“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 139 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 140 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 141 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 142 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 143 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 144 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 145 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 146 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 147 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 homœopathy, 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. Homœopathic practice was founded on facts improperly interpreted, 148 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 homœopathy 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 homœopathy, 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 149 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.” Homœopathy 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 homœopathy 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. 150 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.
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 153 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 154 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 155 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 156 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 157 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 158 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 159 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 160 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 161 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 162 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 163 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.
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 166 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 167 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 168 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 169 through the skin, in a manner which has now happily become a thing of the past.
His work was so pre-eminently practical that he never stopped to collect together his experiences into a scientific treatise. Although he revivified midwifery, and was one of the original founders of gynæcology, he left to aftercomers the labour of studying what he had done, and drawing the conclusions on which to strengthen the fabric of the science. His pamphlets, papers, and reports are very numerous. It would be wrong to say that modern thought has approved all that he wrote; but however much time and increased knowledge may have modified his teaching, they have not detracted from the value of his researches, discoveries, and suggestions, or from the stimulating influence of his work upon contemporary practice and thought.
As a lecturer and teacher Simpson succeeded as in the other branches of his work. His brilliant exposition of his subjects and his careful practical manner of teaching his young listeners doubled the fame which had begun with his predecessor, Professor Hamilton, and has ever since belonged to the Edinburgh school of obstetricians. But here again his personal attractiveness and power gained for him the greater part of his success. In the words of the Lancet, written when reviewing a posthumous collection of some of his writings, his lectures used to brighten the gloomy days of the Edinburgh winter; in perusing the 170 publication under review, Edinburgh men would “almost think they saw the big head and face of the great obstetrician, as they used to see him beaming with satisfaction or twinkling with genial humour as he told a good story, or related a happy case, illustrative of his own bold and original practice.” Both as a lecturer and as a bedside teacher he captured his students by the charm of his diction, the wide range of his knowledge, and as Professor Gusserow has pointed out in his masterly memoir, by his peculiar talent of having his knowledge at his fingers’ ends, and that often in very remote details.
Year by year he never failed to obtain the affection of his students; scarcely a man that had been taught by him but would proudly boast that he was his friend as well as his teacher. He treated his large class in a confiding spirit—not as the superior person delivering ex cathedrâ utterances, but as the friend rejoicing in his function of admitting those around him into the knowledge in which he seemed to revel. He had a happy method of getting on good terms with his audience before proceeding to the serious business of the lecture. When his health began to fail he was sometimes unwillingly laid aside, and the lectures were delivered by a substitute. On one occasion he re-appeared pale, weak, and lame, after such an enforced holiday, and was greeted enthusiastically by a crowded class. He told them that his servant had said to him that a rumour was 171 abroad that he was in Morningside Asylum. He had asked what answer he had made, and heard that he had replied that so far from being wrong in his mind his master was writing a book in bed. While he did not say that this answer was strictly correct, he was happy to assure them, his pupils, that he was quite right in his mind, although a friend had hinted that morning that he was rather weak in his understanding!
Old fellow-students meeting each other in after life as staid practitioners take pleasure in recalling the idiosyncrasies and peculiarities of their teachers; it is probable that no professor has ever been talked over with the appreciation which breathes through the reminiscences of Simpson conjured up by those whom he taught.
Simpson left his mark in other departments besides those of the subject of his professorial chair and of anæsthesia. About ten years after the introduction of chloroform he turned his attention to the process of wound-healing—the repair of necessary wounds inflicted by surgeons in the course of their work—and although he was promptly told to go back to his midwifery, he worked persistently at the subject. In those days the subject was the most burning one in surgery and the methods employed to bring about successful results varied in different schools. The object of all methods was the same, viz., to obtain a healthy, clean, and sightly result after an operation; to leave the part which had been of necessity cut in a condition 172 as nearly as possible approaching that in which it had been found, without the incidence of any of the too frequent grave complications. Surgeons did not recognise at first the power of nature to effect for them what they strove after; they thought to attain their object by compelling the tissues to heal as they desired by complicated applications, and many were the layers of ointments and masses of dressings heaped on wounds for this purpose. For a long time all efforts were directed to the discovery of some specific substance, the application of which would give the necessary impulse towards healing in the desired manner. Before Simpson’s day it had been generally recognised that the cause—but its nature was quite undreamt of—of the trouble lay in the air surrounding the wound, and more dressings were piled on to keep out the air. But at the same time bleeding was arrested by tying the cut arteries with ligatures—chiefly silken—and these were left with long ends hanging out of the wound to work their way out by a process of ulceration, or irritation of the tissues until liberty was obtained. This process was practically incompatible with the ideal form of healing, known as healing by first intention, i.e., union without appreciable loss of substance or the formation of pus or matter. So-called “surgical fever,” secondary hæmorrhage, and blood-poisoning were the frequent fatal results of operation wounds treated in this manner. Simpson and others thought to prevent these alarming diseases by devising other means of closing the arteries; 173 thinking that if some method or material were used, which nature resented less, the wound would more readily close by first intention. In 1858 Simpson stated that he had for some time past been experimenting with substitutes for the ordinary silk and thread ligatures, and in the course of his experiments had made use of iron, silver, and platinum wires. In his usual way he hunted up old authorities, and found a record of both silver and gold threads having been experimentally used by bygone practitioners. He seems to have been pleased with his results, stating that he found the tissues much more tolerant of these metallic ligatures than they were of the ordinary organic ones; that only “adhesive inflammation,” not ulcerative suppurative inflammation, was excited. This success, however, was probably due to the superior cleanliness of the metal, but this he did not recognise; had he done so he might have been led to strive after surgical cleanliness, and have partly anticipated the great work done subsequently by others. He went off, however, on a different line, and searched for some readier method of using metallic means of closing the blood vessels, being stimulated by the desire to abolish ligatures altogether. Thus he was led, after ten years’ careful research, to the introduction of a method entirely original—that of Acupressure. This consisted in the introduction of a fine needle through the tissues across the course of the artery, so that while the needle pressed upon one side of the artery the resisting tissues 174 of the body exerted counter-pressure on the opposite side. He claimed for his method the merits of simplicity, elegance, and cleanliness, and urged that not only did the tissues tolerate the needle as they did not tolerate silk or hemp, but that unlike the ligature the needle could be withdrawn as soon as nature had closed the blood vessel by the process of coagulation of the blood within it set up by the pressure; thus the prolonged irritating presence of a body within the wound which delayed healing until it had ulcerated its way out was rendered unnecessary, and a better and more rapid result was attained. He verified his theoretical considerations by experiments on animals and in one or two operations on the human subject, and in 1859 read a communication on the subject to the Royal Society of Edinburgh.
The paper was written under great pressure of work, indeed he stated that at that time he was hardly ever able to write except when himself “confined”; it was hastily prepared to take the place of that of another Fellow which had failed to be forthcoming a few days before the appointed meeting. It was composed at a country house where he had to sleep for two or three nights watching a case of diphtheria. It was headed as usual by a Shakspearian quotation, this time briefly in Justice Shallow’s words, thus:—“Tut, a pin!” On the evening of its delivery an abstract of the paper was forwarded to the leading surgeons in England, Europe, 175 and America, and diverse were the opinions expressed.
In Scotland the new method met with the greatest favour and the strongest opposition at one and the same time. Throughout Europe and America it was everywhere received with applause and support. Excellent results were obtained when the method was properly applied, but technical considerations, particularly the difficulty of using it upon blood vessels far removed from the surface, rendered it unsuitable for universal application.
Professor Syme met the innovation with vehement opposition; possibly he resented this intrusion of the gynæcologist into the regions of general surgery. He took into his class-room one pamphlet on the subject by Simpson, which had especially aroused his wrath; he stormed at the author before his students for “his vulgar insolence,” and then, in a dramatic scene, expressed the violence of his contempt by savagely tearing the pamphlet into pieces and casting it away. In a subsequent controversy between these two old opponents, who had been temporarily united by Simpson’s conduct in consulting Syme professionally, by their joint action against homœopathy, and by Simpson’s defence of Syme when publicly attacked by an English surgeon, the feud was renewed.
Simpson persisted for years in collecting reports of operations in which acupressure was employed, and published them from time to time in the British 176 Medical Journal and elsewhere. In 1864 his work on the subject took the form of a volume containing 580 quarto pages. His friends endeavoured to rank acupressure with chloroform as one of the blessings to humanity made manifest by him. He himself recognised that he had failed to gain for acupressure a place in practice such as he had gained for chloroform, but he looked forward to a time, perhaps a quarter of a century distant, when his method would be beginning to be thought about. In this he was mistaken for, on the contrary, acupressure was beginning to be forgotten long before twenty-five years had elapsed. Another worker on more strictly scientific lines had by that time made healing by first intention, without complications, the rule instead of the exception, and conferred a benefit on humanity as great if not greater than that of anæsthesia. In 1867, while Simpson was still alive, Mr. (now Lord) Lister (then a hospital surgeon in Glasgow, and subsequently Syme’s successor in Edinburgh) enunciated the new principle of “antiseptic surgery,” which recognised the living infective micro-organisms of the air as the cause of the trouble in wounds. He directed that as these invisible organisms (known only by means of the microscope) were present everywhere in the air, found their way into all sorts of wounds, and set up the decomposition which led to disastrous results, they were to be destroyed or excluded from wounds; and he suggested effective means of accomplishing this end. He further abolished 177 the long ligatures which irritated by their presence, and by the organisms they conveyed into the wound when imperfectly cleansed as they usually were; and substituted non-irritating ligatures which nature herself was able to remove by the process of absorption. The recognition of this antiseptic principle effected a much needed revolution in surgery, and in this revolution acupressure was practically annihilated. Simpson did not live long enough to see the complete establishment of the Listerian principle; at first he vigorously opposed what he considered to be an attempt to retain the old-fashioned ligatures in preference to his new acupressure; but with his penetrative eye he must have foreseen that should the new practice prevail and short absorbable ligatures be made possible, acupressure would be completely superseded.
In the estimation of the writer of the obituary notice of Professor Simpson in the British Medical Journal, the greatest of all his works was that undertaken in the subject of Hospitalism. As early as 1847 he had been horrified to read in a report of the work done in the Edinburgh Infirmary, that out of eighteen cases of primary amputation performed during a period of four years only two survived. He faced this fact with the courage of the reformer, and sought far and near for other facts to support the theory which he gradually evolved, that this melancholy failure of surgeons to save their patients’ lives was due not so much to the operation or the operator 178 as to the environment of the patient. In later years he himself often shrank, on account of unfortunate experiences, from performing capital operations which he had formerly unhesitatingly undertaken. The unhealthiness of hospitals had long been recognised; and was especially observed at times when they were overcrowded, as happened during war time. When the public had thoroughly grasped the utility of anæsthetics, and recognised that operations could be performed painlessly, there were fewer refusals to submit to the knife; there was a rush to the hospitals, and the surgical wards throughout the length and breadth of the land became crowded with men and women actually longing for operation. Amongst these all the dreaded sequelæ of surgical interference, which no power seemed able to check, ravaged with alarming severity.
It is to Simpson’s credit that he perceived how the introduction of anæsthesia had taxed the hospitals and bewildered the operators, who sought diligently but unsuccessfully in every direction for some means of reducing hospital mortality. He was one of the first to set to work with method to investigate this question of Hospitalism.
It was towards the end of his career, when the old Edinburgh Infirmary stood condemned, and various proposals for rebuilding it on a new site and improved plan were under discussion, that his voice was most loudly heard. For many years he had thought and 179 taught that the great mortality after operations in hospitals was due to the impure state of the air therein, derived from the congregation of a large number of sick persons under one roof. He picturesquely stated that the man laid on a hospital operating table was exposed to more chances of death than the English soldier was on the field of Waterloo. His original suggestion was that hospitals might be changed from being crowded palaces, with a layer of sick on each floor, into villages or cottages, with one, or at most two, patients in each room; the building to be of iron, so that it could be periodically taken down and reconstructed, and presumably thoroughly renovated. This drastic proposal brings nowadays a smile to the lips, for we see now how he was groping in the dark; but the magnitude of it is but the shadow of the evil it was designed to cure. The change was so great as to be impracticable in the eyes of most men; he, on the other hand, contended that it was to be of incalculable benefit to humanity, and, therefore, no difficulty, however great, should be allowed to stand in the way. He did not understand that the evils arose not from the air itself but from what was in the air, known to us now as the micro-organisms. His remedy was a proposal to run away from the evils without receiving any guarantee that they could not and would not successfully pursue. Had Lister not arisen, Simpson’s proposals might have possibly prevailed, for he laboured with all his persistent energy.