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Sir James Young Simpson
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 confreres 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 blackboard 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 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 archaeology. 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 foiled 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 , 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 i 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 úvery 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 overtaking 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 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 gynaecology, 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 gynaecology. He had done this before the great deed was dreamt of which hands his name down to posterity, before his discovery of the anaesthetic 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 B lantyre, where he says, "the Duchess of Sutherland, the Marquis and Marchioness of Lome, 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 beautifid it looks. Rowans and 4 haws' are often worn beaded into crowns or flowers or chaplets. Heather is also a favourite. On Thursday Lady Lome 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 anaesthetics, 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. Gynaecology, 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 experiments proved that petroleum was vastly superior\p 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 5 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 gynaecology, 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 or 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.

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