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Sir James Young Simpson
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 Grind lay—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 proximo" 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 MA9H2I2 probably prevented his uniting with the brotherhood to worship the EPOS 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, Lilge, 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 minutiae 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 Liege 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 tomorrow for Louvain, and on leaving Liege 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 via 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 4 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 welldoing; . . . 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 feet; 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 archaeological works, are valuable for the historical resume 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.

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