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 black-board notes of
the subject on which he was about to speak--concise, pithy headings,
which were hung up in the theatre and which he proceeded methodically
to explain and enlarge upon. So successful were his efforts that even
in the first session he was able to make the proud boast that his
class was for the first time in its history the largest in the
University, and this in spite of the fact that one of the leading
professors altered his lecture hour to the same hour as Simpson's,
with the purpose of injuring the attendance at Simpson's class.
A direct result of the reputation obtained through his course of
lectures and improved professional position was the rapid increase of
his practice and the improvement of the class of his patients, so that
pecuniary profit came within his reach. He continued to be a general
practitioner, however, attending to all classes of cases that came to
him; but his zeal for midwifery and the diseases of women, together
with his renown in those subjects, brought mostly patients of the
female sex to his consulting-room. With the improved position there
came necessarily increased expenditure, which at first exceeded the
income; he never stopped to consider the patients' circumstances or
whether he was likely to be paid for his services. "I prefer to have
my reward in the gratitude of my patients," he said. He treated all
that came to him, and his generous nature was oftentimes taken
advantage of by persons very well able to remunerate him; moreover, at
this time, when his pecuniary profit did not equal his professional
reputation, he cheerfully helped many who appealed to him with amounts
he could ill spare.
His father-in-law generously and willingly stood by him until the fees
began to come in more freely--his brother Sandy, who had supported him
hitherto, having now other claims upon his purse. He found two
ordinary but costly steps advisable--first, to move into a better and
more centrally situated house; and, secondly, to obtain a carriage,
"both to support my rank among my wealthier compeers and to save my
body from excess of work." The outlay was justified in the result; the
fees from students and from his private practice very soon enabled him
to repay the debts to his brothers and his father-in-law without
inconvenience and with grateful pleasure. Once and for ever within
the first few years of his professorship he placed himself in a safe
position, free from all pecuniary anxiety.
If he had laboured hard to fit himself for the front rank of his
profession, his work on attaining that position showed increase rather
than abatement. His private practice alone was the work of more than
one ordinary individual, and his professorial duties took up some of
the best hours of his day. In the evenings and at all odd times he
busied himself with absorbing current or ancient literature, or in
preparing his own contributions to both professional and general
knowledge either with the pen or by experiment. "Oh that there were
double twenty-four hours in the day," he sighed at a time when he was
working at highest pressure, practising amongst peers, commoners, and
cottagers alike, who all flocked to his residence or sent long
distances for him. When Princess Marie of Baden, wife of the Duke of
Hamilton, came under his special care in 1843 he felt that he was
placed at the top of his profession in Scotland, and must have
smilingly recalled the words of old Dr. Dawson, of Bathgate, when he
heard of the successful contest for the Chair. "It's all very well,"
he had said, "to have got the Chair! But he can never have such a
practice as Professor Hamilton. Why, ladies have been known to come
from England to consult him!"
They came from the furthest parts of Greater Britain to consult
Hamilton's successor, in spite of the old doctor's prognostication!
The energy as well as the versatility of the man is well shown in the
works which he found time to carry on while he was thus establishing
himself as a teacher and as a practitioner, during the years from 1840
to 1845. One of his first literary efforts, not wholly professional,
the Memoir on "Leprosy and Leper-Houses," was produced at that time.
It was a work of relaxation and pleasure, for it carried him deeply
into his favourite 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 failed when they elected as Thomson's successor a man who,
although of brilliant attainments, subsequently brought discredit upon
his University and himself by becoming a convert to homoeopathy.
Simpson, who was indirectly instrumental in securing the Chair of
Pathology for this man became his bitterest opponent when he declared
himself a follower of Hahnemann's unorthodox and mistaken doctrines.
In 1842 it fell to Simpson's lot to deliver the customary address to
the medical graduates after they had received their degrees at the
annual ceremonial on the 1st of August. He treated his listeners to a
discourse on the duties of young physicians. When we remember that he
had attained to his then high professional position while he was no
more than a young physician himself, we recognise that he was but
setting forth the ideals and principles which had been and still were
his guides in life and conduct.
After warning his audience against regarding the gaining of the
coveted degree as the end of their student career, instead of as in
reality the opening up of a lifetime of observation and study, he
pointed out that self-patronage was the best of all patronage. "Place
from the first," he said, "all your hopes of advancement upon the
breadth and extent of your medical abilities alone.... Rather walk by
the steady light of your own lamp than by the more dazzling, but to
you more uncertain, lustre borrowed from that of others ... Young
physicians often dream that by extending the circle of their private
acquaintances they thus afford themselves the best chance of extending
the circle of their private patients.... No man will in any case of
doubt and danger entrust to your professional care the guardianship of
his own life or of the life of those who are near and dear to his
heart, merely because you happen to be on terms of intimacy with him.
The self-interest of human nature forbids it.... The accomplishments
which render you acceptable in the drawing-room are not always those
that would make your visits longed for or valued in the chamber of
sickness and sorrow.... Give therefore your whole energies to
medicine; and in its multiplied departments you will find 'ample room
and verge enough' for the most energetic as well as the most
comprehensive mind. Place your faith in no extrinsic influences. Let
your own professional character be the one great patron to whom you
ever look for your professional advancement." He exhorted the young
practitioners above all to save and economise their time, and to
regard it as a property to be avaricious of and of every item of which
they were to render a proper account to themselves. "It is by
carefully preserving, confirming, and making diligent use of these
broken and disjointed portions of it, which others thoughtlessly waste
and destroy, that almost all the highest reputations in the medical
profession have been formed." He strongly urged the value of a "proper
covetousness of time." "Look around, and you will find that those who
have the most to do in the way of business as practitioners have also
apparently the most time to spare as observers and writers.... And
why? Because they have all their daily duties perfectly assorted and
arrayed; they save from loss and destruction every possible fragment
of time and this very industry and precision procures them more true
leisure than indolence can boast of."
In referring to the relation of practitioner to patient, he
spoke on a subject which has been much discussed in recent years
without altering the principle originally laid down in the oath of
Hippocrates:--"Whatever," said Simpson, "is communicated to you
as a matter of professional confidence, must ever remain buried
within your own breasts in all the silence and secrecy of the
grave." He concluded his address with well-judged remarks on the
relation of the physician to his professional brethren, counselling
his hearers to observe the Golden Rule, and, moreover, "if it be
possible, as much as lieth in you, live peaceably with all men;
never allow the darker part of your nature to persuade you to
the attempt of over-taking him who has distanced you in the race
of life by any unjust efforts to lame the character, and thus
diminish the speed, of your adversary. And if such attempts are
made upon you by others, have no dread of them--if you are armed
strong in honesty, if you have pursued a line of irreproachable
truth and unbending rectitude of conduct. 'Be thou as pure as
snow thou shalt not escape calumny.'... Your future career is a
matter of your own selection, and will be regulated by the conduct
which you choose to follow. That career may be one of happiness or
self-regret, one of honour or of obscurity, one of wealth or of
poverty. The one or other result is not a matter of _chance_, but
a matter of choice on your part. Your diligence and industry for
the next few years will almost inevitably secure for you the one;
your apathy and indolence will almost inevitably entail upon you
the other. May God, in His infinite goodness, enable you to
select the wiser and the better path."
In this address, as in that previously quoted, we hear him exhorting
his young listeners to a line of conduct which we know to have been
broadly his own in practice as well as in ideal. During these early
years as professor, Simpson had to ward off many ill-disposed
adversaries, and he met their attack with the determination and
powerful preparedness that characterised his attitude in later years,
when he experienced the hostility so constantly opposed to genuine
reformers, and men who have lived ahead of their times. He sometimes
regarded these encounters regretfully himself; but none the less
remembered to
"Bear't that the opposed may beware."
The correspondence pertaining to some of these disputes was filed and
ticketed, with brief contempt, "Squabbles." His controversy with
Professor Syme over a personal matter in 1845 was not to the credit of
either of these great men, and, as Simpson himself confessed, was
equally discreditable to their profession. Simpson had seen, as has
been pointed out, several of his teachers fighting long and strongly
for their own cherished objects; and he doubtless then, in his student
days, learnt the lesson that vigorous persistence had the power to
gain much that at first seemed hopeless; he fought with such energy,
that he accomplished in his own lifetime what the example of others
might have led him to think would have been accomplished only by his
successors.
The growth of his practice up to 1847 was little short of phenomenal.
In 1845 he purchased No. 52, Queen-street, the house which he
inhabited up to his death, and which became the Mecca of hundreds upon
hundreds of pilgrims from all quarters of the globe. Here, in those
years, he was sought and consulted by unceasing crowds; in the public
mind he was undoubtedly endowed with more than human powers, and
regarded as a magician, at the wave of whose wand pain and disease
would vanish. This caused him much embarrassment, and brought upon him
the abuse of ignorant persons, irritated to find that, after all, even
in Simpson's person, there was a limit to human powers; or of others
with unimportant ailments who were disappointed to find that, once
having made his diagnosis of their condition, he would have no more of
them, preferring to place his time at the disposal of those whose
sufferings were real and capable of relief, or whose cases were
complicated and interesting. The question of remuneration was always
secondary, and so careless was he in pecuniary matters that it is
related that he would wrap up interesting specimens, professional or
antiquarian, in bank notes; and his trusted valet was in the habit of
emptying his pockets at night of the money earned in the day, to
prevent its being lost, mislaid, or given away to undeserving persons.
With him work was first and fee second. Like a great modern teacher he
was able to say, "Work first--you are God's servant; fee first--you
are the fiend's." To Simpson "work was master and the Lord of Work,
who is God."
The personal power and attractiveness of the man were large factors in
gaining the practice which he now enjoyed. But he did not depend for
success on these alone, by any means. His professional reputation was
fully won by great work in obstetrics and 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 Blantyre, where he says, "the Duchess of Sutherland, the Marquis
and Marchioness of Lorne, and two Ladies Gower have made up with myself
all the strangers." "Tell Janet," he wrote to his brother, "I think now
artificial flowers very ungenteel. The ladies here wear nothing but
real flowers in their hair, and every day they come down with
something new and for us males to guess at. Often the Duchess wears a
simple chaplet of ivy leaves, sometimes a bracken leaf is all she sports
in her head ornaments, and beautiful it looks. Rowans and 'haws' are
often worn beaded into crowns or flowers or chaplets. Heather is also
a favourite. On Thursday Lady Lorne came down with a most beautiful
chaplet tying round and keeping down her braided hair. It was a long
bunch of bramble leaves and half-ripe bramble berries--actual true
brambles. They have been all exceedingly kind to me, and I really
feel quite at home among them though the only untitled personage at
table."
The daily scene at 52, Queen Street was now unique. Those who had the
fortune to lunch or breakfast in that hospitable house never forgot
it. Statesmen, noblemen, artists, scientists, clergymen, and
politicians from various countries sat down together and entertained
each other or attempted to do so in their different languages. The
host guided the conversation while he still glanced over the newspaper
or some newly published book, and never failed by skilful leading to
entice out of every one the best knowledge that they possessed. With
his quick insight he rarely failed in his estimate of character, but
rapidly perceived even in a stranger where the conventional ceased and
the real man began.
No stranger to Edinburgh omitted to bring or obtain an introduction
to the genial professor; all were welcome, and an open table was kept.
The scene has been described from intimate knowledge in the columns of
the _Scots Observer_ as follows:--"Luncheon is set on the table, and
some ten, twenty, or even fifty people wait the appearance of their
host, who is on his rounds maybe, or in another room ministers to an
urgent case. A stranger who has not learnt that the great Simpson was
only in the broadest sense a punctual man--of minutes, hours, he knew
nothing, but none more reliably punctual, few so unsparingly regular
in working while 'tis called to-day--might be prompted by hungry
discontent to suggest that none but the wealthiest can keep the doctor
from his guests. The mere suggestion would be infamous, for rich and
ragged alike pay fees or not exactly as it pleases them. Whatever the
cause, the host still lingers, and the impatient stranger has time to
wonder how it is that so odd an assortment of human beings should be
met together in one room. Lords and Commons rub shoulders at his
table; the salt of the earth sit down side by side with the
savourless; tweed jostles broadcloth; the town-bred Briton looks
askance at his country-bred compatriot, and both unconsciously shudder
at the Briton with no breeding at all. In one room are assembled
together the American of bluest blood; the Yankee bagman; the
slave-owning Southerner, and even the man of colour hateful to both
alike. The atmosphere is chill like the grave, each guest, eyeing his
neighbour suspiciously, shrinks into his own social shell; on each
face the meanness and snobbery of humankind is, if not aggressively
expressed, at least clearly legible; when all at once Simpson bustles
in. In a few minutes, under the genial influence of his presence, all
tongues are set a-wagging, and well may you ask whether the men who
leave his house after luncheon are those who half-an-hour ago regarded
each other with cold disdain. For now they are cordial, kindly,
sympathetic; each has been induced to show whatever was attractive in
his nature, or to give the fruits of his experience. If in one short
hour Simpson could thus transform a crowd of frigid, haughty strangers
into an assemblage of decent, amiable human beings, what could he not
achieve in a day, a year, or a life?"
His reception of members of his own profession was specially cordial,
and if those from any one country were more welcome than others, it
was the many who crossed the Atlantic to see and hear him. America had
the greatest share in the birth of 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 hours."
Their experiments proved that petroleum was vastly superior to sperm
oil, the best known and most commonly used lubricant. Simpson
proceeded to take out a patent, having no such scruples as Christison;
but to his chagrin found that he had been forestalled by others, and
had to abandon the subject.
About the period now referred to Scotland was stirred from end to end
by the ecclesiastical movement which culminated in the crisis known as
the Disruption, when, for reasons connected with the jurisdiction of
the National Church, a majority of its members severed their
connection therewith in a public and dramatic fashion, and "came out"
to found the now strong and vigorous Free Kirk. Simpson at first
steered clear of all the squabbles and discussions which the movement
gave rise to, but when affairs approached a crisis he threw his lot in
with the leaders of the new movement, and became a staunch Free
Churchman.
Busy as he was, Simpson fully enjoyed his home and all the inner
domestic life. He was a cheery and hearty host to his intimate
friends, and took a pleasure in impromptu entertainments got up by
himself in his own house, when he found time at his disposal for such
amusement. His first child--a daughter--of whom he was mightily proud,
was born in 1840; his first son, David, in 1842; and the second,
Walter, in 1843. In 1844 the young couple, in the midst of their
rising prosperity, suffered the loss of their daughter, who died after
a brief illness. Simpson felt the loss keenly, and wrote pathetically
on the subject to his relations; long afterwards he loved to talk of
her and her winning ways.
By 1846 the vast majority of his work lay in obstetrics and
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 of Sutherland, wrote to
inform him that the Queen had much pleasure in conferring upon him the
vacant post of Physician to Her Majesty. In the Queen's own words,
"His high character and abilities made him very fit for the post." He
held this post until his death, under the title of Physician
Accoucheur to the Queen for Scotland.
Thus in his thirty-sixth year, to the pride of his family and of the
whole village community in which he had been born and received his
early training, to the admiration of patients and friends, as well as
to his own conscious satisfaction, the Bathgate baker's son had risen
by his own efforts to the highest attainable position in his native
land. But the work which was to make him one of the most conspicuous
figures in the history of medicine, and raise him to a place of honour
in the grateful estimation of humanity, was scarcely begun.