CHAPTER VProfessor and Physician.1840-1847

The gift of this Chair, as of many others in the University, has now passed from the hands of the Town Council into those of a body of curators, seven in number, three nominated by the University Court and four by the Town Council; such a body might have made a more cautious choice, but never a more fortunate one both for the city and the University than this of their long-headed and far-sighted predecessors.

66CHAPTER VProfessor and Physician.1840-1847

Success as a lecturerâ€”Increased practiceâ€”Generosityâ€”Fashionable patientsâ€”Memoir on Leprosyâ€”Controversy concerning the Pathology Chairâ€”Address to the Graduates, 1842â€”Squabblesâ€”Purchases 52, Queen Streetâ€”A great and good physicianâ€”Called to Londonâ€”Visit to Erskine Houseâ€”The daily scene at 52, Queen Streetâ€”Rangoon petroleum and Christisonâ€”The disruptionâ€”His familyâ€”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 bakerâ€™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 thoseconfrÃ¨reswho 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 feelingâ€”that of respect for him as a man and a worker. He had dealt heavy blows himself during the conflictâ€”blows not easily forgotten. The position demanded tact and67patience, 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 speakâ€”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 Simpsonâ€™s, with the purpose of injuring the attendance at Simpsonâ€™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 continued68to 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 patientsâ€™ circumstances or whether he was likely to be paid for his services. â€œI prefer to have my reward in the gratitude of my patients,â€ 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 freelyâ€”his brother Sandy, who had supported him hitherto, having now other claims upon his purse. He found two ordinary but costly steps advisableâ€”first, to move into a better and more centrally situated house; and, secondly, to obtain a carriage, â€œboth to support my rank among my wealthier compeers and to save my body from excess of work.â€ 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 inconvenience69and 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. â€œOh that there were double twenty-four hours in the day,â€ 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. â€œItâ€™s all very well,â€ he had said, â€œto 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!â€

They came from the furthest parts of Greater Britain to consult Hamiltonâ€™s successor, in spite of the old doctorâ€™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 â€œLeprosy and Leper-Houses,â€ was produced at that time. It was a work of relaxation and pleasure, for it carried him deeply into his favourite archÃ¦ology. The fascination which this subject always had for him sprang from his love of nature, and of the greatest work of natureâ€”man. â€œThe leading object and intent of all the antiquarianâ€™s pursuit isMAN,â€ he said, â€œand manâ€™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.â€

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 Acts71of 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 employedâ€”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 â€œleprosie, which the maist expert men in medicine are not abil to do.â€ The indictment set forth that she â€œtook a reid cock, slew it, baked a bannock with the blude of it, and gaf the samyn to the leper to eat.â€ The witchâ€™s remedy is scarcely more curious and certainly no less useful than those recommended two centuries later by John Wesley in his â€œPrimitive Physic,â€ where, moreover, he cheerfully,72if somewhat too briefly to satisfy the modern inquirer, reports the cure â€œof a most desperate caseâ€ 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.

Simpsonâ€™s paper was published in theEdinburgh Medical and Surgical Journalin 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 connectedâ€”a new thought even so recently as fifty years agoâ€”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.

Simpsonâ€™s conduct when Professor Thomson resigned73the 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 theirAlma Mater. Professors Syme and Alison actively led an agitation that with Thomsonâ€™s resignation the separate teaching of pathology should be brought to an end. Without a momentâ€™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, who74showed the same foresight which had led them to appoint Simpson, in deciding to maintain its existence. Unfortunately their wisdom failed when they elected as Thomsonâ€™s successor a man who, although of brilliant attainments, subsequently brought discredit upon his University and himself by becoming a convert to homÅ“opathy. 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 Hahnemannâ€™s unorthodox and mistaken doctrines.

In 1842 it fell to Simpsonâ€™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. â€œPlace from the first,â€ he said, â€œall your hopes of advancement upon the breadth and extent of your medical abilities alone.... Rather walk by the steady light of75your 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 â€˜ample room and verge enoughâ€™ 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.â€ 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. â€œIt 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 the76medical profession have been formed.â€ He strongly urged the value of a â€œproper covetousness of time.â€ â€œLook 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.â€

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:â€”â€œWhatever,â€ said Simpson, â€œis 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.â€ 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, â€œif 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 themâ€”if you are armed strong in honesty, if you77have pursued a line of irreproachable truth and unbending rectitude of conduct. â€˜Be thou as pure as snow thou shalt not escape calumny.â€™... 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 ofchance, 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.â€

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

â€œBearâ€™t that the opposed may beware.â€

The correspondence pertaining to some of these78disputes was filed and ticketed, with brief contempt, â€œSquabbles.â€ 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 Simpsonâ€™s person, there was a limit to human powers; or of others with unimportant ailments who were disappointed to find that, once79having 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, â€œWork firstâ€”you are Godâ€™s servant; fee firstâ€”you are the fiendâ€™s.â€ To Simpson â€œwork was master and the Lord of Work, who is God.â€

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 gynÃ¦cology, 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 gynÃ¦cology. He had done this before the great deed was dreamt of which hands his name down to posterity, before his discovery of the anÃ¦sthetic power of chloroform. Simpson was a great physician, the80leading 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 Stevensonâ€™s description of the physician:â€”

â€œGenerosity 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.â€

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, â€œthe Duchess of Sutherland, the Marquis and Marchioness of Lorne, and two Ladies Gower have made up with myself all the strangers.â€ â€œTell Janet,â€ he wrote to his brother, â€œI think now artificial flowers very ungenteel. The ladies here81wear 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 â€˜hawsâ€™ 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 berriesâ€”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.â€

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 or82obtain 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 theScots Observeras follows:â€”â€œLuncheon 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 manâ€”of minutes, hours, he knew nothing, but none more reliably punctual, few so unsparingly regular in working while â€™tis called to-dayâ€”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, each83guest, 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?â€

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 anÃ¦sthetics, and Simpsonâ€™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. GynÃ¦cology, too, was eagerly taken up in America, and many were Simpsonâ€™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 in84other 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 â€œSimpsonâ€™s incomparable antifriction lubricant!â€

â€œWhen I called for Simpson,â€ says Christison, in his Recollections, â€œhis 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.â€

Their experiments proved that petroleum was vastly superior to sperm oil, the best known and most commonly85used 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 â€œcame outâ€ 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 childâ€”a daughterâ€”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 his86relations; long afterwards he loved to talk of her and her winning ways.

By 1846 the vast majority of his work lay in obstetrics and gynÃ¦cology, 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 beau courantwith 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 Queenâ€™s own words, â€œHis high character and abilities made him very fit for the post.â€ 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 bakerâ€™s87son 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.

88CHAPTER VIThe Discovery of AnÃ¦sthetics.1844-1847

His early sympathy for sufferingâ€”Surgical methods before the discovery of anÃ¦stheticsâ€”His mental struggle caused by the sickening sights of the operating theatreâ€”His researches into the history of anÃ¦sthesiaâ€”Indian hempâ€”Mandrakeâ€”Alcoholâ€”Hypnotism and other methodsâ€”Inhalation of drugsâ€”Sir Humphry Davyâ€”AnÃ¦sthetics discovered in Americaâ€”Horace Wells and laughing-gasâ€”Morton and etherâ€”Ether in Great Britainâ€”He uses it in midwifery practiceâ€”Search for a better-anÃ¦stheticâ€”Discovery of anÃ¦sthetic power of chloroform.

From his earliest student days the desire had ever been present in Simpsonâ€™s mind to see some means devised for preventing the sufferings endured by patients on the operating table, without, as he put it, â€œinterfering with the free and healthy play of the natural functions.â€ It is difficult for us at the close of the nineteenth century to understand, without an effort of the imagination, the strong incentives which he had for such a wish. Even to-day, when operations are conducted without the infliction of pain, young students are not unfrequently overcome by the sight and the thought of what is in front of89them. At the commencement of a winter session the theatre is crowded with those students who are entering upon surgical study, and with others, not so far advanced, who have come to get a preliminary peep at the practice of this fascinatingly interesting art. Many of these at first succumb and faint even before the surgeon has begun his work, and sometimes are only persuaded to pursue their studies by the encouragement of kindly teachers.

Simpson also went through this trying experience, but it must have been a greater struggle to him to persist. The surroundings of the surgeon at the commencement of the century were vastly more repugnant to a youth of sensitive nature than to-day. The operating theatre then has been compared to a butcherâ€™s shambles; cleanliness was not considered necessary, and little attention was paid to the feelings of the patient. He was held down by three or four pairs of powerful arms as the surgeon boldly and rapidly did his work, despite the screams, stopping, perhaps, only to roughly abuse the patient for some agonised movement which had interfered with the course of action. The poor wretch saw the instruments handed one by one by the assistant, and heard the surgeonâ€™s calm directions and his remarks on the case. The barbarous practice of arresting bleeding by the application of red-hot irons to the surface of the wound had indeed ceased three centuries before, when that humane reformer, ParÃ©,90displaced it with the method of tying the open blood-vessel, but the patientâ€™s blood gushed forth before him until arrested, into the sawdust spread to receive it, and the sight and the hot odour of it oftentimes mercifully caused him to faint. The spirit of ParÃ© who, when relating a successful operation, would humbly add at the end, â€œI dressed him; God healed him,â€ had not descended to those who practised in Simpsonâ€™s day the art for which ParÃ© did so much. It had grown to be necessary for a surgeon to be rough and callous; it was expected of him by the public; he was a man to be pointed at in the street, and shuddered at when he passed, by all who devoutly prayed they might escape his clutches. Much of this conduct was mere mannerism; it had become the custom, and had to be maintained in order to preserve the dignity and stamp the identity of the surgeon. Much of it arose from the haste with which the surgeon had to work; the quicker the operation the better chance had the patient; it was no uncommon thing to see a bystander timing the surgeonâ€™s work, as the professional time-keeper carefully times a race; and the rapidity of each surgeonâ€™s performances was a subject of comparison and admiration amongst the students of his day. Much of it also arose from the effect of the hideous scenes in the operating room upon the surgeon himself; his nerve had to become of iron if he desired to succeed, and with the nerve the face and the manner, but not necessarily always the heart hardened91also. Tennyson possibly recollected these days, when he wrote of the surgeon who

â€œSent a chill to my heart when I saw him come in at the door,Fresh from the surgery schools of France, and of other lands;Harsh red hair, big voice, big chest, big merciless hands.â€

â€œSent a chill to my heart when I saw him come in at the door,

Fresh from the surgery schools of France, and of other lands;

Harsh red hair, big voice, big chest, big merciless hands.â€

When Simpson first saw Liston raise his knife to operate on a poor Highland woman, he actually felt so repelled that he contemplated abandoning his studies, and made a serious attempt to enter upon legal work instead. But the mental struggle with which medical men of all countries, and in all times, can sympathise out of their own knowledge, ended in a victory for medicine, and a triumphant return to his studies with the question permanently engraved on the tablets of his mind, â€œCan nothing be done to prevent this suffering?â€

It is necessary and it is certainly beneficial that we should thus remind ourselves of the horrors which surrounded the surgeon so recently as sixty years ago. â€œBefore the days of anÃ¦sthetics,â€ wrote an old patient to Simpson, in a letter which he treasured with prideâ€”the writer was himself a medical manâ€”â€œa patient preparing for an operation was like a condemned criminal preparing for execution. He counted the days till the appointed day came. He counted the hours of that day till the appointed hour came. He listened for the echo in the street of the surgeonâ€™s carriage. He watched for his pull at the door bell;92for his foot on the stair; for his step in the room; for the production of his dreaded instruments; for his few grave words, and his last preparations before beginning. And then he surrendered his liberty and, revolting at the necessity, submitted to be held or bound, and helplessly gave himself up to the cruel knife.â€.

It was, indeed, a monstrous ogre this giant Pain, holding the poor weak human creature in its merciless clutches, which Simpson even in his youthful days bethought himself to attack. It is well that we who are the heirs, should know how Simpson and those others whose names are ever associated with his, slew the monster, won the victory, and championed the human race forward into a land where further victories undreamt of by themselves are now being daily won.

Simpson searched into ancient history in order to ascertain the methods, if any, by which in remote and mediÃ¦val times surgeons sought to prevent the pain of operations. The most time-honoured method seems to have been by the internal administration of drugs, the chief one used being Indian hemp, which was well known in the East, and under one of its nameshaschishgave origin to the term assassin (strictly eater of haschish). A certain Arab Sheikh got together a band of followers to whom he administered haschish, which produced in them its usual effectâ€”beautiful dreams of a delightful paradise. He induced them to believe so thoroughly in his power to gain for them at93death permanent entrance to this paradise that they obeyed all his ferocious and bloodthirsty behests. Thus these assassins became known as men obedient to their leader in any murderous enterprise. Indian hemp was, and still is, used as a luxury all over the East, as well as to annul pain, and was used by criminals doomed to torture or execution. Simpson thought thenepentheof Homer was a preparation of this drug; he also refers to the fact that Herodotus relates that the MassagetÃ¦ inhaled the vapour of burning hemp to produce intoxication and pleasurable excitement.

Mandrake was used in a similar manner and for similar purposes as Indian hemp in the Middle Ages, but it fell into disuse on account of the fatal results that often followed. It is frequently referred to by Shakspeare both for its narcotic properties and for its fabulous power of uttering a scream when torn up by the roots, to hear which meant death or madness. Simpson cited also well-known passages from Shakspeare to prove that the practice of â€œlocking up the spirits a timeâ€ was known to that poet.

In later days the intoxication produced by alcohol was taken advantage of, and instances of its use have been known in quite recent years in the Colonies, where both a surgeon and chloroform were out of reach.

No drug, however, was known to be of such value in producing anÃ¦sthesia as to be constantly used, and94many trials were made of other means, notably that of compressing the nerves supplying the part to be operated upon, but this was found to be too painful in itself. The stupor produced by compressing the carotid arteriesâ€”a method taken advantage of by the ruffians known as garottersâ€”was also put in practice for a time during the sixteenth and seventeenth centuries, but it was found too barbarous a method even for those days.

Hypnotism was known to the Indians, Egyptians, and Persians at a very remote period, and may possibly have been used by them sometimes to produce anÃ¦sthesia for surgical purposes. Simpson was attracted by the words of the poet Middleton in his tragedy â€œWomen, beware Womenâ€ (1617) where he saysâ€”

â€œIâ€™ll imitate the pities of old surgeonsTo this lost limbâ€”who ere they show their artCast me asleep, then cut the diseased part.â€

â€œIâ€™ll imitate the pities of old surgeons

To this lost limbâ€”who ere they show their art

Cast me asleep, then cut the diseased part.â€

When hypnotism made one of its periodic re-appearances in 1837, this time under the name of mesmerism, after that extraordinary exponent of its powers Mesmer, Simpson recognised in it a possible method for â€œcasting the patient asleepâ€ before operation and set to work to investigate its phenomena. A Frenchman named Du Potet, disheartened by the prejudice against mesmerism in his own country, came to London in 1837, and was fortunate enough to receive the support of Dr. John Elliotson, physician95to University College Hospital. Elliotsonâ€™s advocacy of the new practice was received with ridicule by the profession, and was treated with such scathing contempt by theLancetand other journals, that he was completely ruined.

Simpson was very successful in his experiments with mesmerism, conducted on the lines suggested by Elliotson, but he recognised that, after all, it was not the agent for which he was seeking, and dropped his researches.

He did not resume them even when Liston, a few years later, stimulated by the advocacy of the Manchester surgeon Braid, who met with a better reception than Elliotson, and by the relation of a long series of successful cases by a surgeon named Esdaile, in Calcutta, actually performed operations with success on patients brought under its influence.

The first suggestion to produce anÃ¦sthesia by theinhalationof drugs was made by Sir Humphry Davy in 1800. He discovered by experiment upon himself that the inhalation ofnitrous oxidegasâ€”commonly known as alaughing gasâ€”had the power of relieving toothache and other pains; he described the effect as that of â€œuneasiness being swallowed up for a few minutes by pleasures.â€ Although he stopped short at this stage, and does not seem to have used the inhalation to produce actual loss of consciousness, he, nevertheless, forecast the future by suggesting that nitrous oxide might be used as an inhalation in the performance96of surgical operations, in which â€œno great effusion of bloodâ€ took place.

Some thirty years later Faraday pointed out thatetherhad effects upon the nervous system when inhaled, similar to those of laughing-gas. These two drugs came to be inhaled more in jest than in earnest; more as an amusing scientific experiment for the sake of the pleasure-giving excitement they set up, than for the purpose Davy had suggested. Ether, it is true, was recommended even before Davyâ€™s day for the relief of the suffering in asthma, but until the fifth decade of the century no one had attempted to prevent suffering as inflicted by the surgeon or the dentist, by producing the state of unconsciousness brought about by the inhalation of such drugs as etherâ€”a process now known to the world as anÃ¦sthesia.

The persons who first made the bold experiments which resulted in the discovery of how to produce anÃ¦sthesia were Americans; and two men were prominently concerned in the discovery. Several others made isolated and successful efforts with both ether and nitrous oxide, but they lacked the confidence and the courage to make their success public and to persist in their experiments. Of these, Dr. Long, of Athens, Georgia, was one of the earliest; he is said to have successfully removed a tumour from a patient under the influence of ether in 1842, and in the Southern States he is regarded as the discoverer of anÃ¦sthesia. Dr. Jackson, of Bostonâ€”a scientific97chemistâ€”laid claim to the honour of the discovery after others had fought the fight and established the practice of anÃ¦sthesia. Neither of these men, for the reason already given, deserves the honour which is now universally attributed to their fellow-countrymen, Wells and Morton.

Horace Wells was born at Hartford, Connecticut, in 1815, and was educated to the profession of dental surgeon. He gave much attention to the desire present in the minds of many men at that time to render dental operations painless. On December 10, 1844, he witnessed at a popular lecture the experiment of administering laughing-gas, and noticed that a Mr. Cooley, while still under the influence of the gas, struck and injured his limb against a bench without suffering pain. The idea at once occurred to Wells that here was the agent he was in search of, and the very next day he experimented upon himself. If it has ever been fortunate to have toothache it was so for Wells that day; he was troubled by an aching molar which was removed by a colleague named Rigg, whilst he was fully under the influence of nitrous oxide; and thus he began what he himself at once called on recovering consciousness, â€œa new era in tooth-pulling.â€ He proceeded promptly to test the experiment upon others and with complete success; and then making his success known, he proceeded with his former pupil Morton to Boston, and gave a public demonstration of his method which unfortunately was so imperfectly98carried out that he was laughed at for his pains and stigmatised an impostor. Wells himself stated that the failure was due to the premature withdrawal of the bag containing the gas, so that the patient was but partially under its influence when the tooth was extracted. Wells and Morton were ignominiously hissed by the crowd of practitioners and students gathered to see the operation. Wells never recovered from the disappointment and the illness which resulted, and although he was able to explain his discovery to the French Academy of Science in 1846, he unfortunately died insane in New York two years later. Undoubtedly he was the first to discover the practicability of nitrous oxide anÃ¦sthesia, and to proclaim the discovery with a discovererâ€™s zeal. Although his career ended so sadly, his efforts had, nevertheless, inspired to greater endeavour his colleague Morton, who had not only been associated in his experiments, but had been deeply interested in the subject for many years.

William Thomas Green Morton was born in 1819; his father was a farmer at Charlton, Massachusetts. He qualified as a dentist at Baltimore, and entered into successful practice at Boston. Fired with the same ambition as Wells, he made attempts to extract teeth painlessly with the assistance of drugs administered, or sometimes of hypnotism. In December, 1844, after Wellsâ€™s failure with nitrous oxide gas, he wisely abandoned that agent and investigated another which99promised better results. He experimented first with a drug known aschloric ether, but failing to get the desired effect, and at the suggestion of the aforementioned Dr. Jackson, he proceeded to investigate the effect of ordinary ether. The first experiments were made on animals, and were so encouraging that he believed he had at last found the desired agent, provided the effect on human beings corresponded with that upon dumb creatures. Boldly and heroically he made the necessary experiment upon himself, and on September 30, 1846, inhaled ether from a handkerchief while shut up in his room and seated in his own operating-chair. He speedily lost consciousness, and in seven or eight minutes awoke in possession of the greatest discovery that had ever been revealed to suffering humanity. We can picture the man gradually awakening in his chair first, to the consciousness of his surroundings and then to the consciousness of his great achievement; sitting with his physical frame excited by the influence of the drug which he had inhaled, and his soul stirred to its deepest depth by the expanding thought of the far-reaching effects of what he had done.

â€œTwilight came on,â€ he said, in subsequently relating the event. â€œThe hour had long passed when it was usual for patients to call. I had just resolved to inhale the ether again and have a tooth extracted under its influence, when a feeble ring was heard at the door. Making a motion to one of my assistants100who started to answer the bell, I hastened myself to the door, where I found a man with his face bound up, who seemed to be suffering extremely. â€˜Doctor,â€™ said he, â€˜I have a dreadful tooth, but it is so sore I cannot summon courage to have it pulled; canâ€™t you mesmerise me?â€™ I need not say that my heart bounded at this question, and that I found it difficult to control my feelings, but putting a great constraint upon myself I expressed my sympathy, and invited him to walk into the office. I examined the tooth, and in the most encouraging manner told the poor sufferer that I had something better than mesmerism, by means of which I could take out his tooth, without giving him pain. He gladly consented, and saturating my handkerchief with ether I gave it to him to inhale. He became unconscious almost immediately. It was dark. Dr. Haydon held the lamp. My assistants were trembling with excitement, apprehending the usual prolonged scream from the patient, while I extracted the firmly-rooted bicuspid tooth. I was so much agitated that I came near throwing the instrument out of the window. But now came a terrible reaction. The wrenching of the tooth had failed to rouse him in the slightest degree; he remained still and motionless as if already in the embrace of death. The terrible thought flashed through my mind that he might be deadâ€”that in my zeal to test my new theory, I might have gone too far, and sacrificed a human life. I trembled under the sense of my responsibility to my Maker, and to my101fellowmen. I seized a glass of water and dashed it in the manâ€™s face. The result proved most happy. He recovered in a minute, and knew nothing of what had occurred. Seeing us all stand around he appeared bewildered. I instantly, in as calm a tone as I could command, asked, â€˜Are you ready to have your tooth extracted?â€™ â€˜Yes,â€™ he answered, in a hesitating voice. â€˜It is all over,â€™ I said, pointing to a decayed tooth on the floor. â€˜No,â€™ he shouted, leaping from his chair. The name of the man who thus for the first time underwent an operation under anÃ¦sthesia induced by ether was Eben Frost.â€

The nature of the agent used by Morton was kept secret only a short period; the steps he took to bring his discovery before the medical profession would have rendered it difficult if not impossible, even if ether had not a penetrating tell-tale odour. Morton laid his method before one of the surgical staff of the Massachusetts General Hospital, Boston, the same institution where Wellsâ€™s ill-managed demonstration had taken place two years before; he requested, with complete confidence, to be allowed to exhibit the powers of his agent. The surgeon was sceptical, but wisely consented, after having satisfied himself that there was no risk to life. A patient suffering from a tumour was chosen, and readily consented to act as a subject for demonstration. A large crowd of professional men and students assembled in the surgical theatre on the morning of October 16, 1846, the day chosen for the trial.102The senior hospital surgeon, Dr. J. Collins Warren, was to perform the operation. The spectators, many of whom no doubt recollected the failure with laughing-gas, were disposed to deride when the appointed hour passed and Morton did not appear; but the delay was due only to the desire of the dentist to bring a proper inhaler, and although the crowd received him with a chilling reserve, and the occasion was one fit to try the nerve of the strongest, Morton did not lose his presence of mind. He promptly anÃ¦sthetised the patient, and as unconcernedly as does the modern administrator, nodded to the surgeon that the patient was ready. From the first moment that the knife touched the patient, until the operation was concluded, no sound, no movement indicated that he was suffering. The men who had scoffed once and had come, even the surgeon himself, prepared to scoff again, realised the success and the wonder of it, and remained to admire. â€œGentlemen, this is no humbug,â€ exclaimed Dr. Warren, as he finished his handiwork. When the patient recovered he was questioned again and again, but stoutly maintained that he had felt no painâ€”absolutely none. â€œGilbert Abbott, aged twenty, painter, single,â€ was the description of the man on whom was performed the first surgical operation under the influence of ether.

News of the great success rapidly spread, and the experiment was repeated by Morton and others in America, and similar work was taken up throughout103Europe. It cannot be said that Morton derived much benefit from his discovery. Although the greatness of it was recognised in his lifetime, and he received several honours and presents, he entered into prolonged squabbles concerning the discovery which worried him into a state of ill-health, ending in his death in 1868. A monument was erected over his grave by the citizens of Boston, bearing the following concise description of his achievement:â€”

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