SIR JAMES YOUNG STMPSON Bart, M.D., D.C.I..

CIarum et venerabile nomen gentibus (Lucan)*

DOUGLAS MILLER, M.D., F.R.C.S.Ed., F.R.C.O.G. BY

IT is a signal honour, Mr. President, for which I must at once record my grateful appreciation, to have been invited to deliver the first James Young Simpson oration. To address the College on the subject of my illustrious countryman is a great privilege; yet to do adequate justice to a theme so challenging is no light task.

The mysteries of Nature with which our work brings us into daily contact tend to keep our minds in the present or the future rather than in the past, and it is natural that much of our time should be occupied as was that of the Athenians in “telling or hearing some new thing”. Yet it is rewarding to pause from time to time and reflect on the lessons that may be learnt from a study of the lives and work of the great masters of the past; and it is fitting at the same time that we should pay homage to those who have so well served their day and generation and to whom the indebtedness of posterity far outranges com- putation. It is with this thought in mind that I would invite you to join with me in a tribute to one whose impact on contemporary obstetric thought and practice was measureless and whose influence in its beneficence extended far beyond the boundaries of his own speciality and the span of his own lifetime.

BIRTH AND EARLY YEARS

In the year 181 1 a country doctor made the following laconic entry in his case book “275, June 7th, Simpson, David, Baker, Bathgate, Wife Mary Jarvey, aet. 40, Lab. nat. easy rapid 8th child. Natus 8 o’clock. Uti veniebam natus. Paid 10s. 6d.” The material circumstances of Simpson’s home were straitened rather than easy or comfortable-the “res angusta domi” of Juvenal-but his family had the ambition to

furnish him with a fuller education than the village school could provide. Such an ambition, at that time even more than now, was commonly entertained by Scots families no matter how humble their social or economic position might be. It was not seldom realized only at the cost of sacrifices and hardships which in these days of generous grants and foundations are almost incredible. Frequently it was the youngest son who was helped in this way as when the time came for him to leave school the other members of the family were self-supporting and could contribute to his maintenance at the university. This was so in Sjmpson’s case, and it was in the confident assurance of his success that each member of the family gladly and generously made his contribution to send him at the age of 14 to the College of Edinburgh. Without doubt the atmosphere of industry and self-denial and mutual helpfulness in the old home in Bathgate was crucially important in the forma- tive period in Simpson’s life; and the prayers and hopes and trust of his people, which were always with him, were at once a benediction and an inspiration.

Simpson enrolled as a student in the Faculty of Arts and shared lodgings with two medical students. His performance as an Arts student was undistinguished, for his interest was less in the Humanities than in the medical textbooks of his friends, and in their company he was often to be found in the lecture-room of the celebrated anatomist, Dr. Knox, who soon afterwards had to leave Edinburgh because of his sinister association with the resurrectionists Burke and Hare. It is not surprising, therefore, to find that after two years, and without taking his Arts degree, he entered the Faculty of Medicine. The medical course was a short one, and before his nineteenth birthdav he became a member of the Royal College of Surgeons with a full licence to practice. * A name illustrious and revered by nations.

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For the degree of Doctor of Medicine, Simpson submitted a thesis on “Death from Inflammation” which so impressed Dr. Thomson, the Professor of Pathology, that he made Simpson his University assistant. In this association he found one of the great formative influences of his life. It was in the Department of Pathology that he formed habits of accurate observation and lucid and concise description ; it was at this period that he developed the Hunterian “don’t think but try” att,tude of mind, and it was Thomson who first suggested that he should turn his attention to Obstetrics. On this advice he acted with characteristic energy and resolution. He attended for the second time and with fresh interest Professor Hamilton’s class of Midwifery, and a year later in 1832 at the age of 21 he read his first im- portant paper, on “Diseases of the Placenta”, before the Royal Medical Society. This work was of such merit that it attracted widespread attention at home and abroad and was re- published in German, French and Italian journals.

In 1835, at the age of 24, Simpson left the department of Pathology, and after a short intensive tour of hospitals in London and in France he returned to Edinburgh and com- menced private practice. As yet, however, his knowledge of practical obstetrics was rudi- mentary and he was fortunate in securing on a part-time basis the post of House Surgeon to the Lying-In Hospital in Edinburgh. This appointment he held for a year. At its conclusion he had more time to devote to scientific work, and a series of papers, based on laboratory studies or clinical observation, appeared in such rapid succession and were of such quality that in a few years he had achieved an international reputation.

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ELECTION TO CHAIR OF MIDWIFERY In 1839 Hamilton resigned from the Chair of

Midwifery and Simpson, at the age of 28, was elected to succeed him. The Chair was then exclusively in the gift of the Town Council. His candidature was strongly opposed by the Faculty of Medicine. Their hostility was based partly on his youth and inexperience and partly, it would appear, on his social credentials which

were considered inadequate. After his election this opposition continued and developed into a mutual antagonism between him and his associates which persisted and was responsible for numerous wretched misunderstandings and estrangements. As an example of the unfriendly atmosphere in which he found himself may be instanced the action of one of his colleagues who altered the hour of his lecture so that it should clash with Simpson’s and damage the attendance at his class, but who found, with poetic justice, that it was his own class-room which suffered.

All the evidence of contemporary writing and of biographical notes indicates that Simpson must be ranked as one of the greatest teachers in the history of Obstetrics. His own corre- spondence makes it clear that he regarded his class as having the first claim on his time and energy, and one with which the ever-increasing demands of private practice were never allowed to interfere. His class lectures, which are included in his published works, show that his teaching was based on extensive reading so that it should represent the best that was known on the subject, illustrated by his own personal observations in the laboratory and at the bed- side. The qualifications that Osler demanded from the good teacher-the ability to bring an atmosphere of enthusiasm into the class-room, a full and personal knowledge of the subject, and a sense of obligation which impelled him to be also a contributor-these attributes were his in full measure, and in a few years the class of midwifery became, for the first time in its history, the largest in the University, attended daily not only by students but by graduates from all over the world.

ANAJSTHFSIA The discovery of the anaesthetic property of

chloroform is, of course, Simpson’s chief claim to the grateful remembrance of posterity. As a student his sensitive nature had been so revolted by the barbarous cruelty of an operation he watched-it was for the removal of the breast, performed, of necessity, on a fully conscious patient-that he seriously contemplated giving up Medicine in favour of Law as a career. On that day was formed the resolve to discover a means whereby the suffering which surgery

10B

1 44 then entailed could be avoided, and thenceforth all his thought and energy were dedicated to this end. As his usual practice was, he eagerly studied all that had already been written on the subject, and found that from the earliest dawnings of history painless surgery was an ideal that had occupied men’s minds. From time to time patients had been made insensible by drugs and vapours of different kinds. In 1800 Humphrey Davy, by experimenting on himself, had discovered analgesic properties in nitrous oxide, and a few years later Faraday had experimented with ether. So far, however, no anaesthetic agency had been found of sufficient merit to compel general acceptance, and it was left for Morton of Boston on 16th October, 1846, again after self-experimentation, to demonstrate the anaesthetic properties of ether in such a way as to convince the medical world. Surgical anaes- thesia was at last an accomplished fact.

It is not difficult to imagine with what intense interest Simpson learnt of Morton’s discovery, and with what anxiety and hope he contem- plated its applicability to obstetric practice. The employment of ether in midwifery might at first seem to be an obvious extension of its use in surgery, but various possibilities had first to be considered; for example, the time over which it could safely be given had to be studied, and its effects on the action of the uterus, on the occurrence of haemorrhage, and on the welfare of the child had to be determined. These and other considerations made anaesthesia in ob- stetrics a problem in itself. It was, however, in keeping with Simpson’s “don’t think but try” attitude of mind that on 19th January, 1847, three months after Morton’s demonstration, the first case of midwifery in which a general anaesthetic was ever employed was safely delivered in Edinburgh under his care. Two months later he published a series of cases in which ether had been used with success. As usual his paper was headed by a quotation from Shakespeare, taking the form on this occasion of the well-known lines:

“Not poppy, nor mandragora, Nor all the drowsy syrups of the world, Shall ever medicine thee to such sweet

This was an epoch-making advance, but sleep.”

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Simpson was not satisfied that ether was in all respects the ideal anaesthetic for his purpose. He wanted, if possible, to find a preparation not only more portable and less unpleasant to inhale, but one whose action was primarily to induce analgesia without necessarily complete loss of consciousness; such a substance would have obvious advantages in obstetric practice.

The history of the discovery of chloroform anaesthesia is so well known that it is un- necessary to relate it in detail. The sacrifice of leisure and rest so that night after night might be spent in study and research; the courage which inspired him and his assistants, as it had Davy and Morton, to self-experimentation with one unknown substance after another; the repeated disappointment as months passed and each of these in turn was found unsuitable; and at length the thrill of discovery when on 4th November, 1847, a historic date in our annals, chloroform was tested and found to fulfil his requirements-all combine to make a dramatic chapter in medical history. “At a stroke”, writes Osler, “the curse of Eve was removed, that multiplied sorrow of sorrows, representing in all ages the very apotheosis of pain.” It is characteristic of Simpson’s energy and methods of work that no more than six weeks later, on 10th December, he read a paper to the Medico- Chirurgical Society of Edinburgh, describing a series of fifty cases in which chloroform had been successfully used.

The employment of anaesthesia in surgery, and more especially in obstetrics, aroused an opposition the extent and character of which it is at this date as difficult to understand as that which delayed acceptance of the work of Harvey and Jenner and Lister. Objections were raised on both medical and moral grounds. On the former it was argued that anaesthesia would increase the already high mortality of surgery, and would be followed by such diverse sequelae as haemorrhage, convulsions and insanity, On moral and religious grounds, anaesthesia. especially in obstetrics, was opposed by a group of theological pedants as being contrary to scriptural precept, and it was urged in all seriousness that pain was “a desirable, salutary and conservative manifestation of life force”.

To indulge in controversy on any subject in which he was interested was a temptation at all

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times beyond Simpson’s power to resist, and when the question at issue was one of such vital importance and personal concern as anaes- thesia, it roused in him fighting qualities that were at once passionate and uncompromising. The story of his fight for anaesthesia cannot be read without admiration for the courage, the single-mindedness and the personal force which enabled him to challenge, defy and overcome the forces of ignorance, prejudice, casuistry and obscurantism by which he was opposed. Great as was his discovery of chloroform anaesthesia the way in which he compelled its acceptance, where another would have been a voice crying in the wilderness, was a no less notable achieve- ment. Herein indeed lay his genius, or at least one aspect of it. He produced statistics to show that the mortality and morbidity of surgery, far from being increased by anaesthesia, were reduced by the elimination of shock and of the necessity for speed, and that the forecast of other untoward consequences was quite without foundation.

The controversy aroused immense interest throughout the country, and the general public for the most part ranged themselves enthusiasti- cally on the side of Simpson, whom they regarded with an admiration amounting to hero- worship as the champion of anaesthesia and as the leader of a crusade against suffering. The opposition yielded but slowly to Simpson’s powerful advocacy and the support of an increasing number of eminent surgeons, and it was not until Queen Victoria had been given chloroform in her confinement and had pro- nounced favourably on it, that the fight for anaesthesia was won.

Anaesthesia and asepsis have become such commonplace accompaniments of modern sur- gical and obstetrical practice that we are apt to take them for granted without pausing, as often perhaps as we should, to reflect on what we owe to those whose work brought to the practice of medicine no less than a new heaven and a new earth. May I read to you an extract from a letter to Simpson, which serves to remind us of the magnitude of this debt?

“I have recently read, with mingled sadness and surprise, the declarations of some surgeons that anaesthetics are needless luxuries, and that unendurable agony is the best of tonics.

145 “My present object in writing is not to

supplement your arguments in favour of the administration of anaesthetics to those who are about to undergo surgical operations; but, as one who knows from personal experience what operations were to the patients before ether or chloroform was employed anaesthetically, I am anxious to state certain reasons in justification of their use, which only those who suffered without their help are in a condition to urge.

“Several years ago I was required to prepare, on very short warning, for the 10:s of a limb by amputation. A painful disease, which for a time had seemed likely to yield to the remedies employed, suddenly became greatly aggravated, and I was informed by two surgeons of the highest skill, who were consulted on my case, that I must choose between death and the sacrifice of a limb, and that my choice must be promptly made, for my strength was fast sinking under pain, sleeplessness and exhaustion.

“I at once agreed to submit to the operation, but asked a week to prepare for it, not with the slightest expectation that the disease would take a favourable turn in the interval, or that the anticipated horrors of the operation would become less appalling by reflection upon them, but simply because it was so probable that the operation would be followed by a fatal issue, that I wished to prepare for death and what lies beyond it, whilst my faculties were clear and my emotions were comparatively undisturbed.

“The week, so slow, and yet so swift in its passage, at length came to an end, and the morning of the operation arrived. Suffering so great as I underwent cannot be expressed in words, and thus fortunately cannot be recalled. The particular pangs are now forgotten; but the black whirlwind of emotion, the horror of great darkness and the sense of desertion by God and man, bordering close upon despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so.

“Further, during the operation, in spite of the pain it occasioned, my senses were preter- naturally acute, as I have been told they generally are in patients in such circumstances. I watched all that the surgeons did with a fascinated intensity. 1 still recall with unwelcome vividness the spreading out of the instruments; the twisting of the tourniquet; the first incision;

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the fingering of the sawed bone; the sponge pressed on the flap; the tying of the blood vessels; the stitching of the skin; and the bloody dismembered limb lying on the floor.

“Before the days of anaesthetics, a patient preparing for an operation was like a con- demned criminal preparing for execution. He counted the days till the appointed day came. He listened for the echo in the street of the surgeon’s carriage. He watched for his pull at the doorbell; for 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.”

CONTRIBUTIONS TO OBSTETRICS These earlier years of Simpson’s life, in which

his time and energies were devoted mainly to the problem of anaesthesia, were a period of intense and increasing activity in other directions. His success in private practice was immediate. Within a few years of graduation he had more work of this kind on his hands that he could conveniently undertake. When he was appointed to the Chair, young and comparatively un- known, the hotel-keepers in Edinburgh were seized with alarm that the large clientele which Hamilton’s reputation had attracted to Edin- burgh would be lost, but within a few years they were finding difficulty in accommodating those who came to consult his successor. His appointment in 1847, at the age of 36, as Physician to the Queen, set the seal on his success.

A man of weaker fibre would have been dazzled and destroyed by success so rapid and complete as he had achieved, and would have found irresistible the temptation to exploit his talents commercially at the expense of the class-room and the laboratory. It is a trite observation that material success coming too early and too fully in professional life to a man of high intellectual gifts may turn him from the worship of Minerva to the idolatry of Mammon with a lowering of ideals which reminds us of Wordsworth’s lines :

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“When I have borne in memory what has

Great nations; how ennobling thoughts

When men change swords for ledgers, and

The student’s bower for gold . . .” Simpson’s life had been one of self-denial and

frugality not far removed from privation, and material prosperity was now within his grasp, but from his full duty to the University and his scientific studies he was deflected neither by “the deceitfulness of riches” nor yet by the “fickle coquetry of public favour”. As a student and young graduate, while dependent on his brothers, he had been scrupulously careful and frugal. After his debts had been discharged he became as careless in money matters as formerly he had been careful. In his letters to his family, which throw a clear and intimate light on his character and interests and ambitions, the subject of fees or income is almost never mentioned.

The thirty years of Simpson’s professional life- time represented a period of rapid progress and emancipation in our specialty. In the 1830 edition of Burns’s Principles of Midwifery, probably the most enlightened textbook of obstetrics of this period, we find that blood- letting, purgation and opiates comprised the standard and almost the only remedies in obstetric practice. The different types of ante- partum haemorrhage had not been differentiated, nor was the significance of oedema and head- ache as possible precursors of eclampsia under- stood. Tedious labour was treated by vene- section and opiates, by manual dilatation of the cervix and by lubrication of the birth canal with lard. Delivery of the placenta was generally effected by traction on the cord or by manual removal.

The maternal and foetal mortality were as high as one would expect where the practice of obstetrics was conducted along these lines, and were probably higher than such figures as are available would indicate. In 1840, when Simpson was elected to the Chair, the maternal death rate throughout the country was in the neighbourhood of 10 per 1,000. By 1870, the year of his death, a striking improvement had been achieved and the mortality rate had fallen

tamed

depart

desert

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to a figure which remained fairly constant until the introduction of chemo- and antibiotic therapy seventy years later. A comparative study of the practice of midwifery at this date ( I 870) with that of thirty years earlier makes it clear that, with the notable exception of Listerism, the advances made during Simpson’s professional lifetime were as great in extent and importance as those made during the following half-century, and further that much of this improvement in the standard of practice was due to his own observation and teaching.

A study of Simpson’s collected works shows that there was scarcely a topic in the whole range of obstetrics and gynaecology on which he did not write and to the knowledge of which he did not make some important contribution. The introduction of anaesthesia, of course, made possible, or safer and more practicable, many procedures which formerly were impossible or fraught with serious difficulty or danger. Next to puerperal sepsis the commonest cause of maternal death was delayed labour. That this should be so is not surprising when it is recalled that forceps were applied not oftener than in one out of every 400 births and that this was accompanied by a mortality of 20 per cent. The discovery of chloroform anaesthesia led to a complete change of attitude towards the management of delayed labour and resulted in an enormous saving of maternal and foetal life. Tt is natural that Simpson should have been among the first to appreciate the importance of anaesthesia in this respect. In a series of publications he demonstrated the dangers of serious delay in labour and enunciated clearly the principles that should govern its manage- ment. The increased scope of Caesarean section which Listerism made possible naturally altered again and radically the conduct of labour so complicated. None the less Simpson’s teaching not only led to an immediate and substantial reduction in mortality but did much to form the basis on which modern obstetric practice has been built, and his papers, written a century ago, can still be read with interest and profit.

Puerperal sepsis and the monstrous toll of life it exacted inevitably attracted Simpson’s atten- tion, and a series of papers which embodied his studies considerably influenced the thought and practice of his time. The communicable nature

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of the disease had already been pointed out by White (1763)’ Gordon (1795), Oliver Wendell Holmes (1843) and above all by Semmelweis (1847). But in spite of the marked reduction in mortality which Semmelweis was able to achieve his observations were not generally accepted and applied. Simpson indeed was one of the few obstetricians of his time fully to appreciate the importance of Semmelweis’s discovery and he was a strong advocate of the hand disinfection which Semmelweis taught.

Simpson’s studies on infection, both puerperal and surgical, directed his further thought to the part which hospital design and organization might play in its incidence and transmission. He was convinced that overcrowding and inadequate ventilation of hospital wards were important agencies, and among his most interesting papers are those embodying his views on hospital construction. These were novel and indeed revolutionary. A paper written in 1864 opens with these words: “Perhaps one of the most weighty and momentous questions to which at the present day the physician, the surgeon and the accoucheur can direct his attention is the proper resonstruction and arrangement of our hospitals.” How apposite and relevant are these words today a century later when, with the exception of neoplastic disease, hospital construction is perhaps our most formidable pre-occupation. How much in harmony in their general principles were his views on hospital planning with those held today will emerge in a moment. Simpson had been impressed by two sets of personal observations pointing the same lesson. The first was that the mortality from puerperal sepsis was many times greater in normal cases delivered in hospital than in the patients’ own homes. The second was that the mortality from amputation of the thigh, the commonest operation of his day, was considerably higher in the large infirmaries in the cities than in cottage hospitals in rural areas, and this despite the greater skill available in the urban institutions. He also adduced evidence from the German and American civil wars to show that wounded treated in small wooden or tented units recovered more satis- factorily than those in larger hospitals. On these premises he advocated the abolition of the large self-contained hospital and in its place the

148 construction of small cottage units, providing adequate isolation and ventilation and built of wood or brick so that as their design became obsolete they could be demolished and rebuilt at no great cost. Simpson’s views did not prove acceptable to his colleagues, possibly because of the advent of Listerism, otherwise he might well have been remembered as a pioneer in hospital reform as much as for his work on anaesthesia.

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“Made weak by time and fate, but strong

To strive, to seek, to find, and not to

Apart from broken health the closing years of Simpson’s life were saddened by bereave- ment and adversity. His eldest son, a doctor of brilliant promise, died after a short obscure illness, and soon afterwards death also took from him his eldest surviving daughter and another son. In addition, he suffered serious financial losses from imprudent investment. These trials he faced with great courage and a strengthening of those convictions by which, though never paraded, he had been sustained all his life. “To visit the afflicted, to do justly and love mercy, and to keep himself unspotted from the world”: such in essence was his creed. His work went on as before and his home in 52 Queen Street continued to be the centre of an extraordinary and unique social activity. Not only were his reception rooms constantly filled with patients, but almost every day statesmen, noblemen, and distinguished men of letters or science from all over the world were entertained to breakfast or luncheon. His hospitality was princely. As a Mecca to which all were attracted, 52 Queen Street was exactly what Abbotsford had been a quarter of a century earlier, with Simpson as presiding genius adequately taking the place of Sir Walter Scott as the most out- standing personality and distinguished celebrity of his day.

It is tempting to dwell for a moment on the parallelism between these two great figures. Each had a giant intellect, together with the gift of intense concentration and a prodigious capacity for hard work. Each was the most distinguished Scotsman of his day and had qualities which attracted to his home men from all over the world that they might pay tribute to his genius. Each in his day was recognized as the supreme master of his craft, and yet to study their lives is to be left with the conviction that in each case the man was greater than the craftsman. Each was to experience sweeping success followed by adversity and sorrow and these two stern tests of character each met with such equanimity and fortitude as may be shown only by those who have their fundamental values right.

in will

yield.”

CONTRIBUTIONS TO GENERAL MEDICINE Although the bulk of Simpson’s published

work was the fruit of observation and study in his own specialty his interests, as has already been indicated, were by no means exclusively obstetrical. He was primarily a general physician and had the catholic outlook and comprehensive knowledge of disease which all the great masters of medicine have possessed. His general publi- cations attest to the diversity of his interests and some of them, such as his monographs on “Leprosy and Leper Hospitals in Scotland and England” and on “Antiquarian Notices of Syphilis in Scotland” have permanent historical value. Many were of such importance as con- siderably to influence contemporary thought and practice. Of these should be mentioned in particular his series of papers on “acupressure” which were designed to improve the technique of the operation of amputation and did in fact result in an important saving of life.

CLOSING YEARS As the years passed, Simpson’s life continued

to be one of incessant and intensely concen- trated hard work. He was everywhere in demand in Scotland and in England. The hotels in Edinburgh were full of his patients and the greater part of his house at 52 Queen Street was converted into a private hospital. Under such prolonged and intense physical and mental strain it was inevitable that Nature should exact her forfeit and attacks of precordial pain and breathlessness began to appear, together with a loss of buoyancy and of resilience after effort. This was the writing on the wall which none could read better than he yet, sustained by his indomitable spirit, he continued to work desperately hard.

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During the autumn of 1869 and spring of 1870 anginous attacks recurred with increasing frequency and severity but except when he was completely prostrated his work went on. Even when he was no longer able to leave his sick- room patients would not be denied and demanded to be carried to his bedside that he might prescribe for and advise them. His last public appearance, on 9th February, 1870, was at a meeting of the Edinburgh Obstetrical Society of which he was an original fellow and had been President from 1842-1857. He died on the 6th May, 1870, at the age of 59. Of no one is the commonest obituary tributes, that devotion to duty shortened his life, more literally true. The national honour of burial in Westminster Abbey was declined by Lady Simpson and he lies in a quiet corner of an Edinburgh graveyard.

And so there passed one whom today we acclaim as worthy of the praise which the author of Ecclesiasticus bestows on famous men. If, in so far as this is possible, an analysis is made of those qualities which contributed to his achievement, there emerge three which may be briefly considered. The first of these was an intellect exceptional in its discernment and resource and balanced versatility. Yet, gifted though he was with a master mind and a pro- found and original thinker, Simpson was essentially a man of action, not a philosopher; a realist, not a theorist. Ever at the centre of his heart and thoughts was a passionate solicitude for woman in the hour of Nature’s danger. This was the inspiration of his best work and herein it found its direction and its purpose. And so in all his published work we find evidence that his thoughts, even when imaginative, moved along essentially practical lines. He was a master of obstetrical strategy and at the same time a brilliant exponent of tactics and tech- nique. In the words of the Preacher he “sought out many inventions” and devised new methods and equipment which were a striking improve- ment on those formerly in use. Various instruments he designed were to be found till recent years, at least as prototypes, in every instrument cupboard.

A second factor in Simpson’s success was a dynamic personality of which the chief com-

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ponents were an exuberant vitality and an ardent enthusiasm together, it must be added, with great goodness of heart. He was imbued with the pioneer spirit which impelled him to explore unknown territory and enabled him to enlarge the frontiers of our knowledge. So it was given him to free obstetrics from the dead hand of an arid, static traditionalism which still prevailed despite the pioneer work of Smellie a century earlier. And when a new truth was discovered it was with an evangelical fervour that he proclaimed it and with such personal force and authority as to command its acceptance.

A robust individuality formed another facet of his character. Nothing was accepted that he did not first prove for himself. It has been said of him that he was controversial and even con- tentious in temperament. There is some sub- stance in these charges, and it is true that when important issues were at stake his convictions impelled him at times to write in Carlyle’s phrase “with his heart’s blood” and express himself in writing or speech with a dogmatism and an assertiveness that were bound to invite antagonism and even hostility. And so we find that among his colleagues, while he had a few warm supporters, he had singularly few friends and there were several from whom for many years he was completely estranged.

Medical Edinburgh a century ago was a veritable hotbed of controversy and partisan- ship, in which our predecessors did not trouble to cloak their mutual animosities in polite insincerities. The evolution in medical practice during the past hundred years has been accom- panied not only in Edinburgh but throughout this country by no change more beneficent than that which has transformed our relationships with one another so that in place of being embittered by jealously and discord they are made pleasant by co-operation and comrade- ship. Much of this is due to the development and wholesome influence of the many scientific institutions in which our profession is now SO

rich, much to the more intimate contacts we enjoy in our various gynaecological visiting groups, and much to the spirit of concord and good fellowship which since its foundation this College has done so much to inculcate and to foster both in these Islands and throughout the Commonwealth.

I50 The third factor of Simpson’s success, and

perhaps the most important, was his prodigious industry. Year after year, despite the increasing demands of other work, his literary output continued to be enormous. Along with his phenomenal powers of concentration and industry was an ability to do with little sleep that was no less remarkable. In a letter to his brother he writes “I have been up writing a paper for the Edinburgh Medical Journal since three this morning”; in another, referring to the preparation of his daily lecture “I rise regularly at three every morning to get all ready by breakfast”. And yet it was his animation and vivacity that were the characteristics that most impressed themselves on those who knew him. Anyone who is tempted to self-pity on the ground of overwork will find a salutary corrective in a study of Simpson’s daily routine.

His zest for hard work was insatiable and was matched by a capacity for sustained mental and physicaleffort thatwas virtually inexhaustible.This was the solid foundation on which the brilliant superstructure was built and without which, des-

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pite exceptional gifts of intellect and personality, his achievement would not have been possible.

When on occasions such as this we remember in honour and with grateful hearts those by whose labours our lives have been enriched, the name of James Young Simpson must ever hold a foremost place in our thoughts. No one did more than he to establish our specialty as a science as well as an art. It was the torch he lit that was to dispel the shadows of ignorance and superstition in which at the outset of his career obstetrics was enshrouded and which illumined for those who followed him the pathway to further progress. Yet our indebtedness to him is to be measured not only by his contribution to our knowledge, massive though that was, but also and even more by the example he gave us of an enthusiasm for his vocation that never languished, of an energy in well-doing that never wearied, and of a life in which were richly displayed the essential virtues of courage, self- discipline and service, and every day of which was dedicated to the relief of suffering,