amongst the others, and proved
that when performed under anæsthetics amputation of the thigh had its
mortality reduced to 25 per cent. His figures were as follows:--

TABLE OF THE MORTALITY OF AMPUTATIONS OF THE THIGH.

    Reporter.                     Cases.  Deaths.  % of Deaths.

  Not anæsthetised.
    Parisian hospitals--Malgaigne    201    126      62 in 100
    Edinburgh   "     --Peacock       43     21      49  "
    General collection--Phillips     987    435      44  "
    Glasgow hospitals --Lawrie       127     46      36  "
    British     "     --Simpson      284    107      38  "

  Cases on patients in an
   anæsthetised state                145      37     25  "

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 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 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 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, 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 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 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. 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.).

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 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 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 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 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.

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 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.

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 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
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.




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--Homoeopathy--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 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 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 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: 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 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
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 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 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 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 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 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 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 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 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 homoeopathy, 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. Homoeopathic practice was founded on facts
improperly interpreted, 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 homoeopathy 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 homoeopathy,
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 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." Homoeopathy 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 homoeopathy 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. 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.

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.




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 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 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 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 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 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 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 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 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 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
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 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.




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.

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 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 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 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 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 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 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 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; 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 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, 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 homoeopathy, 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 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 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 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 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,
    "     "       deaths    226 }     10.8 per cent.

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

  669 Thigh cases; deaths, 123; mortality, 18.3 per cent.
  618 Leg     "  ;   "      82;     "      13.2    "
  433 Arm     "  ;   "      19;     "       4.3    "
  378 Forearm "  ;   "       2;     "       0.5    "

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

FOR INJURY.

          Cases.  Deaths.  Mortality.
                           per cent.
  Thigh      313    80       25.5
  Leg        409    57       13.4
  Arm        344    14        4.0
  Forearm    313     2        0.6

FOR DISEASE.

          Cases.  Deaths.  Mortality.
                           per cent.
  Thigh      356    43       12.0
  Leg        209    25       12.0
  Arm         89     5        5.6
  Forearm     60     0        --

These statistics were accompanied by an exhaustive detailed
examination and explanation; every possible point of attack was
considered and protected. "I doubt not," he said, "that the
segregation of the sick from the sick--every diseased man being a
focus of more or less danger to the diseased around him--is a
principle of no small moment and value." He attributed the comparative
brilliancy of these statistical results to the _isolation_ of the
patients only; he endeavoured to show that the operations were often
performed amidst dirty and squalid surroundings, on dirty and squalid
persons. He did not attribute sufficient importance to the fact urged
by many of his correspondents, who supported his general contentions
almost to a man out of their own experience, that where fresh air,
ventilation, and cleanliness prevailed, the results were always the
most satisfactory.

The next step was to take hospital statistics of similar operations,
and the general result appears in the table on page 183.

This testimony to the truth of Simpson's opinion was more pronounced
than even he himself had anticipated. "Shall this pitiless and
deliberate sacrifice of human life to conditions which are more or
less preventable be continued, or arrested? Do not these terrible
figures plead eloquently and clamantly for a revision and reform of
our existing hospital system?" This was his cry until at length
breath failed him. The opposition was not strong, but the support
was weak. Although there was much criticism, his conclusions were
scarcely called in question at all; trifling holes were picked in
his statistics, but his contentions were universally acknowledged
to be correct; a few reformers only, persuaded as he was of the
evils of hospitalism and working at the subject, lent him their
advocacy. But he alone stood unperturbed at the extent of the evils
and the magnitude of the change which he proposed in order to
uproot them; death laid him low as he stood, but not before he had
modified his proposals by suggesting that existing hospitals might be
reconstructed, and new hospitals built on the now almost universally
adopted pavilion system on which the new Edinburgh Royal Infirmary was
one of the first to be built.

  Column Headings--
  C: Cases.
  D: Deaths.
   _______________________________________________________________________
  |                       |                                               |
  |      HOSPITAL.        |                  FOR INJURY.                  |
  |_______________________|_______________________________________________|
  |                       |           |           |           |           |
  |                       |  Thigh.   |    Leg.   |    Arm.   |  Forearm. |
  |                       |___________|___________|___________|___________|
  |                       |     |     |     |     |     |     |     |     |
  |                       | [C] | [D] | [C] | [D] | [C] | [D] | [C] | [D] |
  |_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
  |                       |     |     |     |     |     |     |     |     |
  | Edinburgh Infirmary   | 134 |  48 |  28 |   9 |   7 |   3 |  19 |   7 |
  | Glasgow   "           | 100 |  60 |  93 |  50 | 101 |  38 |  66 |   9 |
  | Nine London Hospitals | 320 | 123 | 173 |  53 |  48 |  13 |  37 |   7 |
  |_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
  |                       |     |     |     |     |     |     |     |     |
  | Total                 | 631 | 239 | 283 |  89 |  78 |  22 |  75 |  15 |
  |_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
  |                       |           |           |           |           |
  | Mortality per cent.   |   64.4    |   54.8    |   40.1    |   14.8    |
  |_______________________|___________|___________|___________|___________|

   _______________________________________________________________________
  |                       |                                               |
  |      HOSPITAL.        |                 FOR DISEASE.                  |
  |_______________________|_______________________________________________|
  |                       |           |           |           |           |
  |                       |  Thigh.   |    Leg.   |    Arm.   |  Forearm. |
  |                       |___________|___________|___________|___________|
  |                       |     |     |     |     |     |     |     |     |
  |                       | [C] | [D] | [C] | [D] | [C] | [D] | [C] | [D] |
  |_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
  |                       |     |     |     |     |     |     |     |     |
  | Edinburgh Infirmary   |  65 |  48 |  58 |  29 |  21 |  12 |  39 |   5 |
  | Glasgow   "           | 177 |  68 |  82 |  27 |  23 |   6 |  19 |   1 |
  | Nine London Hospitals | 139 |  88 | 179 | 102 |  97 |  33 |  64 |  11 |
  |_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
  |                       |     |     |     |     |     |     |     |     |
  | Total                 | 304 | 196 | 330 | 181 | 219 |  88 |  169|  25 |
  |_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
  |                       |           |           |           |           |
  | Mortality per cent.   |   37.8    |   31.4    |    28.2   |     2.0   |
  |_______________________|___________|___________|___________|___________|

  The total number of cases  2,089 } mortality 41 per cent.
  The total number of deaths   855 }
  Placed side by side the Town (hospital only) and Country (private
        practice only) figures compared as follows:--
    _Hospital_ cases 2,089; deaths 855; mortality 41 per cent. or 1 in 2.4
    _Country_    "   2,098;   "    226;    "      10.8     "      1 in 9.2

The steady advance of aseptic surgery has slowly but surely brought
about the results which Simpson strove to attain by a radical measure.
The enemy which had baffled surgeons for centuries was revealed by
Lister. He sent surgeons smiling into the operating-room practically
certain of success instead of dreading the terrible onslaught upon
their own handiwork of the formerly unseen and unknown destroyer. The
death rate of operations is being daily brought nearer and nearer to
vanishing point. In his review of the progress of wound treatment
during the Victorian Era published in the Diamond Jubilee number of
_The Practitioner_, Mr. Watson Cheyne says the mortality of major
operations does not now exceed in hospitals more than three or four
per cent., and this is made up practically entirely by cases admitted
almost moribund and operated on _in extremis_ with faint hope of
survival. The field of surgery, too, has been vastly enlarged, and the
term "major operation" includes not merely operations of necessity,
undertaken through ages past as the only possible means of saving
life, but also operations which have become possible only in recent
years--some of them performed merely to make the patient "more
comfortable," or even only "more beautiful." And this glorious result
is due, as Mr. Cheyne truly says, to the immortal genius of Lister.

In 1867 Simpson propounded in the _Medical Times and Gazette_ a
proposal for stamping out smallpox and other infectious diseases such
as scarlet fever and measles. In spite of vaccination, which, however,
was imperfectly carried out, smallpox alone carried off five thousand
lives annually in Great Britain. A serious outbreak of rinderpest in
the British Islands amongst cattle had recently been arrested and
exterminated by the slaughter of all affected animals. The disease
spread as smallpox did by contagion, and Simpson fell to wondering why
smallpox could not also be exterminated. His paper was a noteworthy
contribution to the then infant science of Public Health, and his
proposal, which was, however, universally regarded as impracticable,
sprang from his courageous enthusiasm as did that concerning
hospitals. He suggested that the place of the pole-axe in the
extermination of rinderpest might in the arrest of smallpox be taken
by complete isolation, and he laid down simple but rigid rules for its
enforcement. An attempt was made to utilise these a few years after
when an epidemic of fatal violence broke out in Edinburgh. He was in
no way an anti-vaccinationist, but his isolation measures were too
strong for the people in those days. We are not surprised that he
boldly proposed this measure, for he related glaring instances of
neglect of the simplest precautions. Beggars held up infants with
faces encrusted with active smallpox into the very faces of passers-by
in the streets of Edinburgh; and on one occasion a woman was found in
Glasgow serving out sweetmeats to the children of a school with her
hands and face covered by the disease. He cried aloud for legislation
to prevent such gross abuses, which he did not hesitate to stigmatise
as little short of criminal.




CHAPTER XI

FURTHER REFORMS--HONOURS

  Professional and University Reform--Medical women--Honours--The
  Imperial Academy of Medicine of France--Baronetcy--Domestic
  bereavement--The University Principalship--Freedom of the City of
  Edinburgh--Bigelow of Boston--Views on education--Graduation
  addresses.


Professor Simpson took a warm interest in medical politics, and made
himself heard as a member of the Senatus of the University. That body
was not renowned for any spirit of harmony prevailing in its midst; it
included the medical professors many of whom were in professional
opposition to each other and were actuated by conflicting interests.
The rivalry prevailing amongst the leaders of the profession in the
Scots capital was amusingly shown in one of Sir James's letters, where
he related how Professor Miller had just given a capital address to
the young graduates and recommended them to marry chiefly because Mr.
Syme had advised the reverse two years before. "At least," he said,
"so Mr. Syme whispered to me, and so, indeed, did Miller himself
state to Dr. Laycock!"

On the principles of Medical Reform and University Reform the
professors were, however, practically unanimous, but their interests
came into conflict with those of the extra-academical school. The
two opposing bodies worked hard to gain their own ends when a
Parliamentary Committee was appointed in 1852 to inquire into
medical reform. The modern Athens became once more disturbed by
wordy warfare. The general ends aimed at by the reformers were the
obtaining of a proper standing for qualified practitioners; some
satisfactory means of enabling the public to distinguish between
regular and irregular, quack, practitioners; and to define the amount
of general and professional knowledge necessary for degrees and
qualifications. It was also desired to remove the absurd anomaly
whereby, although Scots medical education was then ahead of English,
Scots graduates had no legal standing in England. The Medical Act
which was passed in 1858 carried out many of the best suggestions
made before the Committee, and effected desirable improvements both
in the status of practitioners and in medical education; but it was
inadequate, as time has shown, and the question of reform still
burns. Simpson took an active interest in the proceedings before the
Committee, and made several dashes up to London to further the
projects which he had at heart. The annual meeting of the British
Medical Association was held in Edinburgh in July, 1858, at the
moment when the fate of the Bill hung in the balance. As the journal
of the Association said at the time the fruit of a quarter of a
century's growth was plucked in the midst of the rejoicings. Sir
Robert Christison publicly stated that owing to Simpson's energetic
efforts certain far-reaching and objectionable clauses, which had
been allowed to creep into the Bill, were expunged at the last
moment. Simpson went up to London by the night train, employed the
following day in effecting his purpose, and returned the next night;
this was when the journey took nearly twice as many hours as now.

The Universities (Scotland) Act was also passed in 1858; by it the
complete control of the University, and with it the patronage of many
of the Chairs, was lost to its original founders, the Town Council,
who had so carefully and successfully guided it through nearly three
centuries. The Council did not part from their charge without a
struggle; in urging their cause they proudly pointed to the fact that
they had appointed Simpson to the Chair of Midwifery against the
opposition of the medical faculty. To have elected him, they thought,
under such circumstances displayed their discernment, vindicated their
existence, and pleaded for the perpetuation of their elective office.

When the question of the admission of women to the study of medicine
came up in Edinburgh and divided the ancient city once more into two
hostile camps, Simpson's sympathies appear to have gone with the sex
to which he was already a benefactor. He recognised that there was a
place, if a small one, within the ranks of the profession for women;
and when the question came to the vote he cast his in their favour.
The proposal, however, was rejected, and has only quite recently
become law in the University.

Numerous honours were heaped upon him during the last five-and-twenty
years of his life. In 1847 he filled the office of President of the
Edinburgh College of Physicians, and in 1852 held the corresponding
post in the Medico-Chirurgical Society. In the following year the
Imperial Academy of Medicine of France--a body which lacks an analogue
in this country--conferred upon him the title of Foreign Associate.
This was a jealously guarded honour awarded only to the most highly
distinguished men of the day, and it was conferred upon Simpson in an
altogether unprecedented manner which doubled its value. According to
custom a commission of members prepared a list of renowned men whom
they advised the Academy to elect; in the list no British name
appeared although Owen, Faraday, and Bright were entered as
"reserves." On the day of election the members accepted all the
candidates named in the original list until the last was reached. When
the president asked for the vote for this individual a sensational
and truly Gallic scene was enacted. Almost to a man the members rose,
and loud and long proclaimed Simpson's name. Excited speeches were
made, and amidst great enthusiasm he was elected to the one remaining
vacancy by an overwhelming majority. It had remained for Simpson to
prove, as the President courteously pointed out at the time, that
there existed a greater honour than that of being elected by the
Academy--viz., that of being chosen in _spite_ of the will of the
Academy itself.

This was by no means the only honour awarded to him by France. In 1856
the French Academy of Sciences voted him the Monthyon Prize of two
thousand francs for "the most important benefits done to humanity."
Other foreign societies added their compliments, and he was elected
Foreign Associate of the Belgian Royal Academy of Medicine, of the
Parisian Surgical and Biological Societies, and of the Medical
Societies of Norway, Stockholm, Copenhagen, New York, Massachusetts,
Leipsic, and other places.

In 1866 his own country made an acknowledgment of his eminent
attainments when the Queen offered him a baronetcy on the advice of
Lord John Russell. Twice before he had refused a title, but this
time he wrote to his brother that he feared he _must_ accept
although it appeared so absurd to take a title. This honour was the
first of its kind ever conferred upon a doctor, or even upon a
professor, in Scotland. It was entirely unsought, and scarcely
welcomed by its recipient for its own sake; he regarded it not merely
as a personal honour but also as a tardy recognition of the services
of the Edinburgh school in the cause of medicine. He enjoyed the
congratulations which showered upon him, and felt glad when the
citizens flocked to Queen Street to express their feelings, much to
Lady Simpson's delight. The medical papers unanimously approved of
the honour, the _Lancet_ remarking that apart from his connection with
chloroform, Simpson was distinguished as an obstetric practitioner, as
a physiologist, as an operator, and as a pathologist of great
research and originality.

Domestic bereavement quenched the rejoicings over the baronetcy, and
condolences displaced congratulations. He fell ill for a time himself,
and in a condition of unusual mental depression spoke of the baronetcy
as appearing even more of a bauble in sickness than in health. In less
than a fortnight after the offer of the title his eldest son David
died after a short illness. He had been educated for the medical
profession, and was a youth of considerable promise and of an earnest
temperament; his death fell as a severe blow, and Simpson even
contemplated abandoning the baronetcy which had not yet been formally
conferred. The words of his friends, however, and the thought that his
dead son had particularly insisted on its acceptance, persuaded him.

A coat of arms had to be drafted for the new Baronet, and this was a
pleasant interest for one of his tastes. The family history was
searchingly entered into, and the arms of his father's family were
differenced on the most correct lines with those of the Jervays from
whom his mother had sprung. In the matter of a crest he was able to be
boldly original, and adopted the rod of Æsculapius over the motto
_Victo dolore_, and thus handed down to his family the memory of his
great victory over pain. In June of the same year, 1866, the
University of Oxford conferred upon him one of the few honours which
reached him from England in awarding him the honorary degree of Doctor
of Civil Law. The University of Dublin made him an honorary Doctor of
Medicine, and he was created an honorary Fellow of the King's and
Queen's College of Physicians of Ireland.

By the death of the veteran Sir David Brewster, in February, 1868, the
office of Principal of Edinburgh University fell vacant. This post is
a survival from the earliest days. The College out of which the
University grew was established in 1583 by the Town Council under a
charter granted by James VI. Only one regent or tutor was necessary at
first to teach the "bairns," as the students were termed in the
contract entered into between Rollock, the first regent, and the city
fathers. Rollock was promised that as the college increased "in policy
and learning" he should be advanced to the highest post created. By
his own efforts the number of students increased so greatly that
within the first few years several other regents were appointed, and
the Council, remembering their promise, dignified him with the title
of Principal or First Master in 1586. This office was held during the
succeeding two centuries by a series of more or less worthy men,
prominent among whom were Leighton, afterwards Archbishop of Glasgow,
and William Carstares, better known as a statesman and for his
connection with the Rye House Plot in 1684. During Carstares's tenure
the tutors were turned into professors, and the college became more
strictly speaking a university, although from the first it had assumed
without any right by charter the function of degree-granting. Although
the utility of the post quite vanished when the college became a
university, and the principal had no place in the constitution of a
university, nevertheless the principalship was not abolished. The
Universities Act of 1858 recognised the office, but only as that of an
ornamental head, acting as president of the assembly of professors
constituting the Senatus Academicus. The salary is a thousand pounds a
year with an official residence, not within the precincts or the
University. The former head master of the college, known by and
knowing every student, became a sinecurist of whose existence it is no
exaggeration to say many of the students are, through no fault of
their own, unaware. Brewster had been a distinguished occupant of the
post--distinguished not as a principal, for he received the
appointment only at the age of seventy-eight, but as a scientist. To
the public he was best known as the author of the "Life of Sir Isaac
Newton," and as the inventor of the kaleidoscope. It is said that
Brewster never spoke as much as five lines at the meetings of the
Senatus Academicus without having previously written them down; and it
is probable that this lack of spontaneous utterance from the Chairman
gave the tone to the assembly. The rival professors doubtless nursed
their animosities for some less dignified meeting-place, differing
there only on the most correct academic lines.

It is not surprising that Simpson at first refused to be a candidate
for the vacant post. He would undoubtedly have made an unrivalled
figure-head for his _Alma Mater_; he was the leading figure in
Scotland already and "did the hospitalities" of Edinburgh to
distinguished visitors of all classes. But he would probably have been
obliged to resign his professorship and have thus been cut off from
his sphere of greatest usefulness; and although he would have grasped
with ease the details of university affairs it is open to question
whether he would have suitably filled the post of president over men
to many of whom he was in professional opposition. The most that the
suggestion that he should be a candidate conveyed was a well-meant
compliment, but it would have been a greater compliment on his part if
he had really ended his life as the ornamental head of the University
he had already done so much to adorn. He would certainly have turned
his position to good account, and perhaps might have earned the
gratitude of all succeeding students by improving their position in
the University and bettering their relationship with their teachers--a
much needed reform at that time. But he was a man for more active
occupation, and it was more fitting that he should persevere to the
end in the work of his life. Simpson expressed his opinion that the
most suitable man for the post was the one already named by Brewster
and desired by a majority of the Senatus; but that man, Professor
Christison, then over seventy years of age, generously said that Sir
Alexander Grant, an active candidate, would better fill the post. A
strong section of Edinburgh folks persisted in pushing Simpson, and in
deference to their wishes he consented to enter the lists. It cannot
be said that he displayed any of the eager energy which had marked his
candidature for the midwifery chair; but his friends made up for his
comparative apathy. They were met by a strong opposition, not
instigated by his rivals for the post, but offered by insignificant
persons who cherished ill-will against him and spread untrue
statements with the object of damaging his character. Greatly owing to
the reports spread in this manner he was not elected. Sir Alexander
Grant became the new Principal. The fact that he could not gain the
post was communicated to him in a letter which reached him one morning
before prayers. He conducted the worship as usual after reading the
letter, and when the family had afterwards all assembled at the
breakfast table he intimated the fact to them and dismissed the
subject from his mind with the quiet remark, "I have lost the
Principalship."

An interesting episode pertaining to this period was narrated by the
Free Church minister of Newhaven. "The election," he wrote to Dr.
Duns, "took place on a Monday, and it was on the Sabbath preceding,
between sermons, that one of my people, a fisherman, called on me
stating that his wife was apparently dying, but that she and all her
friends were longing most intensely for a consultation with Sir James.
I did not know well what to do, for I knew that his mind was likely to
be very much harassed, and I shrank from adding to his troubles. But
in the urgency of the case I wrote him a note simply stating that one
of the best women in the town was at the point of death and longed for
his help, leaving the matter without another word to himself. The
result was that he came down immediately, spent three hours beside his
patient, performed, I am told, miracles of skill, and did not leave
her till the crisis was over. She would, I am assured, have died that
evening, but she was one of the sincerest mourners at his funeral, and
she still lives to bless his memory. After all was over he went into a
friend's house and threw himself down on a sofa in a state of utter
exhaustion. This was the way in which, without hope of fee or reward,
and while others were waiting for him able to give him both, Sir James
spent the evening preceding the election. Some will say it was no
great matter after all. Why, for that part of it, neither was the cup
of cold water which the dying Sir Philip Sidney passed from his own
lips to those of a wounded soldier in greater agony than himself. But
the incident is recalled whenever his name is mentioned as adding to
the glory of the knight _sans peur et sans reproche_, and the incident
I have mentioned in the Newhaven fisherman's house surely gives to Sir
James a place beside him in the glorious order of chivalrous
generosity."

Among the last of the honours offered to Simpson was the Freedom of
the City of Edinburgh; a fitting tribute from the City in which and
for which he had so nobly and untiringly laboured. It was proposed to
present him with the burgess-ticket at the same time that it was
publicly presented to another hero in a different sphere, Lord Napier
of Magdala; but by his own desire the ceremony was postponed so far as
he was concerned in order that full honour might be paid to Lord
Napier. At the eventual presentation the Lord Provost made a short
speech recapitulating the achievements for which they desired to
honour him, and referring to his reputation as being great on the
banks of the Thames and the Seine, as well as on the shores of the
Firth of Forth; he likewise expressed the pride of his fellow-citizens
that Sir James had remained amongst them and had not been drawn away
like other men of genius before him by the attractions of the greater
metropolis of the south. Simpson's reply took the form of an impromptu
review of his career from the time he first entered the City as a
wonderstruck boy. "I came," he proudly said, "to settle down and fight
amongst you a hard and up-hill battle of life for bread and name and
fame, and the fact that I stand here before you this day so far
testifies that in the arduous struggle I have--won."

The accounts of the speeches delivered on this occasion which reached
America raised the indignation of Dr. Bigelow, of Boston. Reference
had been made to chloroform in a manner which appeared to slight
Morton's work in introducing ether as an anæsthetic before chloroform
was heard of. In Bigelow's estimation Simpson posed as a hero at the
expense of Morton. Simpson had certainly been far from liberal in his
allusions to Morton and others in his article upon Anæsthesia in the
_Encyclopædia Britannica_, and had written almost entirely about his
own discovery. A controversy was excited, and on his deathbed Simpson
wrote a letter to Bigelow to prove that he had duly considered the
priority and the value of Morton's and Wells's work. In his concluding
sentences he expressed regret at having taken up so much of his own
and his correspondent's time in such a petty discussion, but blamed
his illness which prevented him from writing with the force and
brevity required. "With many of our profession in America," he said,
"I have the honour of being personally acquainted, and regard their
friendship so very highly that I shall not regret this attempt--my
last, perhaps--at professional writing as altogether useless on my
part if it tend to fix my name and memory duly in their love and
esteem."

The widespread national expression of the sense of loss and of
sympathy which reached Edinburgh from the United States after Sir
James's death testified to the regard in which he was held from one
end to the other of that country. In Boston itself the Gynæcological
Society, of which he had been the first honorary member, convened a
special memorial meeting, which was solemn and impressive. He had not
been mistaken in presuming with his last breath that he held the
regard of his American _confrères_.

On the subject of education Simpson held what were considered advanced
opinions, but which had already been expressed by Mr. Lowe. A few
years before his death he delivered a lecture on Modern and Ancient
Languages at Granton, in which he lamented the common neglect of
modern languages in the education of the day. He had personally felt
the want of a mastery over French and German, both in the course of
his studies and during his travels; nor did he feel the want
compensated for by his ability to write and talk in Latin. He
strongly advocated the paying of more attention to the modern and
less to the dead languages, and he urged that natural science should
take its place in the ordinary curriculum of the great public schools.
These views were used as an argument against his fitness for the post
of Principal of the ancient University.

On three separate occasions it fell to Simpson's lot to deliver the
annual address to the newly-fledged graduates, which is the duty of
the professors of the medical faculty in rotation. This ceremony
remains deeply impressed in the memory of Edinburgh men, simple and
dull as it undoubtedly is. The homily delivered by the orator of the
day contains excellent counsels appropriate to the occasion, but
the young man eager to rise and confidently try his wings pays
little attention to the words of wisdom; unless it be to feel wonder
that just as he is about to leave them, probably for ever, his _Alma
Mater_ and her priests have discovered an affectionate regard for
him and his welfare. A few years later the struggling young
practitioner may perhaps turn to the copy of this graduation address,
forwarded to him by post with the author's compliments, and find
in such an one as Simpson delivered much to strengthen and encourage
him. In 1842 and 1855 he delivered addresses from which quotations
have already been made; and in the third one, spoken in 1868, he
made a forecast of the future of medical science, predicting _inter
alia_ that by concentration of electric or other lights we should yet
be enabled to make many parts of the body sufficiently diaphanous for
inspection by the practised eye of the physician. It was his habit
to commit such lectures to memory and to deliver them without notes.
He was a ready public speaker on any subject in which he was
interested; speeches made on the spur of the moment teemed with
pleasantly-put facts and apt anecdotes from the vast storehouse of
his memory. A speech from Sir James was one of the treats in which
Edinburgh folks delighted.




CHAPTER XII

FAILING HEALTH--DEATH

  Poetical instincts--Religious views--Religious and emotional
  influences in his life--Doubts--Revivalism--Health--Overwork
  tells--Bed--Gradual failure--Death on May 6, 1870--Grave offered
  in Westminster Abbey--Buried at Warriston--Obituary notices--Bust
  in the Abbey--His greatness.


The emotional part of Sir James Simpson's nature found some small
expression in versifying both, as we have seen, in early years and in
later days. We know that he was a close student of Shakspeare, but
Miss Simpson states that her father probably never entered a theatre,
so that he can never have seen a representation. He was familiar with
modern poets, especially with Burns. It is related that he once tested
a lady friend's insight into the vernacular by quoting from memory for
explanation the following lines from the national bard:--

  "Baudrons sit by the ingle-neuk,
    An' wi' her loof her face she's washin',
  Willie's wife it nae sae trig,
    She dichts her grunzie wi' a hooschen."

His own verses were neither better nor worse than those written by
other men whose abilities have led them to excel in more practical
pursuits. In youth they celebrated student life, or were, as usual,
dedicated to Celia's eyebrows; in mature life they were of a more
serious, and latterly of a strong religious description. At all times
he delighted in writing little doggerel verses to his children or
friends; valueless as such efforts are, they served a useful purpose;
their composition was a recreation and pleasant relief to his
over-taxed brain, while it was an amusement to him to watch their
effect upon the recipients, and perhaps to receive a reply clothed
also in the garb of rhyme.

Sir James's example so influenced the people amongst whom he lived
that it is impossible to omit reference to his attitude throughout
life towards religion and an account of what is one of the most
interesting phases in his history. Up to Christmas, 1861, he had
been, in the eyes of the religious public, an ordinary citizen; as
regular in church-going as his professional engagements permitted;
thoroughly interested in Church affairs, and a strong supporter of
his own Church; possessing to the full the national characteristic
of intimate acquaintance with the letter of the Old and New
Testaments; and something of a theologian as well, as his answer to
the religious objections to anæsthesia showed. At that period, to
the delight of many, and the genuine astonishment of others among
his fellow-citizens, he became a leading spirit in the strong
Evangelical movement which was then spreading through the country,
"Simpson is converted," cried the enthusiastic revivalist. "Simpson
is converted now," laughed those who had opposed every action of
his. "If Professor Simpson is converted, it is time some of the rest
of us were seeing if we do not need to be converted," wisely
answered one of his friends. In the ordinary sense of the word Simpson
was not converted. Had he passed away without developing this
latter-day Evangelical enthusiasm, all sects would still have
united in thankfulness that such a man had lived. Why this religious
revival during the sixties affected him as it did becomes evident
in looking at the religious, moral, and emotional influences which
affected him throughout his career.

The simple-minded, devout mother, strong in faith and strong in works,
who passed out of his life when he was but nine years old, left a
vivid impression on the boy's mind. In after years he would call up
the picture of the good woman retiring from the shop and the worries
and troubles of daily life into which she had so vigorously thrown
herself and so bravely faced even with failing health, into the quiet
little room behind, to kneel down in prayer; and would describe how at
other times she went about her work chanting to herself one of the old
Scots metrical psalms:

  "Jehovah hear thee in the day, when trouble He did send
  And let the name of Jacob's God thee from all ill defend.
  Let Him remember all thy gifts, accept thy sacrifice,
  Grant thee thine heart's wish and fulfil thy thoughts and counsel
        wise."

He used to relate one memory of her, touching in its simplicity: how
one day he entered the house with a big hole in his stocking which she
perceived and drew him on to her knee to darn. As she pulled the
repaired garment on she said, "My Jamie, when your mother's away, you
will mind that she was a grand darner." He remembered the words as if
they had been spoken but yesterday, and subsequently offered to a lady
who had established a girls' Industrial School in his native village a
prize for the best darning.

The simple faith which beat in the life of the Bathgate baker's
household was ingrained into James Simpson; he went forth into the
world full of it, and full of the determination that by his fruits he
should be known.

The tender, loving care for his welfare of his sisters and brothers,
particularly of Sandy, who never faltered in his inspired belief in
James's great future, kept alive in Simpson something of his mother's
affectionate nature, and kindled the sympathies and emotions which
bulked so large in his character. His goodness was displayed in his
kindly treatment of the poor, who formed at first the whole and
afterwards no small part of his patients. When name and fame and bread
were his, he did not turn his back on the poor, but as we have seen,
ever placed his skill at their disposal for no reward, as readily as
he yielded it to the greatest in the land. As in his daily practice,
so in his greatest professional efforts, the revelation of chloroform,
the fight for anæsthesia, the introduction of acupressure, the crusade
against hospitalism, one thought breathed through his work--that he
might do something to better the condition of suffering humanity. He
never attempted to keep discoveries in his own hands, to profit by the
monopoly, but scattered wide the knowledge which had come to him that
it might benefit mankind and grow stronger and wider in the hands of
other workers.

In his domestic life he was a tender, loving, and companionable
husband and father, a charming host, and a warm-hearted friend. "In
this Edinburgh of ours," says a recent writer, "there are familiar
faces whose expression changes greatly at the mention of his name;
there are men whose speech from formal and precise turns headlong and
extravagant, as if it came from a new and inspired vocabulary." In
Scotland his personal influence was immense. As was afterwards written
of him, "Great in his art, and peerless in resource, yet greater was
he in his own great soul;" such a man stood in no need of the violent
revolution in mode of life implied in conversion. A gradual process of
development led to his feeling that although to labour was to pray,
there was a need for more attention to the spiritual, even in his
self-sacrificing life.

There is evidence that during a brief period of his career Simpson
became affected by speculative doubts; indeed it would have been
surprising if his mind had not been affected by some of the new
schools of thought which sprang up in the footsteps of Charles Darwin,
and appeared for a time to threaten a mortal antagonism to all that
was dear to orthodox Christians. But these did not influence him long;
true to his character he examined every new thought and finding it
wanting remained firm in his old and tried faith, and ranged himself
on the side of those who perceived nothing seriously incompatible
between religion and modern science.

In his bearing, when the angel of sorrow afflicted his household with
no unsparing hand, we find him always a religious-minded man. The
first trial was the loss of the eldest child, his daughter Maggie,
in 1844. Another daughter, Mary, was lost in early infancy. In
1848 his friend of boyhood and student days, Professor John Reid, was
smitten with a painful malady and died after a prolonged period of
suffering during which, knowing that the shadow of death was hanging
over him, he devoted himself in retirement to religious thoughts.
Experiences such as these made Simpson pause and question himself.
Brimful of life and vigour, however much he came in contact with
death in his professional rounds, the sight of it in his own inner
circle powerfully stirred his emotional nature. His friend the Rev.
Dr. Duns noticed in him after these sad events a gradually
increasing earnestness in his spiritual life, and a closer inquiry
into the meanings of the Scriptures. He sought out the company, and
placed himself under the influence of those among his patients whom he
knew to possess fervid religious temperaments. The last mental
stumbling-block was the question of prayer; he had seriously
doubted in examining the question intellectually that human prayer
could influence the purpose of the Deity. It is difficult, if not
presumptuous, to inquire into the process whereby, under the
guidance of spiritually minded friends, his doubts were satisfied.

          "... One indeed I knew
  In many a subtle question versed."

       *       *       *       *       *

  "He fought his doubts and gathered strength,
    He would not make his judgment blind,
    He faced the spectres of the mind,
  And laid them--thus he came at length"

       *       *       *       *       *

  "To find a stronger faith his own."

The simple earnest faith of his fathers in which he had commenced
life, ran all through his mature years and prompted his strong
purposeful energies. After the combat with the only seriously
perplexing doubt he re-embraced his faith with the simplicity of a
child and the strength of a giant. For one accustomed to apply to
every subject taken in hand the rigid process of careful scientific
investigation, it required no small effort to lay aside his usual
methods and suffer himself to be led wholly by faith.

It was impossible for Simpson to enter into any movement without
taking a prominent part in it. That Christmas Day on which all doubts
left him was followed by days of extraordinarily zealous work, such as
would have been expected of him after he had convinced himself that he
had a mission to spread abroad this, the latest, and, in his opinion,
the greatest, of his discoveries. He plunged at once into the midst of
Evangelical societies, missions, and prayer-meetings, amongst the
upper and lower classes of Edinburgh, and made excursions into the
mining districts of his native county to deliver addresses. He
interested himself in the education of theological students, and in
foreign missions, and added to his literary work the writing of
religious addresses, tracts and hymns. His example had a powerful
influence in Edinburgh. It is said that he frequently addressed on a
Sunday evening Evangelical assemblies of two thousand persons. The
news of his so-called conversion was gleefully spread by well-meaning
folks, who had given credence to statements published by his enemies,
and imagined that here was a bad if a great man turned aside from the
broad to the narrow path. This enthusiastic revival movement died down
in time, and Simpson returned to his ordinary everyday life.

More sorrow soon fell to his lot. In 1862 his fifth child, James, who
had always been an invalid, was taken from him at the age of fifteen.
In 1866 the sad death of Dr. David Simpson, the eldest son, which has
already been referred to, was followed in about a month's time by that
of the eldest surviving daughter, Jessie, at the age of seventeen. The
death of James, a sweet-natured child, stimulated him in the revival
work. Pious friends had surrounded the little sufferer and led him to
add his innocent influence in exciting his father's religious
emotions.

There is reason to believe that Simpson perceived much insincerity in
the revival movement, and attempted to dissociate himself from active
participation in it, on account of finding it impossible to work in
harmony with some who, though loud in profession, flagrantly failed in
practice.

The subject of Simpson's health has been little referred to in these
pages, because throughout his life he paid little attention to it. The
chief remedy for the feeling of indisposition was change of work. He
found it impossible to be idle, and sought as recreation occupations
such as archæological research, or a scamper round foreign hospitals,
which to most people would have savoured more of labour. The part of
his body which was most worked, his nervous system, was naturally the
one which most often troubled him with disorder; like other great men
of high mental development he suffered from time to time with severe
attacks of megrim, which necessitated a few hours of rest. The
blood-poisoning, for which he availed himself of Professor Syme's
services, was soon recovered from with prompt treatment ending in a
foreign tour; but after it little illnesses became more frequent, and
he was perforce occasionally confined to the house. During these times
he busied himself, for the sake of occupation and to distract his
attention from his sufferings, in professional reading or the
preparation of literary papers. Rheumatic troubles became frequent,
and soon after his eldest son's death he had to run over to the Isle
of Man to free himself from a severe attack of sciatica.

Long, weary nights spent at the bedside of patients or in tiresome
railway journeys, and exposure to all varieties of weather, had a
serious effect upon him. Travelling was slow, according to modern
ideas, and long waits at wayside stations in winter-time helped to
play havoc with his constitution. He was well known to the railway
officials in Scotland. The figure of the great Edinburgh professor was
familiar at many a station, striding up and down the platform with the
stationmaster, chaffing the porter, or cheerily chatting to the driver
and stoker leaning out of the engine. After his death many of these
men would proudly produce little mementoes of their services to him,
which he never forgot to send.

The little rest house, Viewbank, on the Forth, had to be more
frequently sought refuge in, if only to get away from the harassing
night-bell and secure a full night's sleep. In the last year or two of
his existence he found the work of his practice and chair hard to
carry on, not because of any defined illness, but on account of the
loss of that buoyant elasticity of constitution which had enabled him
to bear without apparent effort or injury the fatigue which would have
been sufficient to prostrate more than one ordinary man. He had early
trained himself to do with a minimum of sleep; to snatch what he could
and when he could, if it were only on a sofa, a bare board, or in one
of the comfortless railway carriages of the day. He took full
advantage during his career of the modern facilities for travelling
which he had seen introduced and developed. Many a night was spent in
the train, going to or returning from a far-distant patient, or after
a combined professional and archæological excursion; the next morning
would find him busy in his usual routine. On the day after receiving
the degree of D.C.L. at Oxford in 1866, he started for Devizes, which
was reached the same evening; here he had a hasty meal and drove on to
Avebury to see the standing stones there. He returned at midnight, and
at five o'clock next morning set off for Stonehenge, a place he had
long desired to see, thoroughly examined the remarkable remains, and
on his return took train to Bath, where he found time to examine more
antiquities. At midnight a telegram reached him calling him
professionally to Northumberland. He snatched a few hours' sleep, and
taking the four a.m. train to London set out for Northumberland, where
he saw his patient, and then proceeded to Edinburgh. This is no
solitary instance of his journeyings, but an example of many.

When the year 1870 had been entered upon, he awoke to the fact that
his flesh was too weak for his eager spirit; despite this, he held on
his course, and worked without ceasing, never refusing an urgent call,
although he now suffered from angina pectoris. On February 12th he
hastened to London to give evidence in a notorious divorce case. He
arrived only to find that the trial had been postponed for four days.
He returned to Edinburgh on the 14th, spent the next day in
professional visits in the country, and arrived again in London in
time to appear in the witness-box on the 16th, although chilled to the
bone by the coldness of the long journey. On the following day he
stopped at York on his way home, dined with Lord Houghton, and
visited, at 11 p.m., his friend Dr. Williams, in Micklegate. During
the remainder of the journey from York to Edinburgh he suffered
severely, and "was glad to rest for awhile upon the floor of the
railway carriage."

A few days after this last run to London he was summoned to see a
patient in Perth, but was this time so fatigued by the effort, that
after his return on February 25th he was obliged to take to bed. The
news sped to all quarters of the globe that Simpson was gravely ill,
for nothing but grave illness could compel that vigorous man to
completely lay down his work.

His symptoms improved at first under appropriate treatment
sufficiently to allow him to be placed on a bed in the drawing-room;
and he even once more took up his favourite archæology, revising some
of his work in that subject. Patients also were not to be denied; many
were seen and prescribed for in his sick room, some even being carried
up to his presence. But the fatal disease regained ascendancy, and the
fact became apparent to all, not excepting himself, that the last
chapter of the closely written book of his life had been entered upon.
Towards the end of March, by his own request, his eldest surviving son
was telegraphed for to be near him, and he wrote a touching letter to
his youngest son, then a student in Geneva, encouraging him in his
studies, asking him to look for cup-markings cut in the curious islet
rock in Lake Geneva, and ending with an expression of his feeling of
impending death, for which he felt perfectly and happily prepared. In
these last days he loved to have his nearest and dearest around him;
Lady Simpson and others read to him, and his daughter tells us how she
daily prepared her school lessons in the sick room with his help; to
the last he interested himself in the work of his relations and
friends. He answered the attack of Bigelow, of Boston, conscious that
it was his last effort on behalf of chloroform, and wrote to all his
old opponents asking their forgiveness if at any time words of his had
wounded their feelings. He might well have spared himself the
regrets--such as they were--which troubled him. "I would have liked
to have completed hospitalism," he said, "but I hope some good man
will take it up." On another occasion he asked, "How old am I?
Fifty-nine? Well, I have done some work. I wish I had been busier."

He expressed a desire that his nephew should succeed him in the Chair
of Midwifery--he would, he thought, help to perpetuate his treatment.

There was much communing with himself on his future, and all his
sayings on the subject breathed the simple faith first inculcated in
him in the Bathgate cottage. His great sufferings, sometimes allayed
by opiates and his own chloroform, were bravely borne, but the days
dragged sadly on. On the evening of May 5th Sandy took his place at
his side, and the last conscious moments of the great physician were
spent with his head in the arms of him who had helped and guided him
through the difficult days of his career. At sunset on May 6th he
passed peacefully away.

The extent of the feeling evoked by the tidings of his death was
represented in Mr. Gladstone's remark that it was a grievous loss to
the nation and was truly a national concern. There was a universally
expressed opinion that he merited without a shadow of doubt the rare
national honour of public interment in Westminster Abbey. A committee
was formed out of the leading medical men in London to carry out this
suggestion. Their task was light, for the Dean acceded to the request
at once. Much as his family and the Scots people valued this tribute
to his greatness, they decided otherwise. Scotland has no counterpart
of Westminster in which to lay to rest those whom she feels to have
been her greatest; but Edinburgh felt that she could not part with him
who in life had been her possession and her pride. He had long ago
chosen a piece of ground in the Warriston cemetery, and Lady Simpson
decided, to the gratification of his fellow-citizens, that he should
be buried there beside the five children who had preceded him. His
resting place was well chosen; it nestled into the side of the
beautiful city, and from it could be viewed some of the chief objects
of the scene he knew so well--on the south the stately rock crowned
with the ancient castle, and the towering flats of the old town
stretching away to Arthur's Seat; on the north the long stretch of the
Firth of Forth and in the distance on the one hand the Ochills; on the
other the Bass Rock.

The funeral was one of the most remarkable ever witnessed in Scotland.
It took place on May 13th in the presence of a crowd estimated to
consist of thirty thousand persons. The hearse was followed by a
representative procession comprising close upon two thousand persons.
His own relatives assembled at 52, Queen Street, the general public
and the Town Council in the Free Church of St. Luke, and the
representatives of the University, the Colleges of Physicians and
Surgeons, and the Royal Society and many other public bodies, in the
Hall of the College of Physicians. At each of these meeting-places
religious services were held. The whole city ceased to labour that
afternoon in order to pay the last tribute to its dearly loved
professor. The poor mourned in the crowd as deeply and genuinely as
those with whom he had been closely associated in life mourned as they
followed his remains in the procession. Every mourner grieved from a
sense of personal loss, so deeply had his influence sunk down into the
hearts of the people.

The companion of his troubles and his triumphs, who had bravely joined
him to help him to the fame he strove after, was soon laid beside him.
Lady Simpson died on June 17th of the same year.

But two notes were struck in the countless obituary notices and
letters of condolence which appeared from far and near--those of
appreciation of his great nature, and sorrow for the terrible loss
sustained by science and humanity. The Queen caused the Duke of Argyle
to express to the family her own personal sorrow at the loss of "so
great and good a man." A largely attended meeting was held in
Washington to express the feeling of his own profession in the United
States, at which Dr. Storer moved, "that in Dr. Simpson, American
physicians recognise not merely an eminent and learned Scots
practitioner, but a philanthropist whose love encircled the world; a
discoverer who sought and found for suffering humanity in its sorest
need a foretaste of the peace of heaven, and a devoted disciple of the
only true physician, our Saviour Jesus Christ."

The following original verses from the pen of a well-known scholar in
the profession, were given prominence in the columns of the
_Lancet_:--

PROMETHEUS.

(Our lamented Sir James Simpson was the subject of angina pectoris.)

          1

  "Alas! alas! pain, pain, ever forever!"
  So groaned upon his rock that Titan good
  Who by his brave and loving hardihood
  Was to weak man of priceless boons the giver,
  Which e'en the supreme tyrant could not sever
  From us, once given; we own him in our food
  And in our blazing hearth's beatitude;
  Yet still his cry was "Pain, ever forever!"

  Shall we a later, harder doom rehearse?
  One came whose art men's dread of are repressed:
  Mangled and writhing limb he lulled to rest,
  And stingless left the old Semitic curse;
  Him, too, for these blest gifts did Zeus amerce?
  He, too, had vultures tearing at his breast.

          2

  Hush, Pagan plaints! our Titan is unbound;
  The cruel beak and talons scared away;
  As once upon his mother's lap he lay
  So rests his head august on holy ground;
  Spells stronger than his own his pangs have found;
  He hears no clamour of polemic fray,
  Nor reeks he what unthankful men may say;
  Nothing can vex him in that peace profound.

  And where his loving soul, his genius bold?
  In slumber? or already sent abroad
  On angels' wings and works, as some men hold?
  Or waiting Evolution's change, unawed?
  All is a mystery, as Saint Paul has told,
  Saying, "Your life is hid with Christ in God."

In a peaceful corner of the St. Andrew Chapel in Westminster Abbey,
alongside memorials of Sir Humphry Davy and a few other scientists of
note, stands a speaking image in marble--perhaps the most expressive
representation that exists--of this wonderful man,

          "To whose genius and benevolence
          The world owes the blessings derived
          From the use of chloroform for
          The relief of suffering.
          LAUS DEO."

Mr. Jonathan Hutchinson, when writing to the medical journals in
support of the proposal to secure Simpson's burial in Westminster
Abbey, foretold that his reputation would ripen with years, that
jealousies would be forgotten, and antagonism would be buried.
Twenty-seven years have elapsed since then, and few remain with whom
he came in conflict; those who do remain exchanged, along with others
of his opponents, friendly words of reconciliation in the end, and
took the hand which he held out from his deathbed. As a man, Simpson
had his faults; but they were exaggerated in his lifetime by some,
just as his capabilities and achievements were magnified by those who
worshipped him as inspired. He was full of sympathy for mankind,
benevolent and honest to a fault, and forbearing to his enemies. He
rushed eagerly into the combat and oftentimes wounded sorely, and
perhaps unnecessarily. His genius was essentially a reforming genius,
and impelled him to fight for his ends, for genius is always the
"master of man." We can forgive him if sometimes it caused him to
fight too vigorously, where the heart of a man of mere talent might
have failed and lost. His social charms were excelled only by his
marvellous energy, his prodigious memory, and his keenness of insight;
but he was regrettably inattentive to the details of ordinary everyday
life and practice.

He approached the study of medicine when the darkness of the Middle
Ages was still upon it, and was one of the first to point out that
although many diseases appeared incurable, they were nevertheless
preventable. Although no brilliant operator himself, he so transformed
the surgical theatre by his revelation of the power of chloroform, and
by his powerful advocacy of the use of anæsthetics, that pain was shut
out and vast scientific possibilities opened up; many of which have
been brilliantly realised by subsequent workers. He devoted himself
specially to the despised obstetric art, fighting for what he
recognised as the most lowly and neglected branch of his profession,
ranging his powerful forces on the side of the weak, and left it the
most nearly perfect of medical sciences.

He was enthusiastic in his belief in progress, and in the power of
steady, honest work to effect great ends. With the exception of the
time of that temporary burst into revivalism in 1861, his motto
throughout life might very well have been _laborare est orare_. He was
no believer in speculations, but curiously enough kept for recreation
only the subject of archæology, in which he entered into many
intricate speculative studies. In his professional work he avoided
speculation, and never adopted a theory which was not built upon firm
fact.

If we are asked for what we are most to honour Simpson, we answer, not
so much for the discoveries he made, not for the instruments he
invented, not for his exposure of numerous evils, not for the
introduction of reforms, not for any particular contribution to
science, literature, or archæology; but rather for the inspiring life
of the man looked at both in outline and in detail. He was guided by
high ideals, and a joyous unhesitating belief that all good things
were possible--that right must prevail. He was stimulated by a genius
which, as has been pointed out, gave him the energy to fight for his
ends with herculean strength. The fact that chloroform was by his
efforts alone accepted as _the_ anæsthetic, and ether, which from the
first was generally thought to be safer in ordinary hands, was
deliberately put on one side practically all over the world, testified
to his forcible and convincing method, and to his power of making
others see as he saw. As a man of science alone, as a philanthropist
alone, as a worker alone, as a reformer alone, he was great. But
although to the popular mind he is known chiefly because of his
introduction of chloroform, medical history will record him as greater
because of his reforming genius, and will point to the fight for
anæsthesia, and his crusade against hospitalism as the best of all
that he accomplished or initiated. And he who, while making allowances
for the weaknesses of human nature which were Simpson's, studies the
life which was brought all too soon to a close, will recognise the
great spirit which breathed through all his life.


THE END.




APPENDIX


I.

The following is a list of Sir James Simpson's contributions to
_Archæology_. His professional writings, in the form of contributions
to the medical journals, or of papers read to various societies or
meetings, number close upon two hundred.

1. "Antiquarian Notices of Leprosy and Leper Hospitals in Scotland and
England." (Three papers read before the Medico-Chirurgical Society,
March 3, 1841.) _Edinburgh Medical and Surgical Journal_, October,
1841, and January and April, 1842.

2. "Notice of Roman Practitioner's Medicine Stamp found near Tranent."
Royal Society of Edinburgh; Dec. 16, 1850.

3. "Ancient Roman Medical Stamps." _Edinburgh Journal of Medical
Science_, Jan., March, April, 1851.

4. "Was the Roman Army provided with any Medical Officers?" Edinburgh,
1851, private circulation.

5. "Notes on some Ancient Greek Medical Vases for containing Lykion;
and on the modern use of the same in India." Edinburgh, 1856.

6. "Notice of the appearance of Syphilis in Scotland in the last years
of the fifteenth century." 1860.

7. "Note on a Pictish Inscription in the Churchyard of St. Vigeans."
Royal Society, April 6, 1863.

8. "Notes on some Scottish Magical Charm-Stones or Curing Stones."
_Proceedings of Antiquarian Society of Scotland_, vol iv., 1868.

9. "An Account of two Barrows at Spottiswoode, Berwickshire, opened by
the Lady John Scott." _Proceedings of Antiquarian Society of
Scotland_, vol iv., 1868.

10. "Did John de Vigo describe Acupressure in the Sixteenth Century?"
_British Medical Journal_, Aug. 24, 1867; _Medical Times and Gazette_,
1867, vol. ii., p. 187.

11. "Account of some Ancient Sculptures on the Walls of Caves in
Fife." 1867.

12. "Notices of some Ancient Sculptures on the Walls of Caves."
_Proceedings of the Royal Society_; Edinburgh, 1867.

13. "Cup-cuttings and Ring-cuttings on the Calder Stones, near
Liverpool." 1866. _Transactions of the Historical Society of
Lancashire and Cheshire._

14. "Archæology--its past and its future work." Annual Address to the
Society of Antiquarians of Scotland, January 28, 1861.

15. "The Cat Stane, Edinburghshire." _Proceedings of the Society of
Antiquaries, Scotland_, 1861.

16. "Archaic Sculpturings of Cups, Circles, &c., upon Stones and Rocks
in Scotland, England, and other countries." 1867.

17. "Is the Pyramid at Gizeh a Meteorological Monument?" _Proceedings
of the Royal Society_; Edinburgh, 1868.

18. "Pyramidal Structures in Egypt and elsewhere." _Proceedings of the
Royal Society_; Edinburgh, 1868.

19. "Cell at Inchcolm."

The above list is founded on that given by Professor Gusscrow in his
"Zur Erinnerung an Sir James Y. Simpson." Berlin, 1871.


II.

On _post mortem_ examination the following observations on Sir James
Simpson's head were made:--

  Skull--circumference round by occipital protuberance and below
        frontal eminences, 22-1/2 inches.
        --from ear to ear, 13 inches.
        --from occipital protuberance to point between superciliary
        ridges, 13 inches.
  Brain--weight of entire brain (cerebrum and cerebellum) was 54
        ounces; the cerebellum, pons, and medulla oblongata weighed
        5-1/4 ounces.

The convolutions of the cerebrum were remarkable for their number,
depth, and intricate foldings. This was noticed more particularly in
the anterior lobes and the islands of Reil.

Extract from _British Medical Journal_, May 14, 1870.




INDEX


  A

  Academy of Sciences (France), 194
  Acupressure, 173
  Adam Street, Simpson's lodgings in, 20, 30
  Addresses, Graduation, 74-77, 200
  Alcohol as an anæsthetic, 93
  Alison, Professor, 56, 59, 73, 148
  America, United States of, and anæsthesia, 83, 96, 199
  Anæsthesia, 88, 178
    opposition to:
      (1) medical, 113
      (2) moral, 120
      (3) religious, 123.
    Discovery of, 88
    results of, 130
  Antiquarians, Scots Society of, 8, 71, 156
  Appendix, 223
  Archæological works, Simpson's, 223
  Archæology, 4, 8, 152, 223
  Argyle, Duke of, 217
  Arts, curriculum of, 14, 19, 20
  Aytoun, 27


  B

  Baden, Princess Marie of, 69
  Ballingall, Professor, 60
  Baronetcy, Simpson's, 190
  Bathgate, 4, 7, 8, 34, 142
  Bell, Sir Charles, 60, 61
  Bennet, 42
  Bigelow, Dr., of Boston, 198, 214
  Blantyre, Lord, 80
  Boerhaave, 134
  Boston, U.S.A., 97, 98, 199
  Braid, Dr., 95
  Brewster, Sir David, 27, 192
  British Medical Association, 188
  _British Medical Journal_, 176, 177, 188, 225
  Bruce, Robert, 72
  Brunton, Dr. Lauder, 148
  Burke and Hare, 23
  Bursary won by Simpson, 20


  C

  Carstares, William, 192
  Catstane, the, of Kirkliston, 8, 155
  Chalmers, Dr., 27, 125
  Cheselden, 122
  Cheyne, Mr. Watson, 184
  Children, Simpson's, 85, 207
  Chirurgeons, incorporation of, 58
  Chloric ether, 99
  Chloroform, 215, 221, 219
    discovery of, 105
    composition described by Dumas, 106
    Flouren's experiments, 106
    discovery of properties, 106
    used in obstetrics, 108
    Simpson's opinion of, 111
    administration, teaching of, 130
  Christison, Professor, 56, 59, 84, 148, 188, 195
  Clark, Sir James, 129
  Clover, 130
  Cockburn, Lord, 23, 27
  College of Physicians, Edinburgh, 53, 58, 189
  Cooley, Mr., 97
  Cooper, Bransby, 123
  Crest, Simpson's, 192
  Cullen, 2, 27, 41


  D

  Davy, Sir Humphry, 95, 96, 219
  Dawson, Dr., 69
  De Quincey, 127, 128
  Disruption, the, 85
  Doctor of Medicine, degree of, 38
  Dumas, 106
  Dunbar, Professor, 18
  Duncan, Dr. Matthews, 105
  Duns, Dr., 34, 162, 196, 207
  Du Potet, 94


  E

  Edinburgh, 17, 27, 197
  _Edinburgh Medical and Surgical Journal_, 52, 72
  Education, Simpson on, 199
  Elliotson, Dr. John, 94, 95
  _Encyclopædia Britannica_, 198
  Erskine House, Simpson's visit to, 80
  Esdaile, Dr., 95
  Ether, 99, 104, 112
  Evangelical work, Simpson's, 209
  Extra-mural Medical School, Edinburgh, 26, 31


  F

  Faraday, 96
  Fohman, Professor, 45
  Forbes, Edward, 41
  Foreign tour, Simpson's, 43-46
  Free Church, 85
  Freedom of Edinburgh city, 197
  Funeral, Simpson's, 216


  G

  Gairdner, Dr., 37
  Girdwood, Dr., 37
  Gladstone, Mr., 215
  Goodsir, Professor, 42
  Graduation addresses, 74-77, 200
  Graham, Professor R., 59, 148
  Grant, Sir Alexander, 195
  Gregory, Dr., 32, 33
  Grindlay, Miss Jessie, 46, 55, 57
  Grindlay, Mr., 46, 61, 68
  Gusserow, Professor, 113, 170, 225
  Gynæcological Society of Boston, 199
  Gynæcology, 86


  H

  Hahnemann, 147
  Hamilton, Duchess of, 69
  Hamilton, Professor James, 32, 40, 56, 59, 69, 163,
        169
  Hamilton, Sir William, 27
  Health, Simpson's, 210
  Henderson, Professor, 148
  Home, Professor James, 59
  Homoeopathy, 74, 147
  Hope, Thomas, 56, 59
  Hospitalism, 177-184
  Hospitality, Simpson's, 81-83
  Hotels, the Edinburgh, and Simpson, 163
  Houghton, Lord, 213
  Hutchinson, Mr. Jonathan, 219
  Hypnotism, 94, 149


  I

  Imperial Academy of Medicine (France), 189
  Indian hemp, 92
  Infirmary, Royal, of Edinburgh, 31, 109, 177, 178, 187


  J

  Jackson, Dr., of Boston, U.S.A., 96
  James VI., 192
  Jameson, Professor R., 59
  Jeffery, Lord, 27
  Jenner, 119, 145


  K

  Keiller, Dr., 30
  Keith, Dr. George, 105
  Kennedy, Dr. Evory, 61, 63
  Knox, Robert, 23, 24, 25, 26, 28


  L

  _Lancet_, the, 95, 169, 191, 218
  Laughing-gas, _vide_ nitrous oxide
  Laycock, Professor, 186
  Leighton, Archbishop, 193
  Leprosy and leper-houses, 70
  Lippi, 45
  Lister, Lord, 176, 179, 184, 188
  Liston, Professor, 26, 31, 91, 95, 104, 151
  Lizars, John, 26
  London, Simpson's journeys to, 80, 187, 213
  Long, Dr., of Athens, U.S.A., 96
  Lycium, the, of the Muses, 154


  M

  MacArthur, Mr., 20, 21, 22, 26, 39
  Macintosh, Dr., 55
  Maclagan, Sir Douglas, 43
  Maclaren, Mr. Duncan, 61
  _Maga_, the university, 41
  Mandrake, 93
  Master of Arts, the degree of, 19
  Medical faculty, the, 57, 59, 60, 187
  Medical Reform Act, the, 187
  Medical student, the Edinburgh, 33
  _Medical Times and Gazette_, the, 184
  Medicine, condition of, at Simpson's birth, 1-3
  Medico-Chirurgical Society, the Edinburgh, 189
  Meigs, Professor, 117
  Melbourne, Lord, 28, 73
  Mesmerism, 94, 149
  Midwifery, 3, 32, 39, 40, 53, 86, 104
  Midwifery Chair, 55-65, 188, 215
  Midwifery class, Simpson's, 67
  Miller, Professor, 106, 109, 186
  Moncrieff, Lord, 27
  Monro (Primus), 57
  Monro (Secundus), 56
  Monro (Tertius), 23, 59
  Montgomery, Dr., 140
  Monthyon Prize, the, 190
  Morton, W. T. G., 97, 98, 129, 132, 198


  N

  Napier, Lord, of Magdala, 197
  _Nepenthe_, 93
  Newhaven, 143, 196
  Nitrous oxide gas, 97
  North, Christopher, 18
  Nunn, Mr., 123


  O

  Oineromathic, the Society, 42
  Oxford, D.C.L., degree of, 192, 212


  P

  Paré, Ambroise, 90
  Pathology, 39, 53, 55, 73, 74
  Petroleum, 84
  Physician-Accoucheur to the Queen, Simpson appointed, 86
  Pillans, Professor, 18
  _Post mortem_, 225
  _Practitioner_, the, 184
  Principalship, the, of Edinburgh University, 192
  "Prometheus," 218
  "Puck," 138


  Q

  Queen Street, No. 52, 78, 81, 105, 137
  Queen, the, 17, 86, 129, 190


  R

  Reform, medical, 187
  Reform, university, 187
  Regents, the, of Edinburgh University, 192
  Reid, Professor John, 18, 20, 21, 22, 25, 26, 39,
        41, 42, 55, 207
  Religious views, Simpson's, 203
  Rinderpest, epidemic of, 185
  Rollock, the Regent, 192
  Roman army, the, 156
  Royal Medical Society, 41, 52, 53
  Royal Physical Society, 41
  Russell, Lord John, 27, 190


  S

  _Scots Observer_, the, 82
  _Scotsman_, the, 61, 142
  Scott, Sir Walter, 27, 124
  Senatus Academicus, the, of Edinburgh University, 29, 186,
        194.
  Simpson, Alexander, 10, 37, 40, 61, 205, 215
  Simpson, David, 5
  Simpson, David (secundus), 37
  Simpson, David (tertius), 191, 210
  Simpson, Lady, 191, 216, 217
  Simpson, Mary, 10
  Simpson, Miss E. B., 138, 202, 214
  Simpson, Mrs., 5, 6, 204
  Simpson, Professor A. R., 51, 86, 164, 219
  Smallpox, 184
  Snow, Dr., 130
  Snowball riot, the, 42
  Sound, the, 168
  Squabbles, Simpson's, 78
  Stafford House, Simpson's visit to, 80
  St. Bartholomew's Hospital, 151
  Stevenson, R. L., 80
  Storer, Dr., 217
  Student, the Edinburgh medical, 33
  Superstitions, 4, 5, 12
  Surgery at Simpson's birth, 3
    before anæsthesia, 88-91
    after anæsthesia, 131
  Sutherland, the Duchess of, 80, 86
  Syme, Professor, 26, 31, 60, 61, 73, 114, 175, 130,
        140, 148, 151, 186


  T

  Thatcher, Dr., 37, 63
  Thesis, Simpson's, for M.D. degree, 39
  Thomson, Professor, 39, 60, 72
  Town council of Edinburgh, the, 28, 58, 60, 63, 65, 73,
        188, 192
  Traill, Professor, 60


  U

  Universities (Scots) Act, 188, 193
  University of Edinburgh, 14, 18, 26, 28, 31, 130


  V

  Verses, Simpson's, 33, 202
  Viewbank, 143, 211


  W

  Waldie, Mr., 105
  Wallace, Professor, 18
  Warren, Dr. J. Collins, 102
  Warriston cemetery, 216
  Weavers, the, of Bathgate, 8, 9
  Wells, Horace, 97, 132, 198
  Wesley, John, 71
  Westminster Abbey, 215, 219
  Williams, Dr., of York, 213
  Wilson, George, 42
  Wilson, Professor John, 18, 27
  Women, medical, 188
  Wound-healing, 176


  Y

  York, Simpson's visit to, 213
  Young, Professor Thomas, 59




The Gresham Press, UNWIN BROTHERS, WOKING AND LONDON.




THE CENTURY DICTIONARY

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_A Set of 10 Volumes, each with Photogravure Frontispiece, and Map,
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  1. =SIR WALTER RALEGH.= BY MARTIN A. S. HUME, Author of "The
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        WALTER FREWEN LORD.
  3. =JOHN CABOT AND HIS SONS=; the Discovery of North America. By C.
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  4. =LORD CLIVE=; the Foundation of British Rule in India. By Sir A.
        J. ARBUTHNOT, K.C.S.I., C.I.E.
  5. =EDWARD GIBBON WAKEFIELD=; the Colonisation of South Australia
        and New Zealand. By R. GARNETT, C.B., LL.D.
  6. =RAJAH BROOKE=; the Englishman as Ruler of an Eastern State. By
        SIR SPENSER ST. JOHN, G.C.M.G
  7. =ADMIRAL PHILIP=; the Founding of New South Wales. By LOUIS BECKE
        and WALTER JEFFERY.
  8. =SIR STAMFORD RAFFLES=; England in the Far East. By the Editor.

       *       *       *       *       *

THE STORY OF THE NATIONS

A SERIES OF POPULAR HISTORIES.

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  1. =Rome.= By ARTHUR GILMAN, M.A.
  2. =The Jews.= By Professor J. K. HOSMER.
  3. =Germany.= By the Rev. S. BARING-GOULD.
  4. =Carthage.= By Professor ALFRED J. CHURCH.
  5. =Alexander's Empire.= By Prof. J. P. MAHAFFY.
  6. =The Moors in Spain.= By STANLEY LANE-POOLE.
  7. =Ancient Egypt.= By Prof. GEORGE RAWLINSON.
  8. =Hungary.= By Prof. ARMINIUS VAMBERY.
  9. =The Saracens.= By ARTHUR GILMAN, M.A.
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  12. =The Goths.= By HENRY BRADLEY.
  13. =Assyria.= By ZENAIDE A. RAGOZIN.
  14. =Turkey.= By STANLEY LANE-POOLE.
  15. =Holland.= By Professor J. E. THOROLD ROGERS.
  16. =Mediæval France.= By GUSTAVE MASSON.
  17. =Persia.= By S. G. W. BENJAMIN.
  18. =Phoenicia.= By Prof. GEORGE RAWLINSON.
  19. =Media.= By ZENAIDE A. RAGOZIN.
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  24. =The Jews under the Roman Empire.= By W. D. MORRISON.
  25. =Scotland.= By JOHN MACKINTOSH, LL.D.
  26. =Switzerland.= By R. STEAD and LINA HUG.
  27. =Mexico.= By SUSAN HALE.
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        FREEMAN.
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  38. =South Africa.= By GEORGE M. THEAL.
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        and CHARLES L. KINGSFORD.
  41. =Vedic India.= By ZENAIDE A. RAGOZIN.
  42. =The West Indies and the Spanish Main.= By JAMES RODWAY, F.L.S.
  43. =Bohemia.= By C. E. MAURICE.
  44. =The Balkans.= By W. MILLEM.
  45. =Canada.= By Dr. BOURINOT.
  46. =British India.= By R. W. FRAZER, LL.B.
  47. =Modern France.= By ANDRÉ LE BON.
  48. =The Franks.= By LEWIS SERGEANT, B.A.

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       *       *       *       *       *

WORKS BY MARTIN A. S. HUME

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Elizabeth" (Public Record Office).

       *       *       *       *       *

THE COURTSHIPS OF QUEEN ELIZABETH

With Portraits

_Fourth Edition. Demy 8vo., cloth_, =12s.=

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       *       *       *       *       *

THE YEAR AFTER THE ARMADA

AND OTHER HISTORICAL STUDIES

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       *       *       *       *       *

SIR WALTER RALEGH

Being Vol. I. of the series entitled "Builders of Greater Britain,"
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       *       *       *       *       *




Transcriber Notes

Archaic and variable spelling is preserved, including 'receptable'.

Passages in italics indicated by _underscores_.

Passages in bold indicated by =equal signs=.

Greek transliterations are surrounded by ~tildes~.