_LISTON, SYME, LIZARS, AND THE NEWER SURGERY._
Among operating surgeons few names take higher rank than those of
Liston and Syme, at one time close associates in private medical
teaching at Edinburgh, at a later period jealous rivals and even
antagonists, but happily again warm friends before the sudden end
of the elder. ROBERT LISTON was born on the 28th October 1794,
his father being the Rev. Henry Liston, minister of Ecclesmachan,
Linlithgow, whose accomplishments included a considerable
acquaintance with the theory of music, and who wrote a treatise on
Perfect Intonation in addition to inventing an organ calculated to
produce the desired intonation. He was educated chiefly by his father
up to the age of fourteen, and afterwards attended classical and
mathematical lectures in Edinburgh University during two sessions,
obtaining a prize for Latin composition in the second. At this period
of his life he exhibited great fondness for the sea, and was only
induced to give up his desire to become a sailor by a promise that if
he would study medicine he should eventually be a naval surgeon if he
wished. His taste for a seafaring life never forsook him; and one
of the relaxations which he most enjoyed up to within a few weeks of
his death, was sailing in a yacht which he kept on the Thames. He was
also very fond of field-sports.
In 1810 Liston commenced medical study as the pupil of Dr. Barclay,
the well-known anatomical lecturer. He soon became noted by his
instructor for his zeal and untiring assiduity, and he eventually
chose him as his assistant and prosector, an office he retained
until 1815. It was thus that Liston acquired the foundation of his
remarkable knowledge of surgical anatomy, which his later experience
strengthened, and to which he added a dexterity in the use of
surgical instruments, and especially the knife, which was unsurpassed
in his time.
In 1815 Liston became surgeon’s clerk or house-surgeon in the
Royal Infirmary of Edinburgh, in which capacity he availed himself
fully of the opportunities for making _post mortem_ examinations,
which were then performed by the house-surgeons. In 1816 he went
to London, and studied several months at St. George’s Hospital,
and also attended some of Abernethy’s lectures. In 1817, having
taken the diplomas of the College of Surgeons both in London and
Edinburgh, he began practice in Edinburgh, and again assisted Dr.
Barclay in his anatomical teaching. But misunderstandings arising
between them, Liston left Barclay and commenced to lecture on his own
account at the beginning of the session 1818-19, James Syme becoming
his assistant. In 1823 Liston gave up teaching anatomy in favour
of Syme, in order to devote himself entirely to surgical teaching;
but Liston retained a large share of the proceeds of the anatomical
lectures, as the originator and more important proprietor of the
joint school. This arrangement did not last long, Syme withdrawing to
Brown Square in 1824: and it appears that Liston is, at least equally
with Syme, open to the charge of having displayed serious jealousy in
this matter. They were unavoidably serious rivals, too nearly equals
in power, and perhaps too conscious of their own individual claims,
to be able to view with equanimity each other’s proceedings and
advancement.
Liston had published a little book on the Surgical Anatomy of Crural
Hernia (1819), and soon acquired fame by performing several brilliant
operations, difficult amputations, ligatures of arteries, lithotomy,
&c. At that time there were many defects in the management of the
Royal Infirmary, and Liston set to work, young as he was, to agitate
for their removal. Unfortunately he did not make any attempts to
conciliate the managers in so doing, and his outspoken complaints
were met with bitter opposition from some of the surgeons as well as
managers. He entered into the spirit of controversy which Dr. Gregory
had done so much to foment, and in which so much of the talent and
time of Edinburgh men was then wasted. In 1821 Liston records that
he was almost daily applied to by patients from the Infirmary who
had failed to secure relief from the surgeons, and he was exposed
to the charge of decoying patients thence. It was even demanded
of him, on pain of perpetual exclusion from the surgeoncy to the
Infirmary, that he should refuse his professional assistance to any
person who had been a patient there. He naturally refused to comply
with any such condition, nor would he absent himself from attendance
on the Infirmary practice, as was also suggested. It is fair to say
that Liston courted the fullest investigation of his actions, and
denied that he had ever directly or indirectly insinuated to any
patient of the Infirmary that the practice followed there was bad,
or that he himself knew better, or had in any way tried to entice
patients away. But he did complain of the tedious and often injurious
delay which took place before patients were operated upon, and the
unsatisfactory result of many of the operations; while he himself
had undoubtedly cured many discharged as incurable, or imperfectly
relieved. The young surgeon showed so vigorous a front that great
efforts were made to make the most of any imprudences he committed,
and to deter students from attending his classes, especially by hints
that they would come off very badly before the College of Surgeons
if they did. Strange that he who now maintained so bold an attack
upon convention and authority, should have shown such jealousy of
his former demonstrator, Syme, and have endeavoured by manner, and
more than manner, to repress and depreciate a still younger man’s
skill. This was but one of the many inconsistencies and difficulties
that Liston’s consciousness of his own powers and his abrupt and
somewhat rough manner of dealing with differences of opinion led him
into. Nevertheless the scathing charges of incompetency which Liston
brought against some of the surgeons then in office, and supported in
detail, were sufficient to prove to the managers that Liston was no
ordinary young man, but must be allowed a full field for his talents;
and consequently gaining increasing fame as a lecturer on surgery,
and attracting large classes of students, Liston in 1828 became one
of the surgeons to the Royal Infirmary.
But Liston’s interest was insufficient to gain him the Professorship
of Surgery in the University when it fell vacant, and he gladly
accepted the offer of the Surgeoncy to the North London Hospital
with the Professorship of Clinical Surgery in University College in
1834. His transfer to London was a striking success. He had already
published, in 1833, his “Principles of Surgery,” which went through
several editions. Its clearness, simplicity, and homeliness of style
made it popular, and well calculated to widen his fame. Unornamental
almost to a fault, and perhaps deficient in illustration, he gave
much practical information, and definitely elucidated his subject.
His “Practical Surgery,” published in 1837, chiefly giving the
results of his own experiences, was still more popular. His brilliant
talents, however, were those of an operator. It was said of him that
he possessed every qualification for success in this department,
great physical strength and activity, coolness, promptitude, energy,
and unflinching courage, a steady hand and a quick eye, a resolution
which rose with the difficulties he encountered, and rested on a just
reliance on his complete knowledge of anatomy and pathology. Yet the
brilliant operator was not over anxious to exhibit his talents; he
was often considered remarkably cautious. His deliberation was as
marked before undertaking an operation as was his fearlessness when
it was undertaken. His readiness and resource under the most varied
and difficult combinations of circumstances were surprising. He
excelled in irregular operations in which no well established mode of
procedure could be followed, but he had to depend on the decision of
the moment as to the particular case. He knew exactly what he meant
to do and how to do it, and this without delay or hesitation. Thus he
won the reputation of being the most dexterous operator of his day.
In addition to his “Surgery” Liston published numerous valuable
papers on amputation, difficult cases of aneurism, tracheotomy,
lithotomy, and lithotrity. He left his impress on a very large
number of operations, either devising new methods of meeting old
difficulties, or improving the accepted modes of dealing with them.
He invented an improved shoe for the treatment of club-foot, and
was great at reducing dislocations. He once succeeded in reducing a
dislocated hip-joint after the dislocation had continued no less
than two years. He introduced the method of reducing dislocated
phalanges, especially of the thumb, by passing the ring of a
door-key over the part and hitching it against the projecting end
of the bone, so that extension and pressure could be brought to
bear simultaneously. After dislocation of the thigh backwards, he
several times took advantage of the immediate powerlessness of the
muscles from shock, and reduced the limb on the spot without the
use of pulleys or even without the aid of an assistant. He invented
or modified splints for broken limbs. His methods of performing
amputations by flaps became very largely adopted. He had great
success in what are known as plastic operations, such as restoring
a nose by taking a flap from the upper lip. His name is scarcely
more associated with amputations, however, than with lithotomy and
lithotrity, to which he devoted great attention. Many of his lectures
on those subjects were published in the _Lancet_ and were widely read.
Much importance has been assigned to Liston’s personal strength as
constituting a large element in his operative successes. His hand and
arm, it was said, might have furnished models for a Hercules, and
their power was not unfrequently shown in operations requiring great
muscular exertion. But he was equally successful in those in which
the most delicate manipulation was demanded. His decision and force
of character were equal to the accurate control over his powerful
yet adaptable muscles. He would amputate the thigh single-handed,
compress the artery with the left hand, using no tourniquet, and do
all the cutting and sawing with the right, with only the aid of a
house-surgeon to hold the limb and tie the ligatures on the arteries.
He did not need time for reflection; his actions were prompted by
a kind of intuition akin to genius; he seemed to comprehend at a
glance the requirements of any particular case. Yet he never gave up
his habit of studying anatomy, spending as many hours as possible in
actual dissection.
One of Liston’s striking exhibitions of decision and invention
occurred during an amputation of the thigh by Russell, then Professor
of Clinical Surgery at Edinburgh. An artery in the cut bone bled
profusely, and in consequence of its bony surroundings could not be
tied in the ordinary way. Liston with the amputating-knife at once
cut off a chip of wood from the operating table, formed it into
a cone, and drove it into the bleeding orifice, and in this way
immediately arrested the bleeding.[2]
Liston’s general principles of treatment are also worthy of note,
as he exercised by their means a considerable influence on the
profession. He early became alive to the unwisdom of over-treatment,
and tended more and more to trust to natural recuperative powers. He
was thus enabled to dispense with the multitudinous paraphernalia
which surrounded the operating surgeon, the repeated poulticing,
strapping, bandaging, anointing, which often rendered a stay in a
surgical ward almost intolerable.
On the death of Sir Anthony Carlisle in 1840, Liston was elected to
the Council of the Royal College of Surgeons, but did not become one
of the Examiners until March 1846. There is little doubt that he
would before long have attained the Presidency of the College, had
not his career been cut short. His practice became very large, and
there is no doubt that he undertook an amount of work which many men
would have found impossible. Yet he was noted for his consideration
of the poor and necessitous. It was remarked in the _Times_ after
his death that “his nature abhorred everything sordid, and no man
ever was more strongly impressed with the feelings of an honourable,
generous, and independent practitioner. In whatever rank of life the
‘case’ occurred, if it was one of difficulty or interest, this master
of his art was ready with the potent spell of his unerring bistoury,
and his reward was in the consciousness of his own power, and in the
noble pride of having been ministrant to the relief of suffering
humanity. His manner in ordinary society was sometimes complained of
as harsh or abrupt, and he certainly was occasionally neglectful
of the mere trifling courtesies of life, and sometimes careless of
refinement or punctilio. He was a man of thought more than of show.
He could not bear triflers, and he did not always avoid showing
his distaste. He was a fervid lover of truth and sincerity, and
sometimes, perhaps, expressed himself too strongly when he thought
there lurked any meanness or deceit or affectation. But in the proper
and trying scene of the labours of the medical man—in the chamber of
the sick—he was gentle as he was resolute. He never had a patient who
was not anxious to become a friend, and the voice which was sometimes
discordant amid the petty annoyances of daily life was music to the
sick man’s ear. Into the scene of suffering he never brought a harsh
word or an unkind look, and the hand which was hard as iron and true
as steel in the theatre of operation was soft as thistle-down to the
throbbing pulse and aching brow. It may also be added, with perfect
truth, that in the exercise of his arduous duties, among persons of
the highest rank and most fastidious sympathies, his delicacy and
forbearance were as remarkable as the sound sense which regulated all
his professional conduct. His heart was in his business.”
Liston was warm in his friendships though strong in his dislikes. He
did not readily take to strangers. It is to be noted that he became
frankly reconciled to Syme after their serious divergence. He took
the initiative finally in 1839, and a genial correspondence took
place between them. They met once more in the autumn of 1847, when
Liston visited Edinburgh, and were often together. Liston dined with
Syme at Millbank the day after his arrival in Edinburgh, and again
the day before he left for London. Before very long, however, Liston
was carried off by aneurism of the aorta, which must have existed
for years, and been fostered by his great physical exertions, which
characterised his recreation as well as his work. It had been found
impossible to diagnose his ailment with certainty till some little
time before his death, which came with startling suddenness upon
the medical world and the public generally. He died on December 7,
1847, aged 53, and was buried at Highgate Cemetery. A body of 400
students and a large number of medical men attended his funeral. He
left a widow and a family of six children, two of whom were sons.
One of these, however, died very soon after his father. In the
following May Lord Brougham delivered a glowing eulogy on Liston at
the distribution of prizes at University College. A sum of about
£700 was subscribed for a memorial, which took the form of a marble
statue—placed in the College—and a gold medal called the Liston
Medal, which is awarded annually for surgery at the same institution.
* * * * *
JAMES SYME, another of the great Scotch surgeons of this century,
was born in Edinburgh on the 7th November 1799. His father, a
Writer to the Signet, was of good family, but owing to unsuccessful
speculations was involved in difficulties, and left nothing behind
him. Young Syme was educated at the High School of Edinburgh,
and soon showed characteristic patience and perseverance without
brilliant parts. A certain thickness of speech, almost amounting to
an impediment, strengthened the impression of shyness that he gave.
Instead of country sports, he was fond of botanising, and of making
skeletons of small animals. A similar tendency manifested itself in
his attachment to chemistry and his fondness for making chemical
experiments. Thus he was equipped with a sufficient bent towards
studies connected with medicine to render it not surprising when he
adopted the medical profession.
From 1815 onward Syme attended the University of Edinburgh, taking
both Arts and Science lectures at first. Incidentally, in the
course of his chemical pursuits, he made an original discovery of
the waterproofing process, and having first dissolved indiarubber,
was able to construct flexible tubes of it, and to render various
substances waterproof by brushing a thin solution of it into their
interstices. Not to be diverted from his medical work, Syme declined
to take out a patent, but published his method. Mr. Mackintosh of
Glasgow soon after patented a process, and Syme gained no advantage
from his discovery.
Syme’s early friendship with Liston led him to enter Barclay’s
Extra-Academical classes in the winter of 1817-18. In the next
winter, however, Syme followed Liston when he started on his own
account, and assisted him in demonstrating from the beginning. He
perseveringly continued studying, and in 1822 went to Paris to
improve himself both in anatomy and operative surgery, gaining
especial advantage from Lisfranc’s and from Dupuytren’s operations
and instructions.
While demonstrating for Liston, Syme was pursuing his medical studies
at the Royal Infirmary and elsewhere, and became impressed with the
unwisdom of the repeated and severe blood-letting then in vogue. In
1823, having become a qualified surgeon, and entering into practice
in Edinburgh, Syme performed his first striking operation—one
which he himself designated as “the greatest and bloodiest in
surgery”—namely, amputation at the hip-joint. Its success was an
earnest of his future triumphs. In the same year Liston retired from
teaching anatomy to devote himself entirely to surgery, and Syme
occupied his place. The summer of 1824 was spent in studying surgery
as practised in Germany. The same year a coldness which had been
growing between Liston and Syme caused the withdrawal of the latter
from association with Liston, and his starting a new school in Brown
Square in partnership with Dr. Mackintosh. Here Syme taught anatomy
and surgery, Dr. Mackintosh medicine and midwifery, and Dr. Fletcher
physiology. The class in surgery numbered as many as fifty students.
But the difficulties and scandals attending the due supply of
subjects for dissection gradually disgusted Syme with the anatomical
part of his work, and a quarrel with Dr. Mackintosh finally led
to his quitting the Brown Square school, and devoting himself
entirely to surgery. This was a bold stroke, seeing that he had
four or five formidable competitors in Edinburgh, including Liston,
Lizars, and Fergusson (afterwards Sir William). Yet so strikingly
was he justified by the event, that in 1828-9 his class increased
to 250, the largest ever assembled by any teacher of pure surgery
in Edinburgh. Practice had been flowing in upon him, stimulated in
1826 by an important paper on the treatment of wounds, in which
he insisted on the importance of providing a free outlet for all
discharges instead of almost hermetically sealing them up, as was so
frequently done. In 1827 he gave another evidence of his remarkable
operative skill by successfully removing a huge tumour involving part
of the lower-jaw bone, an operation which no other surgeon would
undertake. Sixteen years afterwards the patient was met with, having
his deformity well covered by a vigorous beard.
It was natural that the lack of a hospital appointment should be
keenly felt by Mr. Syme, and that he should apply for one when a
vacancy occurred at the Royal Infirmary; but his action when this
was refused to him, in view of the rivalry existing between himself
and Liston, was eminently energetic and commendable. He started a
small hospital for twenty-four patients at Minto House on his own
responsibility; but although he fortified himself with an influential
committee and received a certain amount of annual subscriptions, the
principal part of the expense throughout fell upon himself. Thus
in the first year the public subscribed £217 and Mr. Syme £779,
including £400 which he received in students’ fees. About this time,
too, he married a sister of his old schoolfellow Robert Willis,
afterwards the biographer of Sydenham, and set up a carriage. These
expenses led him into pecuniary difficulties, which were not easily
surmounted at first, but in a few years his circumstances became easy
through the rapid increase of his practice.
Syme’s clinical lectures became remarkable from the novelty of
the method he employed. It had been customary in Edinburgh to
lecture on a certain number of cases somewhat resembling each
other, without the patients’ presence or anything to emphasise the
instruction. The young innovator brought the patients one by one
into the lecture-room, questioned them, demonstrated the principal
features of their complaint, and then explained the principle of his
treatment, in the presence or absence of the patient, according to
circumstances, and finally operated, when necessary, in the presence
of the pupils. Syme was a man of few words and earnest manner; he
illustrated his remarks by few but well-chosen personal experiences,
but gave nothing superfluous; and it is not to be wondered at that
his success was marked.
Liston’s jealousy increased as the success of Minto House became
assured. In 1830 Liston wrote in the subscription book of his rival’s
hospital, “Don’t support quackery and humbug.” This led Syme to bring
an action for libel against Liston, which the latter had to settle
by apologising. In 1831, however, his exertions were successful
in gaining the professorship of surgery at the Edinburgh College
of Surgeons for his friend Lizars by a majority of one vote over
Syme. In 1832, when Liston’s practical treatise “The Elements of
Surgery” appeared, Syme also came forward with his more theoretical
“Principles of Surgery.” In 1833 Syme took advantage of a chance
which he longed for, and agreed with the retiring professor of
clinical surgery in the University (Russell) to allow him £300 a
year for life if he became his successor. This was after Liston had
refused to come to any such arrangement. When it was carried into
effect in 1833 the managers of the Infirmary felt that they must
allow the new clinical professor to have wards for clinical teaching,
notwithstanding Liston’s active opposition.
Syme’s success as a teacher followed him to the Infirmary, and pupils
crowded his wards. He was regularly present when Liston operated,
but never took any part with him. Syme’s appearance often, it is
said, excited the evident scorn of Liston, though no open hostilities
took place. The strained condition of affairs was alleviated by the
removal of Liston to London in 1835. It is satisfactory to find that
the quarrel was finally healed in 1839, when Liston wrote to Syme,
“Will you allow me to send you a copy of my last book? Write and tell
me that you wish to have our grievances and sores not plastered up,
but firmly cicatrised.” A genial correspondence followed.
We wish it could be said of Syme that all his disputes were as
happily concluded. His intimate friend Dr. Belfrage, minister of
Slateford, whom he consulted in all his difficulties, told him “he
was always right in the matter, but often wrong in the manner, of his
quarrels;” and this must be held to account in part for the number
and seriousness of the controversies in which he became involved, few
of which, however, need be referred to here. It may be questioned
whether, on numerous occasions when Mr. Syme defended himself against
attacks or brought actions for damages, he would not have done better
to content himself with appealing to his well-known character and
attainments, and living down aspersions. But Gregory and others in
Edinburgh had left an evil habit of controversy in the air; and
though Syme was more moderate than his predecessors, he often had his
hands full. Although he was himself a great improver of professional
practice, he was really a conservative in his attitude towards
other men and new methods. His opposition to Simpson’s discovery of
anæsthetics, and to his introduction of acupressure for closing cut
blood-vessels without the use of a ligature, is an example of this.
It is to be noted, however, that Syme’s numerous controversies left
no detrimental impression on the public, and did not detract from
the warmth of affection which a host of friends testified towards him.
Liston’s removal to London left Syme practically in possession of
the leading surgical practice in Scotland at the age of thirty-five.
So marked was his progress that soon after the Queen’s accession
he was appointed Surgeon in Ordinary to the Queen for Scotland. A
little later a considerable fortune was left him by an uncle, and
thenceforward he enjoyed an ease of circumstances which, while it
rendered his actions independent, was not at all detrimental to his
professional success. The good work which, in addition to operative
successes, he was accomplishing may be judged by the titles of
the papers contained in a selection from his published writings,
published in 1848. These “Contributions to the Pathology and Practice
of Surgery” included, among others, papers on senile gangrene, on
the power of periosteum to form new bone, on ulcers of the leg,
on amputation at the ankle-joint, on the treatment of popliteal
aneurism, on excision of the ankle-joint, on the contractile or
irritable stricture of the urethra, and on lithotomy. In all these
he introduced new modes of treatment or operation or propounded
new views, and many of his improvements are generally adopted. In
1847 Liston’s sudden death led to his chair at University College,
London, being offered to Syme. After anxious weighing of the question
he decided to accept the post. On his quitting Edinburgh he was
entertained at dinner by more than a hundred members of the medical
profession. Dr. (afterwards Sir Robert) Christison, who presided,
said no man had ever obtained so early in life as Syme the position
of consulting surgeon for a whole nation; and this he owed entirely
to his intrinsic merits. He referred to the collateral pursuits
with which many doctors had recreated themselves. Dr. Cullen had
his rural retreat; Dr. Gregory his Latin and polemics; Sir Charles
Bell his pencil and his rod; Mr. Liston his hunter; Mr. John Bell
his trombone. Mr. Syme had rendered his garden and conservatories
conspicuous in a land of gardeners.
Mr. Syme arrived in London in February 1848, and settled in Bruton
Street. An amusing incident occurred in connection with his first
lecture at University College. Having been accustomed to give
clinical lectures in the operating theatre at Edinburgh, which was
provided with seats, he supposed a similar arrangement obtained in
London, and announced his intention of lecturing in the operating
theatre without having previously visited it. On entering the room to
deliver his lecture, he found the students were seated inelegantly
on the rails which rise behind one another in the amphitheatre. This
attitude shocked him at first, but was soon exchanged for a more
befitting one.
Difficulties, however, arose in connection with the chair of
systematic surgery, which he was asked to undertake with that of
clinical surgery. This he felt would occupy too much time, and
require a devotion to theoretical surgery and to pathology which
did not accord with his bent. On the 7th of May some discourteous
demonstrations at the College prize distribution towards two of his
colleagues deeply wounded him; and he wrote “that the slightest
approach to any insult of the kind, whether offered in the
comparative retirement of the lecture-room or inflicted publicly with
the silent sanction of the presiding authority of the College (Lord
Brougham), would effectually incapacitate him from ever addressing
his pupils with satisfaction to himself or benefit to them.” In
three days afterwards, having declined the fresh post offered him,
he resigned that for which he had quitted Edinburgh. Fortunately
his old position at Edinburgh had not yet been filled up, and he
returned with alacrity to his familiar theatre and beloved home, his
experiment having cost him £2000. He had been well received by the
heads of the profession in London, and was rapidly gaining practice.
His own brief comment on the change from Edinburgh to London was,
that ambition made him sacrifice happiness, and that he found such a
spirit of dispeace in University College as to forbid any reasonable
prospect of comfort.
The succeeding years furnish a multitude of records of honours paid
to Professor Syme, and of distinguished successes in operating. In
1848-9 he was elected president of the Medico-Chirurgical Society of
Edinburgh, and greatly elevated the character of its proceedings;
in 1850-1 he was president of the Edinburgh College of Surgeons. For
years few numbers of the _Monthly Medical Journal_ appeared without
a lecture, case, or observation of importance from him. One of his
most striking operations was the removal of the entire upper-jaw bone
by making one incision in the cheek, with perfect success; the wound
healed without a drop of matter, and it was difficult subsequently to
trace the line of incision. The patient’s articulation remained quite
distinct. Two of his most difficult operations in 1857 were connected
with the tying of arteries for cure of aneurisms—one of the carotid,
the other of the iliac, artery. The frightful risks and the excellent
procedure by which they were successfully encountered still further
enhanced Mr. Syme’s great reputation. In 1856-7 his “Principles
of Surgery” reached a fourth edition. Its terse style and clear
exposition had rendered it a great favourite with practical surgeons.
A striking feature in it is the constant reference to fundamental
principles. It was said of him at this period, “Mr. Syme is never at
fault. Something unforeseen or unexpected may occur, but its import
is at once understood and the contingency provided for.”
At the Great Exhibition of 1862 Syme was chosen chairman of the
jury on surgical instruments. In 1863 he visited Dublin once more,
and expounded his principles before the leading surgeons, being
received there as a man of European reputation. His operations for
the relief of axillary and carotid aneurisms, as well as his bold
excision of the whole scapula for tumour, with safety and without
much loss of blood, were continually increasing his fame. In 1864
he published his work on the Excision of the Scapula, and proved
that the wound might heal quickly and soundly, and the arm remain
strong and useful. A great operation for relief of a distressing
disease by excision of a large part of the tongue was wonderfully
successful in November 1864. This was the last case Syme had time
to publish. In August 1865 he gave the address in surgery at the
meeting of the British Medical Association in Leamington. In it he
gave a graphic account of modern improvements in surgery, in which
he had himself a large share, and contrasted it with the state of
things at the beginning of his professional career. It constituted a
most valuable review of the history of surgery during the century.
Syme was the first representative at the Medical Council of the
Universities of Edinburgh and Aberdeen, and might not improbably
have been its president but for his illness and death. His last
great controversy was that known at Edinburgh as the “Battle of the
Sites.” A new hospital was required, and at first, in 1866, Syme was
strongly in favour of a new building on the old site. But further
experience of erysipelas and pyæmia in the old hospital convinced him
of the necessity of having an entirely new building in which the old
disadvantages would be absent. He consequently changed his view,
and strongly advocated the new plan, which was ultimately, in 1869,
accepted. But he did not live to see the new work begun.
In private life Syme was genial and happy, throwing off all
professional cares, quarrels, and anxieties in the home circle. His
unobtrusive religion was an essential feature of his character. He
was devoted to truth and earnest in its advocacy, and hence sprang
many of his controversies; but he had no love for controversy as
such. His domestic life was very happy, though broken at various
times by death. His first wife died in 1846: of her numerous family
two daughters only survived to adult age, one of them being now the
wife of Sir Joseph Lister. His second wife was the sister of Burn,
the architect: this union was equally happy with the former; but the
second Mrs. Syme also died before him. Her youngest child was Mr.
James Syme, the present proprietor of Millbank. This house and estate
Professor Syme decorated and improved with all that horticulture and
excellent taste could devise, and it was under his sway one of the
most charming resorts near Edinburgh. His social gatherings of eight,
ten, or twelve choice spirits were delightful, and his hospitality
was both large and discriminating.
It is pleasing to record that Mr. Syme welcomed the greatest surgical
improvement of modern times, that brought forward by Professor
Lister, his son-in-law. In 1868 he contributed a valuable paper
to the _British Medical Journal_ “On the Antiseptic Method of
Treatment in Surgery,” by which he greatly aided its progress. This
was his last year of full practice. In April 1869 he was seized with
paralysis, resigned his professorship and surgeoncy soon after, but
recovered sufficiently in the autumn to receive a testimonial in St.
James’s Hall, London (November 10, 1869), at a public dinner in which
the leaders of the profession vied with one another in honouring
him. The testimonial took the form of the endowment of a surgical
fellowship in the University of Edinburgh, in addition to the placing
of a marble bust in the Infirmary or University library. A bust was
subsequently placed in both of these situations. Syme at length died,
after repeated attacks of paralysis, on the 20th of June 1870.
It has been well said by Professor Goodsir, that few men come to
their principles at such an early age as Mr. Syme. His terseness of
writing aided greatly in their propagation, and his practice was
extended far and wide by the assurance that “he never wasted a word,
nor a drop of ink, nor a drop of blood.” He was great too in his
conservation of all parts which might by any dexterity and patience
be made useful. His revival of operations for the excision of joints
rather than the amputation of limbs is an instance of this. Syme’s
operation of amputation at the ankle-joint will always remain in
vogue as the least fatal and most useful in surgery.
Professor Lister has thus summed up Syme’s character as a surgeon—“A
practical surgeon, Mr. Syme presented a remarkable combination of
qualities; and we have not known whether to admire most the soundness
of his pathological knowledge, his skill in diagnosis, resembling
intuition, though in reality the result of acute and accurate
observation and laborious experience, well stored and methodised; the
rapidity and soundness of his judgment, his fertility in resources
as an operator, combined with simplicity of the means employed,
his skill and celerity of execution, his fearless courage, or the
singleness of purpose with which all his proceedings were directed to
the good of his patients.”
* * * * *
Though his fame has been overshadowed by the greater distinction
of Liston and Syme, John Lizars deserves mention, not only as a
brilliant operator, but also as a teacher, lecturer, and author. He
was fortunate in his instructor, having been the pupil and apprentice
of John Bell. After obtaining his qualification in 1808 Lizars
became a naval surgeon, and saw good service on the Spanish and
Portuguese coasts in Lord Exmouth’s fleet. He left the navy in 1815,
and settled in Edinburgh, joining Allan, who lectured on surgery,
and taking himself the departments of anatomy and surgery. Later,
when this partnership was dissolved, Lizars continued to lecture,
adding surgery before long to his programme, and hence being almost
incessantly engaged during the prolonged winter session with his
daily lectures on each subject. His zeal and method attracted, and
retained for years, classes frequently numbering one hundred and
fifty. He was obliged after a time to limit his labours when the
Edinburgh College of Surgeons decided to recognise lectures in
one department only from any given lecturer; and he resigned his
anatomical lectures to his brother Alexander, afterwards Professor of
Anatomy in the University of Edinburgh, and thenceforward lectured
on surgery alone. In 1831 John Lizars was appointed Professor of
Surgery to the College of Surgeons, a post which he held for eight
years. He had previously become surgeon in the Infirmary, and was
considerably senior to Liston. The two were not unworthy compeers as
regarded brilliancy in operating. Lizars’ ease and coolness under
circumstances of difficulty were remarkable. He is said to have been
the first who performed the operation for the removal of the lower
jaw.
Lizars published a “System of Practical Surgery”; but is perhaps best
known for his great folio series of coloured “Anatomical Plates”
with companion (octavo) volume of text. The engravings of the plates
were for the most part made from original dissections by himself.
They formed an immense series of illustrations, occupying 110 folio
plates, and some of them, especially those on the brain and nervous
system, can scarcely be surpassed for artistic excellence. It was
really a magnificent work for its day, and had a very large sale;
and as regards a great portion of the contents, since they show
actual facts, they cannot be superseded. After his retirement from
teaching, Lizars devoted himself to private practice, both surgical
and general. He died at Edinburgh, May 21, 1860.
FOOTNOTES:
[2] The writer is indebted for this anecdote to Dr. Paterson’s
“Memorials of the Life of James Syme,” in which a number of incidents
relating to Liston are given, with an interesting parallel between
the careers of the two great surgeons (chapter xii., p. 210-216). It
is much to be regretted that no biography of Robert Liston has yet
been written.