PERSONAL--PROFESSORIAL--PROFESSIONAL
His genius--Fertility of resource--Personal influence--Work in
obstetrics and gynaecology and surgery--His lecturing and
teaching--The healing of wounds--Acupressure--Hospitalism--Proposal
to stamp out infectious diseases.
Professor A. R. Simpson has said that his uncle Sir James Simpson's
genius showed itself in his power of seeing things, in his power of
adapting means to ends, and in his power of making others see what he
had seen and do what he had done. We have seen these characteristics
displayed in his work upon anaesthesia; it is literally true that he
left no stone unturned to gain his end and to make others look upon
anaesthesia in the same light as he regarded it. He declared all the
while that if he found the opposition to the administration of
chloroform in midwifery practice too powerful to conquer alone, he
would finally overcome it by bringing about such a state of public
opinion on the subject as would compel the profession to adopt his
methods.
Whether we regard Simpson as a physician or as a surgeon, as a
gynaecologist or as an accoucheur, we find that his success was always
due to the same causes. He possessed no secret remedies such as an
ignorant and imaginative section of the public often credit to
successful medical men. He performed no operations with which other
surgeons were not equally familiar and equally capable of performing;
indeed he frequently sent his surgical cases to operators in whose
hands he considered they would be more skilfully treated than in his.
In obstetrics and gynaecology his skill arose not only from his
unrivalled experience, but also from his power of rapid diagnosis, and
his promptness and boldness in treatment.
His readiness in resource was unfailing. On one occasion, it is
related, during an operation the bottle of chloroform was knocked over
and its contents were spilled upon the carpet before the surgeon had
completed his work; whilst his colleagues were wondering what was to
be done or how a further supply of the anaesthetic could be obtained
with sufficient speed, Simpson was on his knees hacking out with his
knife the portion of carpet on which the chloroform had just fallen;
and by means of this extemporised inhaler the operation proceeded
uninterrupted to the end.
He carried his distinguishing energy and thoroughness into every
branch of his work; even in extempore speeches made at meetings of
professional societies, he placed facts before his listeners in so
convincing and lucid a manner out of the extensive variety of his
knowledge, and aided by his great memory, that if he did not in
reality gain the point he argued in favour of he generally appeared to
do so. On such occasions too his imperturbable temper was a valuable
weapon.
There is no doubt that the genial professor availed himself fully of
the unbounded confidence placed in him by his patients. Those of us
who did not know him cannot appreciate what we have already said, that
the charm of his personality was one of the greatest factors of his
success in practice, and of his social success; there is the risk of
the appearance of exaggeration in any description of this personal
influence. The sympathy of his heart, a real sympathy, not a thin
professional veneer, was made manifest by deed as well as word. It
aroused in his patient, quite unconsciously to both, a feeling that
this man, above all other men, understood his complaint; that he, the
sufferer was the chief, if not the only object of his thought and
care. It was said over and over again of him that his words and look
did more good than all his physic, so able a wielder was he of that
healing power which reaches the body through the mind. Those who knew
him not, but falling sick hastened to Edinburgh to be healed by him,
were oftentimes cured simply because they felt beforehand that he
would cure them. They followed unconsciously the ancient command of
the Talmud, where it says, "Honour your physician before you have
need of him," and went to him full of respect and fired by faith. Wise
men have striven through all ages to take advantage of this influence
of the mind over the body, and the necessity of possessing a healthy
mind if the body is also to be healthy. A striking proof of the
antiquity of the thought has been recently furnished in a fashion that
would have delighted Simpson. On a papyrus, dated A.D. 200, brought to
light by Egyptian explorers, it is written that Christ said: "A
prophet is not acceptable in his own country, neither doth a physician
work cures upon them that know him."
The advances which Simpson made in the science and practice of both
midwifery and gynaecology were due to the magnitude of his experience
and the readiness of his genius to profit by experience. His one
thought being the relief of suffering and the prolongation of life, he
approached the bedside as a man with less high aspirations would fail
to do. He considered only the patient's interest, and gave his genius
free play. He took midwifery and gynaecology by storm, and urged them
on to great developments; he believed in observing, helping, or
imitating nature rather than acting, as his predecessors had done,
upon preconceived ideas which oftener than not ran contrary to
nature's commands. He avoided meddlesomeness, and stepped in only as
the ally of nature. He took numerous hints from bygone practitioners
and writers, and developed them. To-day we are profiting by his
teaching, and the instruments which he devised or perfected.
To mention all his suggestions and all his contributions to the arts
which he specially practised would here be obviously impossible as
well as out of place; but to medical readers the mention of one
instrument associated with his name, and known as _the sound_, will
give a small indication of how much we are in his debt. The principle
of this instrument had been known long before he took it in hand, but
it was left for him to introduce it into practice, perfect it, and
preach its value in diagnosis and treatment. So thorough was his work,
so farseeing his science, that our knowledge of its utility has
scarcely been added to since he first drew attention to it in 1843.
Towards operative work his attitude was characteristically conscientious.
We are told that he habitually put the following question to himself when
contemplating a serious operation: "Am I conscientiously entitled to
inflict deliberately upon my fellow-creature with my own hands the
imminent and immediate chance of death for the problematic and
prospective chance of his future improved health and prolonged life?"
The fact that he habitually thus questioned himself is an evidence of the
state of surgery at that time. Operations were undertaken only as a last
resource to save life; the surgeon knew full well that he placed his
patient in further peril merely by cutting through the skin, in a manner
which has now happily become a thing of the past.
His work was so pre-eminently practical that he never stopped to
collect together his experiences into a scientific treatise. Although
he revivified midwifery, and was one of the original founders of
gynaecology, he left to aftercomers the labour of studying what he had
done, and drawing the conclusions on which to strengthen the fabric of
the science. His pamphlets, papers, and reports are very numerous. It
would be wrong to say that modern thought has approved all that he
wrote; but however much time and increased knowledge may have modified
his teaching, they have not detracted from the value of his
researches, discoveries, and suggestions, or from the stimulating
influence of his work upon contemporary practice and thought.
As a lecturer and teacher Simpson succeeded as in the other branches
of his work. His brilliant exposition of his subjects and his careful
practical manner of teaching his young listeners doubled the fame
which had begun with his predecessor, Professor Hamilton, and has ever
since belonged to the Edinburgh school of obstetricians. But here
again his personal attractiveness and power gained for him the greater
part of his success. In the words of the _Lancet_, written when
reviewing a posthumous collection of some of his writings, his
lectures used to brighten the gloomy days of the Edinburgh winter; in
perusing the publication under review, Edinburgh men would "almost
think they saw the big head and face of the great obstetrician, as
they used to see him beaming with satisfaction or twinkling with
genial humour as he told a good story, or related a happy case,
illustrative of his own bold and original practice." Both as a
lecturer and as a bedside teacher he captured his students by the
charm of his diction, the wide range of his knowledge, and as
Professor Gusserow has pointed out in his masterly memoir, by his
peculiar talent of having his knowledge at his fingers' ends, and that
often in very remote details.
Year by year he never failed to obtain the affection of his students;
scarcely a man that had been taught by him but would proudly boast
that he was his friend as well as his teacher. He treated his large
class in a confiding spirit--not as the superior person delivering _ex
cathedra_ utterances, but as the friend rejoicing in his function of
admitting those around him into the knowledge in which he seemed to
revel. He had a happy method of getting on good terms with his
audience before proceeding to the serious business of the lecture.
When his health began to fail he was sometimes unwillingly laid aside,
and the lectures were delivered by a substitute. On one occasion he
re-appeared pale, weak, and lame, after such an enforced holiday, and
was greeted enthusiastically by a crowded class. He told them that his
servant had said to him that a rumour was abroad that he was in
Morningside Asylum. He had asked what answer he had made, and heard
that he had replied that so far from being wrong in his mind his
master was writing a book in bed. While he did not say that this
answer was strictly correct, he was happy to assure them, his pupils,
that he was quite right in his mind, although a friend had hinted that
morning that he was rather weak in his _understanding_!
Old fellow-students meeting each other in after life as staid
practitioners take pleasure in recalling the idiosyncrasies and
peculiarities of their teachers; it is probable that no professor has
ever been talked over with the appreciation which breathes through the
reminiscences of Simpson conjured up by those whom he taught.
Simpson left his mark in other departments besides those of the
subject of his professorial chair and of anaesthesia. About ten
years after the introduction of chloroform he turned his attention
to the process of wound-healing--the repair of necessary wounds
inflicted by surgeons in the course of their work--and although he
was promptly told to go back to his midwifery, he worked persistently
at the subject. In those days the subject was the most burning one in
surgery and the methods employed to bring about successful results
varied in different schools. The object of all methods was the
same, viz., to obtain a healthy, clean, and sightly result after
an operation; to leave the part which had been of necessity cut in a
condition as nearly as possible approaching that in which it had
been found, without the incidence of any of the too frequent grave
complications. Surgeons did not recognise at first the power of
nature to effect for them what they strove after; they thought to
attain their object by compelling the tissues to heal as they
desired by complicated applications, and many were the layers of
ointments and masses of dressings heaped on wounds for this
purpose. For a long time all efforts were directed to the discovery
of some specific substance, the application of which would give the
necessary impulse towards healing in the desired manner. Before
Simpson's day it had been generally recognised that the cause--but
its nature was quite undreamt of--of the trouble lay in the air
surrounding the wound, and more dressings were piled on to keep
out the air. But at the same time bleeding was arrested by tying the
cut arteries with ligatures--chiefly silken--and these were left
with long ends hanging out of the wound to work their way out by a
process of ulceration, or irritation of the tissues until liberty was
obtained. This process was practically incompatible with the ideal
form of healing, known as healing by _first intention_, _i.e._,
union without appreciable loss of substance or the formation of
_pus_ or matter. So-called "surgical fever," secondary haemorrhage,
and blood-poisoning were the frequent fatal results of operation
wounds treated in this manner. Simpson and others thought to prevent
these alarming diseases by devising other means of closing the
arteries; thinking that if some method or material were used,
which nature resented less, the wound would more readily close by
first intention. In 1858 Simpson stated that he had for some time
past been experimenting with substitutes for the ordinary silk and
thread ligatures, and in the course of his experiments had made use
of iron, silver, and platinum wires. In his usual way he hunted up
old authorities, and found a record of both silver and gold threads
having been experimentally used by bygone practitioners. He seems to
have been pleased with his results, stating that he found the
tissues much more tolerant of these metallic ligatures than they were
of the ordinary organic ones; that only "adhesive inflammation," not
ulcerative suppurative inflammation, was excited. This success,
however, was probably due to the superior cleanliness of the metal,
but this he did not recognise; had he done so he might have been led
to strive after surgical cleanliness, and have partly anticipated the
great work done subsequently by others. He went off, however, on a
different line, and searched for some readier method of using
metallic means of closing the blood vessels, being stimulated by
the desire to abolish ligatures altogether. Thus he was led, after
ten years' careful research, to the introduction of a method entirely
original--that of _Acupressure_. This consisted in the introduction
of a fine needle through the tissues across the course of the
artery, so that while the needle pressed upon one side of the artery
the resisting tissues of the body exerted counter-pressure on the
opposite side. He claimed for his method the merits of simplicity,
elegance, and cleanliness, and urged that not only did the tissues
tolerate the needle as they did not tolerate silk or hemp, but that
unlike the ligature the needle could be withdrawn as soon as
nature had closed the blood vessel by the process of coagulation of
the blood within it set up by the pressure; thus the prolonged
irritating presence of a body within the wound which delayed
healing until it had ulcerated its way out was rendered unnecessary,
and a better and more rapid result was attained. He verified his
theoretical considerations by experiments on animals and in one or
two operations on the human subject, and in 1859 read a communication
on the subject to the Royal Society of Edinburgh.
The paper was written under great pressure of work, indeed he stated
that at that time he was hardly ever able to write except when himself
"confined"; it was hastily prepared to take the place of that of
another Fellow which had failed to be forthcoming a few days before
the appointed meeting. It was composed at a country house where he had
to sleep for two or three nights watching a case of diphtheria. It was
headed as usual by a Shakspearian quotation, this time briefly in
Justice Shallow's words, thus:--"Tut, a pin!" On the evening of its
delivery an abstract of the paper was forwarded to the leading
surgeons in England, Europe, and America, and diverse were the
opinions expressed.
In Scotland the new method met with the greatest favour and the
strongest opposition at one and the same time. Throughout Europe and
America it was everywhere received with applause and support.
Excellent results were obtained when the method was properly applied,
but technical considerations, particularly the difficulty of using it
upon blood vessels far removed from the surface, rendered it
unsuitable for universal application.
Professor Syme met the innovation with vehement opposition;
possibly he resented this intrusion of the gynaecologist into the
regions of general surgery. He took into his class-room one pamphlet
on the subject by Simpson, which had especially aroused his wrath; he
stormed at the author before his students for "his vulgar insolence,"
and then, in a dramatic scene, expressed the violence of his contempt
by savagely tearing the pamphlet into pieces and casting it away.
In a subsequent controversy between these two old opponents, who
had been temporarily united by Simpson's conduct in consulting Syme
professionally, by their joint action against homoeopathy, and by
Simpson's defence of Syme when publicly attacked by an English
surgeon, the feud was renewed.
Simpson persisted for years in collecting reports of operations in
which acupressure was employed, and published them from time to time
in the _British Medical Journal_ and elsewhere. In 1864 his work
on the subject took the form of a volume containing 580 quarto pages.
His friends endeavoured to rank acupressure with chloroform as one
of the blessings to humanity made manifest by him. He himself
recognised that he had failed to gain for acupressure a place in
practice such as he had gained for chloroform, but he looked forward
to a time, perhaps a quarter of a century distant, when his method
would be beginning to be thought about. In this he was mistaken for,
on the contrary, acupressure was beginning to be forgotten long before
twenty-five years had elapsed. Another worker on more strictly
scientific lines had by that time made healing by first intention,
without complications, the rule instead of the exception, and
conferred a benefit on humanity as great if not greater than that of
anaesthesia. In 1867, while Simpson was still alive, Mr. (now Lord)
Lister (then a hospital surgeon in Glasgow, and subsequently Syme's
successor in Edinburgh) enunciated the new principle of "antiseptic
surgery," which recognised the living infective micro-organisms of
the air as the cause of the trouble in wounds. He directed that as
these invisible organisms (known only by means of the microscope)
were present everywhere in the air, found their way into all sorts of
wounds, and set up the decomposition which led to disastrous
results, they were to be destroyed or excluded from wounds; and he
suggested effective means of accomplishing this end. He further
abolished the long ligatures which irritated by their presence, and
by the organisms they conveyed into the wound when imperfectly
cleansed as they usually were; and substituted non-irritating
ligatures which nature herself was able to remove by the process of
absorption. The recognition of this antiseptic principle effected a
much needed revolution in surgery, and in this revolution acupressure
was practically annihilated. Simpson did not live long enough to
see the complete establishment of the Listerian principle; at
first he vigorously opposed what he considered to be an attempt to
retain the old-fashioned ligatures in preference to his new
acupressure; but with his penetrative eye he must have foreseen
that should the new practice prevail and short absorbable ligatures
be made possible, acupressure would be completely superseded.
In the estimation of the writer of the obituary notice of Professor
Simpson in the _British Medical Journal_, the greatest of all his
works was that undertaken in the subject of Hospitalism. As early as
1847 he had been horrified to read in a report of the work done in the
Edinburgh Infirmary, that out of eighteen cases of primary amputation
performed during a period of four years only two survived. He faced
this fact with the courage of the reformer, and sought far and near
for other facts to support the theory which he gradually evolved, that
this melancholy failure of surgeons to save their patients' lives was
due not so much to the operation or the operator as to the
environment of the patient. In later years he himself often shrank, on
account of unfortunate experiences, from performing capital operations
which he had formerly unhesitatingly undertaken. The unhealthiness of
hospitals had long been recognised; and was especially observed at
times when they were overcrowded, as happened during war time. When
the public had thoroughly grasped the utility of anaesthetics, and
recognised that operations could be performed painlessly, there were
fewer refusals to submit to the knife; there was a rush to the
hospitals, and the surgical wards throughout the length and breadth of
the land became crowded with men and women actually longing for
operation. Amongst these all the dreaded sequelae of surgical
interference, which no power seemed able to check, ravaged with
alarming severity.
It is to Simpson's credit that he perceived how the introduction of
anaesthesia had taxed the hospitals and bewildered the operators, who
sought diligently but unsuccessfully in every direction for some means
of reducing hospital mortality. He was one of the first to set to work
with method to investigate this question of Hospitalism.
It was towards the end of his career, when the old Edinburgh Infirmary
stood condemned, and various proposals for rebuilding it on a new site
and improved plan were under discussion, that his voice was most
loudly heard. For many years he had thought and taught that the great
mortality after operations in hospitals was due to the impure state of
the air therein, derived from the congregation of a large number of
sick persons under one roof. He picturesquely stated that the man laid
on a hospital operating table was exposed to more chances of death
than the English soldier was on the field of Waterloo. His original
suggestion was that hospitals might be changed from being crowded
palaces, with a layer of sick on each floor, into villages or
cottages, with one, or at most two, patients in each room; the
building to be of iron, so that it could be periodically taken down
and reconstructed, and presumably thoroughly renovated. This drastic
proposal brings nowadays a smile to the lips, for we see now how he
was groping in the dark; but the magnitude of it is but the shadow of
the evil it was designed to cure. The change was so great as to be
impracticable in the eyes of most men; he, on the other hand,
contended that it was to be of incalculable benefit to humanity, and,
therefore, no difficulty, however great, should be allowed to stand in
the way. He did not understand that the evils arose not from the air
itself but from what was in the air, known to us now as the
micro-organisms. His remedy was a proposal to run away from the evils
without receiving any guarantee that they could not and would not
successfully pursue. Had Lister not arisen, Simpson's proposals might
have possibly prevailed, for he laboured with all his persistent
energy.
The general belief of the profession--but it was no more than a
belief--was that operations performed in country practice were not so
frightfully fatal as those performed in town hospitals. This was
Simpson's opinion, and he determined to test its truth by appeal to
facts. He drew up a circular with a schedule for the insertion of
results in a statistical form, and sent it far and wide amongst
country practitioners. He awaited the result with anxious expectation;
the circular asked for a plain statement of facts only, and for all he
knew the facts might be against his theory; but they were not. From
all over England and Scotland, particularly from mining districts,
where severe operations after accidents were common, the filled-up
schedules flowed in, to the number of 374. These were collected,
carefully classified and summarised. The operations selected were
amputations, and the result briefly was this:--
Total number of cases 2,098 } Mortality,
" " deaths 226 } 10.8 per cent.
The relative mortality of the different amputations was also shown:--
669 Thigh cases; deaths, 123; mortality, 18.3 per cent.
618 Leg " ; " 82; " 13.2 "
433 Arm " ; " 19; " 4.3 "
378 Forearm " ; " 2; " 0.5 "
The table on the next page compared the results of operations for
injury with those performed for disease.
FOR INJURY.
Cases. Deaths. Mortality.
per cent.
Thigh 313 80 25.5
Leg 409 57 13.4
Arm 344 14 4.0
Forearm 313 2 0.6
FOR DISEASE.
Cases. Deaths. Mortality.
per cent.
Thigh 356 43 12.0
Leg 209 25 12.0
Arm 89 5 5.6
Forearm 60 0 --
These statistics were accompanied by an exhaustive detailed
examination and explanation; every possible point of attack was
considered and protected. "I doubt not," he said, "that the
segregation of the sick from the sick--every diseased man being a
focus of more or less danger to the diseased around him--is a
principle of no small moment and value." He attributed the comparative
brilliancy of these statistical results to the _isolation_ of the
patients only; he endeavoured to show that the operations were often
performed amidst dirty and squalid surroundings, on dirty and squalid
persons. He did not attribute sufficient importance to the fact urged
by many of his correspondents, who supported his general contentions
almost to a man out of their own experience, that where fresh air,
ventilation, and cleanliness prevailed, the results were always the
most satisfactory.
The next step was to take hospital statistics of similar operations,
and the general result appears in the table on page 183.
This testimony to the truth of Simpson's opinion was more pronounced
than even he himself had anticipated. "Shall this pitiless and
deliberate sacrifice of human life to conditions which are more or
less preventable be continued, or arrested? Do not these terrible
figures plead eloquently and clamantly for a revision and reform of
our existing hospital system?" This was his cry until at length
breath failed him. The opposition was not strong, but the support
was weak. Although there was much criticism, his conclusions were
scarcely called in question at all; trifling holes were picked in
his statistics, but his contentions were universally acknowledged
to be correct; a few reformers only, persuaded as he was of the
evils of hospitalism and working at the subject, lent him their
advocacy. But he alone stood unperturbed at the extent of the evils
and the magnitude of the change which he proposed in order to
uproot them; death laid him low as he stood, but not before he had
modified his proposals by suggesting that existing hospitals might be
reconstructed, and new hospitals built on the now almost universally
adopted pavilion system on which the new Edinburgh Royal Infirmary was
one of the first to be built.
Column Headings--
C: Cases.
D: Deaths.
_______________________________________________________________________
| | |
| HOSPITAL. | FOR INJURY. |
|_______________________|_______________________________________________|
| | | | | |
| | Thigh. | Leg. | Arm. | Forearm. |
| |___________|___________|___________|___________|
| | | | | | | | | |
| | [C] | [D] | [C] | [D] | [C] | [D] | [C] | [D] |
|_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
| | | | | | | | | |
| Edinburgh Infirmary | 134 | 48 | 28 | 9 | 7 | 3 | 19 | 7 |
| Glasgow " | 100 | 60 | 93 | 50 | 101 | 38 | 66 | 9 |
| Nine London Hospitals | 320 | 123 | 173 | 53 | 48 | 13 | 37 | 7 |
|_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
| | | | | | | | | |
| Total | 631 | 239 | 283 | 89 | 78 | 22 | 75 | 15 |
|_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
| | | | | |
| Mortality per cent. | 64.4 | 54.8 | 40.1 | 14.8 |
|_______________________|___________|___________|___________|___________|
_______________________________________________________________________
| | |
| HOSPITAL. | FOR DISEASE. |
|_______________________|_______________________________________________|
| | | | | |
| | Thigh. | Leg. | Arm. | Forearm. |
| |___________|___________|___________|___________|
| | | | | | | | | |
| | [C] | [D] | [C] | [D] | [C] | [D] | [C] | [D] |
|_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
| | | | | | | | | |
| Edinburgh Infirmary | 65 | 48 | 58 | 29 | 21 | 12 | 39 | 5 |
| Glasgow " | 177 | 68 | 82 | 27 | 23 | 6 | 19 | 1 |
| Nine London Hospitals | 139 | 88 | 179 | 102 | 97 | 33 | 64 | 11 |
|_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
| | | | | | | | | |
| Total | 304 | 196 | 330 | 181 | 219 | 88 | 169| 25 |
|_______________________|_____|_____|_____|_____|_____|_____|_____|_____|
| | | | | |
| Mortality per cent. | 37.8 | 31.4 | 28.2 | 2.0 |
|_______________________|___________|___________|___________|___________|
The total number of cases 2,089 } mortality 41 per cent.
The total number of deaths 855 }
Placed side by side the Town (hospital only) and Country (private
practice only) figures compared as follows:--
_Hospital_ cases 2,089; deaths 855; mortality 41 per cent. or 1 in 2.4
_Country_ " 2,098; " 226; " 10.8 " 1 in 9.2
The steady advance of aseptic surgery has slowly but surely brought
about the results which Simpson strove to attain by a radical measure.
The enemy which had baffled surgeons for centuries was revealed by
Lister. He sent surgeons smiling into the operating-room practically
certain of success instead of dreading the terrible onslaught upon
their own handiwork of the formerly unseen and unknown destroyer. The
death rate of operations is being daily brought nearer and nearer to
vanishing point. In his review of the progress of wound treatment
during the Victorian Era published in the Diamond Jubilee number of
_The Practitioner_, Mr. Watson Cheyne says the mortality of major
operations does not now exceed in hospitals more than three or four
per cent., and this is made up practically entirely by cases admitted
almost moribund and operated on _in extremis_ with faint hope of
survival. The field of surgery, too, has been vastly enlarged, and the
term "major operation" includes not merely operations of necessity,
undertaken through ages past as the only possible means of saving
life, but also operations which have become possible only in recent
years--some of them performed merely to make the patient "more
comfortable," or even only "more beautiful." And this glorious result
is due, as Mr. Cheyne truly says, to the immortal genius of Lister.
In 1867 Simpson propounded in the _Medical Times and Gazette_ a
proposal for stamping out smallpox and other infectious diseases such
as scarlet fever and measles. In spite of vaccination, which, however,
was imperfectly carried out, smallpox alone carried off five thousand
lives annually in Great Britain. A serious outbreak of rinderpest in
the British Islands amongst cattle had recently been arrested and
exterminated by the slaughter of all affected animals. The disease
spread as smallpox did by contagion, and Simpson fell to wondering why
smallpox could not also be exterminated. His paper was a noteworthy
contribution to the then infant science of Public Health, and his
proposal, which was, however, universally regarded as impracticable,
sprang from his courageous enthusiasm as did that concerning
hospitals. He suggested that the place of the pole-axe in the
extermination of rinderpest might in the arrest of smallpox be taken
by complete isolation, and he laid down simple but rigid rules for its
enforcement. An attempt was made to utilise these a few years after
when an epidemic of fatal violence broke out in Edinburgh. He was in
no way an anti-vaccinationist, but his isolation measures were too
strong for the people in those days. We are not surprised that he
boldly proposed this measure, for he related glaring instances of
neglect of the simplest precautions. Beggars held up infants with
faces encrusted with active smallpox into the very faces of passers-by
in the streets of Edinburgh; and on one occasion a woman was found in
Glasgow serving out sweetmeats to the children of a school with her
hands and face covered by the disease. He cried aloud for legislation
to prevent such gross abuses, which he did not hesitate to stigmatise
as little short of criminal.