Edinburgh Medical Journal Ap7~il 1923

THE MEDICAL SCHOOL AND ITS PROFESSORS IN MY STUDENT DAYS (1865-1869).

By BYROM BRAMWELL, M.D., LL.D., F.R.C.P.E.

Mr President and Gentlemen,?Allow me, in the first to to be place, thank you for asking me to give this address: asked to follow in the footsteps of the many distinguished men who have given the Inaugural Address to the Royal Medical Society is an honour which I assure you I fully appreciate. It is always a great pleasure to speak in this hall: it recalls many memories; and I thought it might be interesting to the men you to hear something of my student days and of who were my teachers. I commenced the study of medicine now exactly ty seven years ago?on ist November 1865. The Edinburg now. t e Medical School was then much smaller than it is average annual number of University medical students urm^ the four years that I studied was 4&9> the avera?e alll^ua number during the past four years was 1825. The comparison o is not, perhaps, altogether a fair one, for the numbers stu en years have been swollen by the war and the women in there were, of course, no lady medicals my day. un er At that time we both worked and played disadvantages compared with you students of to-day. t en rma , was no Students' Union; there were no hostels, ui in*., > situated in a hole, was a dingy, dirty, insanitary ica c asse was the me dissecting-room deplorable (all ^ then held in the old University, and the dissecting-room corner o at the top of the stairs in the north-west delivered The Inaugural Address to the Royal Medical Society, 20th October 1922. Byrom Bramwell quadrangle). Sir William Mitchell Banks, in writing to con- gratulate Sir William Turner on his election as Principal, in the year 1903, termed it "that terrible old dissecting-room at the top of the stair." There were at that time no beautiful permanent dissections to study from; the bodies were often imperfectly preserved?sometimes, before we had done with them, in an advanced state of decomposition. Let me illustrate this point by a little incident. One beautiful summer morning in June 1866 I went with my dear old friend, Edward Harriman Dickinson, and another friend, Dods, by an early train to fish the Clyde. We were alone in the carriage. VVe had not gone very far when Dickinson began sniffing about, poking his " head under the seats, and said, There is a beastly smell in this " carriage." Dods, who was a somewhat stolid man, replied, I " " think it must be the maggots in my creel; then he added, / got them from 'my partIn my day there were no practical classes, except in physiology; there were no clinical tutors; we had to work out the cases for ourselves; that was perhaps not a disadvantage, for we had more time to think; we had, too, more clinical material to work with?the proportion of students to beds in the hospital was smaller than it is now; further, we had the Royal Medical Society; then, as now, it was a flourishing institution. I was elected a member on 15th November 1867. I well remember the reverence with which I regarded the Presidents, more particularly, Sir, the Senior President, and the feeling of nervous trepidation with which I got on my feet for the first time to make a few disjointed and incoherent remarks. I was elected the Curator of the Library on 4th December 1868. I was never a President; the winter I would certainly have been a President, I had gone into practice. This also prevented my being house-physician to Professor Sanders, who had just been elected Professor of Pathology, and who, with the assistance of David Hamilton, afterwards Professor of Pathology in the University of Aber- deen, reorganised the pathological department, and made it, as it has since been, one of the most important features of the Medical Faculty. Sanders was a very able physician and clinical teacher, and after Warburton Begbie's death was, for a few years, the leading consulting physician in . By leaving Edinburgh I also had to refuse the invitation of the Professor of Medicine (Professor Laycock) to act as his assistant in succession to David Ferrier. i34 Professors in my Student Days The medical professors of the University, some of their assistants, and many of the extra-mural lecturers and teachers were very remarkable men ; indeed, I speak advisedly when I say that, so far as my knowledge enables me to judge, there was never any medical school in the world at any period of its existence which, at any one time, had such a number of extraordinarily able and distinguished men as the Medical School of Edinburgh had when I became a medical student in November 1865.* Let me try and give you some idea of these men. John Hutton Balfour was the professor of ; he was a great botanist, a distinguished man of science ; we called him " " Woody Fibre ; he was a dry and uninteresting lecturer. George J. Allman was the professor of natural history ; he was an Irishman, and a poet. He used to drive up to the south-west corner of the quadrangle at two o'clock in his jaunting car (I have only seen one other Irish side-car in Edinburgh during the whole time I have lived here), briskly jump off, run up the steps, and give us charming descriptions of such things as coral reefs and the deep-sea fauna of the Tropics. Lyon Playfair (b. 1818, d. 1898) was the professor of . Playfair was a good chemist?he had been a pupil and protege of Liebig, the great German chemist? he was, too, a man of great common sense, a capital organiser, a business man, a man of affairs. During the twenty years he held the professorship he made great improvements in the chemical department, more particularly in the laboratory. In my third year (1868) he resigned the professorship in order to become Member of Parliament for the Universities of Edinburgh and St Andrews ; he at once took a distinguished position in Parliament, was Postmaster-General in one of Mr * Professors in the University :?John Hutton Balfour, George J. Allman, Lyon Playfair, John Goodsir, John Hughes Bennett, William Henderson, , Douglas Maclagan, , Thomas Laycock, , . Assistants to the Professors;?James Dewar, William Turner, Ramsay Heatley Traquair, , James A. Russell, Morrison Watson, William Rutherford, Thomas R. Fraser, James Ormiston Affleck, David Ferrier. Extra-mural Lecturers and Teachers:?Wm. R. Sanders, Mathews Duncan, Thomas Keith, Daniel Rutherford Haldane, George Balfour, Thomas Grainger Stewart, P. H. Watson, D. Argyll Robertson, Thomas Annandale, John Duncan, Joseph Bell, A. Crum Brown, Henry D. Littlejohn, J. Bell Pettigrew, P. D. Handyside. *35 Byrom Bramwell

Gladstone's ministries (1873-74), was knighted in 1883, and raised to the peerage in 1892. Playfair was a very lucid lecturer; he gave an admirable course, well balanced to the needs of his large conglomerate class, composed of medical students, arts students, and men studying to be scientific chemists, commercial chemists, and pharmacists. The numerous experiments made before his class were invariably successful ; this he owed in large part to his assistant, James Dewar. Most of you probably know the name of Sir James Dewar, he is one of the most distinguished, perhaps the most distinguished, chemical physicist of the last fifty years; he has made a great number of most important original investiga- tions and discoveries; with Sir Frederick Abel he discovered cordite (smokeless powder), and is the inventor of the thermos flask (Dewar's flask). I was fortunate in making the personal acquaintance both of Playfair and Dewar, for I happened to get the second medal in Playfair's class; it entitled me to a Hope Scholarship and to work for several months in the chemical laboratory. John Goodsir (b. 1814, d. 1867) was the professor of anatomy. When I knew Goodsir he was a very sick man. I shall never forget his appearance as he came into the lecture- room on the first day of my first session?a tall, gaunt, emaciated man, in a black skull-cap, staggering in on the arm of his stalwart assistant, the curator of his museum, Mr Stirling. Goodsir had suffered for many years from tabes ; and it was remarkable how, though frequently racked with severe lightning pains and heavily handicapped by the other disabilities which advanced tabes entails, he for many years went on fulfilling the duties of the professorship and prosecuting those researches which made his name famous. " Dr Logan Turner, in the Life of his father, states : Goodsir had a world-wide reputation as the most philosophical anatomist of the century." In his obituary notice in the Edinburgh Medical Jout7ial (April 1867, p. 962), it is stated: "Every department of anatomy he had studied minutely?human, comparative, morphological, physiological, pathological and each department he had enlightened by his discoveries." In my day Goodsir was never seen in the dissecting-room, but the practical work of the department was most admirably carried on by a remarkable staff of assistants. 136 Professors in my Student Days

The first assistant was William Turner. I need not say much to this audience of Sir William Turner; he served the the University for long period of sixty-two years, and served it well. He came to Edinburgh on the recommendation of Sir James Paget, as Goodsir's first assistant, at the age of 22 ; he filled this post for thirteen years; then, in my second winter session, when Goodsir died, was elected to the professor- he was ship ; Professor of Anatomy for thirty-six years; he finally was elected to the high and onerous position of I rincipal of the University; this' position he held for thirteen years. Turner was a splendid demonstrator and a lucid lecturer on the somewhat dry subject of anatomy (it is surely absurd to make students attend 100 lectures on systematic anatomy, a subject which can be so much better studied in the dissecting- room and from permanent preparations). Turner was a distinguished anthropologist, a forcible personality, but, above all I a think, business man ; if Turner had gone into commerce and had had a fair start, he would probably have died a millionaire. The second assistant was Ramsay Heatley Traquair. When I a knew him he was young man, aged 25 ; he taught " me the bones"; he became an eminent palaeontologist and ichthyologist, and was for many years Keeper of the Natural History Department of the Royal Scottish Museum. The other three assistants were John Chiene, who succeeded Spence as professor of surgery, and filled the Surgical Chair for many years with great acceptance to the students; James A. Russell, who, after a few years of anatomy, turned his attention to public health, was elected a member of the Town Council, and became a very distinguished Lord 1 rovost of the City of Edinburgh; and Morrison Watson, who, a tew years after I knew him, was appointed Professor of Anatomy in the University of Manchester. John Hughes Bennett (b. 1812, d. 1875) was the professor of physiology. He was elected Professor of Physiology, or the Institutes of Medicine as it was then termed, in 1848, when was he 36 years of age, not merely because of his merits as a physiologist, but because of his knowledge as a pathologist and clinician.* * "At that time it was not considered to be the duty of the holder of the chair to teach physiology, pure and simple, as a branch of scientific enquiry, but to teach it by constant reference to the science of pathology VOL. XXX. NO. IV. 137 I 2 Byrom Bramwell

Bennett was a remarkable man; he had a very keen, penetrative intellect, a critical rather than a constructive mind; he was an advocate and special pleader rather than a judge. Although a very fluent and able speaker, Bennett used to read his lectures ; he excelled especially as a clinical teacher ; he particularly insisted on accuracy and method in the examina- tion of patients and in recording cases. Bennett was a prodigious and indefatigable worker, and made many important contributions to physiology and clinical medicine. He was the first man to institute practical classes in the University, and the first man in this country systematic- ally to teach the use of the microscope in physiology, pathology, and clinical medicine. He introduced cod-liver oil to the notice of the profession in this country, and was the first to use it in the treatment of phthisis; in passing I may say that cod-liver oil is likely to have a still more extended use in the future, since, as you probably all know, it is particularly rich in vitamin A. Bennett was the first to describe leucocythaemia?in 1845 ; he termed it a primary suppuration of the blood. Very shortly afterwards, Virchow, the great German pathologist, published a case which he had independently observed prior to the publica- tion of Bennett's first communication on the subject. Virchow pointed out that the white corpuscles found in the blood were white blood corpuscles and not pus cells; he consequently " termed the condition weisses Blut" or leukaemia; he also, very shortly after his first publication on the subject, recognised the fact that, in some cases of leucocythaemia, the increase of the white corpuscles is due to an increase of the large white cells of the blood, in others to an increase of the small, white cells; and that in some cases the spleen is enlarged, while in other cases the lymphatic glands are enlarged. Basing the distinction upon these points of difference, Virchow divided cases of leukaemia into two varieties?the splenic and the lymphatic forms respectively. A keen controversy was waged for some years between these two celebrated men and their supporters, both as to the question of priority of discovery and as to the correctness of their respective interpretations of the blood and therapeutics. A candidate, therefore, required not merely to be an accomplished physiologist in the ordinary acceptation of the term, but likewise a physician ; and not merely a physician, but also a pathologist." (.Edinburgh Medical Journal, November 1875, P- 466.) 138 Professors in my Student Days condition. Bennett used to give a most entertaining lecture on the subject; and, I need hardly say, left us students completely under the belief that his (Bennett's) opponents had not a leg to stand upon. Bennett was the man above all others who gave the knock- out blow to bleeding. Up to his time bleeding was practised not in the only treatment of acute diseases such as pneumonia, but in all and every sort of disease. If a patient did not get he was better, bled ; if he still continued to get worse, he was bled ; and he was sometimes bled to death. But it was not

John Goodsir. John Hughes Bennett. only sick people who were bled ; healthy people were bled every spring and fall in order to keep them well. At that time, when one went into a country doctor's waiting-room one would see a of who pile soup plates ; these were intended for the patients were to be bled. In the old Royal Infirmary a hundred years ago, there were two bleeding clerks attached to each medical ward?my father acted as a bleeding clerk. Bennett never had a large practice. Although he had a sound all-round practical knowledge of clinical medicine?the first essential for genuine success?he lacked many of the qualities which are essential for great success in consulting practice ; he was too sceptical and critical, too intolerant of the opinion of others ; he wanted tact and savoir faire, and the power i39 Byrom Bramwell of managing doctors and patients; above all, he had not the power of impressing patients with confidence?a quality which is essential for great success in any department of medical life; he was, too, a sceptic as regards drugs. Bennett was dreaded and feared as an examiner, but, as is often the case, his bark in this respect was, I think, worse than his bite. Let me give you an incident connected with Bennett and examinations. The day before the oral examination in physiology, I was standing at the foot of the University steps looking into Nicolson Street, chatting with two friends? Alexander Bennett, the only son of the professor, a lifelong friend of mine, who unfortunately died young, just as he was making a fine reputation and a good practice as a neurologist in , and Joe Dickinson (a cousin of the Edward Harriman Dickinson whom I have mentioned in connection with the maggot incident), a good cricketer but not a brilliant student. We were discussing our chances at the examination which was coming off the next day, and Dickinson, who had been twice " plucked in physiology, said to Bennett, Well, Bennett, I warn you that if your governor plucks me again, you will be an orphan." Unfortunately at that moment the professor, John Hughes, came down the steps behind us; he heard what Dickinson said, looked at him, and passed on without saying a word. The next morning he plucked Dickinson for the third time, with the result that Alexander Bennett did not become an orphan, but poor old Joe shortly afterwards gave up medicine. Bennett had a high opinion of the Royal Medical Society ; he " regarded it as one of the most valuable adjuncts to medical education and culture in Edinburgh, and a session rarely passed without the Society having the benefit of his powerful advocacy from the professorial chair." William Rutherford was Bennett's assistant in my time; he succeeded Bennett in the professorship. Rutherford was an able teacher and an eloquent lecturer. William Henderson (b. 1810, d. 1872) was the professor of pathology. Henderson graduated as M.D. in 1831 ; soon afterwards he was appointed physician to the Fever Hospital, and, shortly after that, a physician to the Royal Infirmary. His early professional life and work gave great promise of success and distinction. In 1835-1837 he published a series of clinical studies on Diseases of the Heart and Great Blood- Vessels which 140 Professors in my Student Days are of value and importance. He was the first to point out that typhus and relapsing fever were two distinct diseases, and not, as had been supposed, merely different types (sthenic and asthenic) of the same disease. In 1842, when he was 31 years of age, Henderson was appointed Professor of General Pathology in the University. Unfortunately, two years after this, he became entangled in the sophistries of homeopathy; he had to resign his position as physician to the Royal Infirmary; and a career, whose early brilliance was so full of hopeful promise, was lost to science. Henderson was an able man ; he also had a keen sense of humour. His class, which was held at 4 o'clock in the after- noon, when we were all tired and perhaps somewhat irritable after a long day's work, commencing with Christison's lectures at 9 a.m., was apt to get a little out of hand. One day Henderson was lecturing on the sounds of the heart and the method of their production. He stated that many animals had been used in the investigation of the sounds of the heart, amongst others the donkey (loud applause). To this he " replied in his strong nasal voice, The donkey, gentlemen, has been a most valuable animal in the progress of science." (Renewed and uproarious applause.) Henderson's eyes sparkled ; he looked up and down the benches until he had covered with " his eye every individual student, then he said, Gentlemen, there is hope for you all yet." Robert Christison (b. 1797, d. 1882) was the professor of materia medica. Christison was a striking figure ; tall, erect, with a commanding presence, a somewhat cold and imperious manner, we used to call him "Dignity Bob." In 1822, when he was 25 years of age, he was elected Professor of Medical Jurisprudence in the ; he occupied this chair for ten years, and during this period wrote " his celebrated Treatise on Poisons, which was received at the time by physicians, jurists, and men of science generally, is the most philosophical exposition of the subject that had ever appeared." In 1832, Christison was appointed Professor of Materia Medica and Clinical Medicine in the University of Edinburgh ; he resigned in 1877, occupying the chair for the long period of forty-five years. During this period he did much original work on and pharmacology and collected a remark- ably fine museum. In his investigations he made many vol. xxx. no. iv. 141 1 3 Byrom Bramwell experiments on himself, "with an amount of enthusiasm and courage bordering on rashness. It is related of him that when the Calabar bean was first brought into notice in this country, he produced such alarming symptoms in himself by a dose of the drug that, with the instinct of a toxicologist, he had recourse to the first emetic which presented itself?namely, his shaving water, which he had just before used for its legitimate purpose." I had no experience of Christison as a clinical teacher ; he had retired from the physicianship to the Infirmary shortly before my time. As a consulting physician, Christison had a large practice ; he held, too, for many years the leading place as a medical jurist; he was an ideal medical witness. I would like to quote to you what Lord President Inglis, who was, I suppose, the greatest judge on the Scottish Bench during the last century, said of him in this respect; it represents my ideal of what a medical and scientific witness ought to be, an ideal which I have always tried to follow in the numerous cases in which I have been called upon to give evidence in the law courts : "In regard to Sir Robert's qualifications for this particular position, I feel myself privileged to speak with confidence, for I have myself been frequently associated with him both in court and in private consultation. I have examined him, and have heard him examined as a witness upon every variety of question, in cases involving issues of life and death, and the most important issues in regard to private interests that could be tried between man and man; and I never saw him at fault. The reason was not far to seek ; for the Professor went into the witness-box not in the spirit of a partisan, but in his proper office as a medical jurist, to aid the court and the jury in the elucidation of truth, and in securing the ends of justice. . . . He formed his opinions after much and careful deliberation ; and when they were formed, they were not to be shaken. . . . And the great quality in Dr Christison's evidence was, that it was almost impossible either to misunderstand or misrepresent him ; because as the course of the reasoning by which he arrived at his result was logical and clear, so his language was terse, unaffected, and precise." For more than fifty years, Christison was a great power in the University; he took a prominent part in the erection of the New Infirmary and the New Medical School. 142 Professors in my Student Days Christison was a great walker and mountaineer; when 80 years of age he ascended Ben Vorlich. He became captain of the University Rifle Corps when he was 62 and years of age, occupied the post till he was 77 ; William Turner was his lieutenant. I made Christison's personal acquaintance through the Rifle Corps. He was in the habit of driving down to the drills in his carriage and pair and picking up the first two or three privates whom he overtook on his way to the Queen's Park. One summer I lodged with two dear friends, William Cleaver, who was the

Sir Robert Christison, Bart. James Spence. handsomest man in the University, and Frederick Page, w o for o many years was professor of surgery in the University Durham a o and leading consulting surgeon in the north England, in Dundas Street?the top house on the east side, one window of our sitting-room commanded the west end o Heriot Row and Darnaway Street. Cleaver and I, who were members of the Rifle Corps, used to wait till Christison s carriage appeared in Darnaway Street; we then nipped down the stairs and walked with our rifles along Abercromby Place, when Christison saw us he used always to take us up. In this way I got several lifts down to the Queen s Park an became personally acquainted with Christison. M3 Byrom Bramwell

Thomas R. Fraser was Christison's assistant in my time; he succeeded him as professor in 1877. Sir Thomas Fraser was a man of high scientific reputation, and for many years an ornament of the Medical Faculty. Douglas Maclagan (/>. 1812, d. 1900). Douglas Maclagan was the professor of medical jurisprudence. He acted for many years as principal adviser to the Crown Authorities in Scotland in all such cases as called for expert medico-legal assistance. As a Professor of Clinical Medicine he chiefly devoted his to attention dermatology. He was not a great physician, but a splendid type of man?polished, courteous, lovable, a fine musician, a raconteur and wit, a keen sportsman. He was a good friend to me for many years after I returned to Edinburgh. I had no personal experience of him as a teacher, for the year I should have taken his class I spent in . In 1868, Maclagan appointed James Ormiston Affleck as his assistant. Sir James Affleck died only a month ago; like his revered he was a master, man who was absolutely straight and without guile. James Spence (b. 1812, d. 1882) was the professor of surgery. was a man of a Spence lugubrious countenance; we used to call him "Dismal Jimmy"; he had a somewhat brusque, bad and was manner, rather apt to frighten children and nervous but when to patients; you got know him, you found that he was one the of most tender-hearted and kindest of men. took a Spence great interest in his students, and was to many of them a and loving generous friend. I had a great regard for James Spence. I knew him well, and for six months had the of as privilege acting his house-surgeon in the Infirmary. Another nickname for Spence was "Patent Leather Jimmy"; he had small, well-shaped feet, and was always beautifully shod. like Spence, Fergusson, Liston, Syme, and the other great of his was a surgeons day, splendid anatomist, and a most skilful dissector. was a fine Spence and most successful surgeon, a skilful he was so very lithotomist; fond of the operation of that we lithotomy, students used to say that " Jimmy Spence's idea of Paradise was to be perpetually employed cutting the damned for stone." Thomas Laycock (b. 1812, d. 1876) was the professor of medicine. was a Laycock remarkable man ; he was a great medical philosopher, an original thinker and investigator; he had a acute a subtle and very intellect, highly speculative mind ; 144 Professors in my Student Days he was a great collector of facts, always trying to find out the reason of things; he thought about everything that came under his notice, and he generalised about everything he thought a out. Laycock w as a man of immense and unceasing industry ; e was t e authoi of works ; he was . many important especially interests in the nervous system and nervous phenomena, and o is many and were far in advance ^ speculations generalisations us time. His theory of the division of the brain into the S^Stems the basilar to animal life, the vui corresponding mi sensorial and the to the intellectual . life, i ? higher -1 functions anticipated Hughlings Jackson's some- a*u !.U si !!"0r^ mi ai and was a view, far-seeing and most important^ generalisation. Laycock was the first in this country to institute a course ec ures on medical psychology; he gave a summer course ec ures I was a member of this class; he used to take us own to a in to see cases ^ private asylum Musselburgh of insanity. neVer much practice as a consultant in Frl"^^C?C^m urgh. He did not impress me as a great clinician or c mical teacher; he was too pernicketty, too apt to dwell on sma 1 points, too keen to make hasty, physiognomic diagnoses. ne day in going round the ward, he came to a new patient, a teeth. woman, in bed ; she had fine, well-preserved, strong aycock immediately said, "Gentlemen, observe the teeth of t is patient; they are highly characteristic of the sanguine arthritic diathesis." The patient, seeing that he was interested m her teeth, took them out and asked him if he would like to was see them closer. As a systematic lecturer Laycock not well-suited to the ordinary student; personally, at all " events, I often found him speaking over my head "; he must, in the class owever, have been a very lenient examiner, for examinations?observe not one, but in three examinations? marks. managed to get 100 per cent, of the total available ut> in spite of his little failings, Laycock was really a great man, often far ahead of his time. David that I had out the Ferrier was, during the session c a different ass, Laycock's assistant. He was a man of very mental career in Arts type; he had had a most distinguished in as a medical Aberdeen, and an equally distinguished career mind, student in Edinburgh; he had a very keen, practical and was " He used to take the always very much on the spot." 145 Byrom Bramwell Friday afternoon lecture, and summarised Laycock's lectures for the previous week. Ferrier's practical teaching was a valuable adjunct to Laycock's theoretical discourses. James Syme (b. 1799, d. 1870) was the professor of clinical surgery. When I knew Syme he was 66 years of age, and no doubt past his best. For many years he was the leading clinical surgeon in Scotland, and one of the greatest, perhaps the greatest, surgeons of the century in which he lived. He looked at everything in the light of clinical surgery; he seems to have despised medicine and science, and vigorously resented anyone, not a clinical surgeon, who introduced innovations or new methods bearing upon clinical surgery. This was notably seen in the reception which he gave to acupressure, devised and advocated by Sir James Simpson. Syme's attitude to depart- ments of medicine outside clinical surgery is shown in his classification of diseases of the ear?"(1) Curable, the province of the surgeon; (2) incurable, those belonging to the aurist." His opposition to science is curious, for, when a boy, he had a taste for chemistry, and at the age of 18 discovered a method of waterproofing cloth, which, had he patented it, might have made his fortune. This same method was patented two years later by a Mr Macintosh of Glasgow, hence the name " Macintosh coat."

Syme's career was a remarkable one. It is said that he never attended a lecture on systematic surgery?not a strong testimonial to the lecture system. In his nineteenth year, he was entrusted with the charge of Liston's anatomical rooms. After a time he with quarrelled Liston, as he did with so many other people. After obtaining the Fellowship of the College of he lectured on Surgeons, systematic surgery for three years to classes. In very large 1829, when he was 30 years of age, twice failed to be having elected surgeon to the Royal Infirmary, he leased Minto House, fitted it up with twenty-four beds, established an out-patient department, and ran it as a complete It was a private surgical hospital. great success. He at once attracted numbers of large patients and students, and it was during his tenancy of Minto House that he wrote his celebrated work on Excision of Joints, and brought out the first edition of his Principles of Surgery. he In 1833 became Professor of Clinical Surgery in the With a break University. of four months, he occupied the Chair of Clinical until Surgery 1869, when, in my last year, he 146 Professors in my Student Days retired. The break occurred in 1847. He was invited to go to London and occupy the Professorship of Surgery in University College in succession to Liston, who had gone to London from Edinburgh several years previously. Syme was not happy in London, and when he had been there less than four months, he resigned the professorship at University College on the plea that they wanted him to teach systematic as well as clinical surgery, came back to Edinburgh, and was re-appointed to his old position?the Chair of Clinical Surgery?which had not been filled up.

Thomas Laycock. James Syme.

made Syme, as I have said, was a very great surgeon ; he numerous and important contributions to surgery, and introduced many new operations and operative procedures into surgical in the practice. In my time, Syme never did any teaching wards; he used, it is true, to go round and see the patients in the with his clinical clerks, but all his teaching was done surgical theatre. He examined the patient before the students, the made a few telling remarks regarding diagnosis, explained a man of few what he intended to do, and did it. Syme was maximum of words; his object seemed to be to give the same instruction in the minimum of words; he followed the were words plan in his writings. His words, though few, always i47 Byrom Bramwell of wisdom. There were several aphorisms which he used to give us, and which I have found of great use in practice :? " E.g., Never look surprised at anything." On one occasion, a patient for whom I had prescribed strychnine, and who, as patients will sometimes do, had taken much larger doses than had been ordered, manifested symptoms of strychnine poisoning. Recognising what had occurred, I immediately changed the medicine, and I got considerable credit for the improvement which took a case rapidly place.?" Before stating your opinion of 07i second ascertain your visit, whether your previous direction has been complied withOn another occasion, seeing an old lady, had looked who very ill at my previous visit, was very much " I I am better, said, glad to see you so much better, I was sure that medicine would do you She looked up and " good." replied drily, But, doctor, I did not take it."?" Never ask the same question twice." At the end of a busy day when one is and the case is an tired, not interesting one, and one is perhaps of thinking something else, one is apt to ask the patient to put out the a tongue second time. Now, immediately one sees the a second tongue time, one recognises one's mistake. It is easy to out of it " get by telling the patient in a firm voice to put it farther out so that I may see the back." took a " Syme leading part in what was termed the Battle of the Sites." The question whether the Royal Infirmary be rebuilt on should the old site or removed to the position where it now stands was very hotly discussed. At a great in public meeting February 1869, Syme proposed a motion which was carried in favour of the new site?a very fortunate thing for the Infirmary and the Medical School. In March had an 1869 Syme attack of right-sided hemiplegia ; it did affect not, however, his speech or his intellect, as I know from personal experience, for in May 1869 I was mixed with a case in which a up Syme took prominent part. I entered the as Infirmary house-surgeon to Professor Spence on 1st May 1869. A few days afterwards a man was admitted with a right-sided carotid aneurism; Spence decided to tie the artery. A short time previously an important article had in the appeared Lancet by Lister, who was then Professor of in Surgery Glasgow, advocating antiseptic catgut in place of the silk ordinary ligature. Spence decided to try this new and not ligature, having any properly prepared catgut of his own, he sent me down to Professor Syme's ward to 148 Professors in my Student Days get some. Syme, who was Lister's father-in-law, was a strong supporter of the new (antiseptic) form of treatment; Spence and the other surgeons to the Infirmary were strongly opposed to it. Well, I went to Svme's ward and got one of Listers catgut ligatures from his house-surgeon, Dr Edward Lawrie, who afterwards entered the Indian Medical Service and attained the high position of Residency Surgeon at Hyderabad. Spence tied the carotid artery with it on 12th May; the following the day patient vomited violently, had an attack of left-sided hemiplegia, and died within thirty-six hours, evidently from embolism. We the were, of course, anxious to get hold of preparation before decomposition set in, in order to see whether had anything gone wrong with the ligature. Accordingly, Lawrie and I borrowed the key of the dead-house, went down in the middle of the night, and cut out the artery. I dissected it the next day. On examining it, Spence said the ligature had softened and given way at a point opposite the ligature. Syme and Lawrie maintained that the knot had been badly wrote tied, had slipped, and that it was Spence's fault. Spence a letter to the Lancet on 5th June 1869 detailing the and that Lister's were not relia e. suggesting catgut ligatures ^ Lawrie wrote an answer to this, criticising Spence's ?P1Walter Scott. Simpson was a man of extraordinary mental ability and power?a genius, a very versatile genius ; he had a prodigious and most accurate memory, a far-sighted imagination, an optimistic temperament which made him believe all good things possible. Further, he was a man of great personal charm, of imperturbable temper, though a very keen con- troversialist and fighter. He was a man of indomitable perse- verance, and endowed with an extraordinary power of work beyond what most men can conceive of. In addition to his lectures at the University he had an enormous practice; his house was continually filled with patients, who came to him from all quarters of the world; his practice, of course, was not merely in midwifery and gynaecology, by far the larger part of it consisted of ordinary medical cases ; he had a very wide consulting practice all over Scotland and England. Further, almost every visitor of distinction who came to Edinburgh used to go and see Simpson. He did a very great deal of original research and writing; his correspondence must have been enormous; his controversies were numerous and would have occupied much of the time and energy of any ordinary man. To my mind the guiding principle of Simpson's life and work was to find out and employ methods and means of relieving human suffering and of saving and prolonging life. He was always trying to find out something new; he was I5? Professors in my Student Days constantly trying new drugs. He told us that salicin, the bitter principle of willow, was an excellent remedy in rheumatism ; this was years before it was introduced to the notice of the profession by Dr Maclagan, then of Dundee, subsequently of London. Many years ago I was discussing Simpson and salicin with one of our leading pharmaceutical chemists. He told me that Simpson was always trying new drugs; on one occasion his firm had a large stock of a rare and costly drug which Simpson had been prescribing left on their hands, for Simpson had suddenly ceased to prescribe it; they were consequently left with the of a prospect heavy money loss. One of the partners went down to Simpson and explained the position to " him. He said, Oh, I will soon put that all right." He began to prescribe it again, and in the course of a very short time it was all worked off. I remember Simpson telling us that he believed the time would come when some means would be found by which we could look into the human body through the surface, through the Bart. solid flesh, not merely Sir James Y. Simpson, by illuminating a hollow before viscus, such as the stomach. This was, of course, years statement. the X-rays were discovered. It was a remarkable Science I have recently been reading an interesting little book, and the Nation, which consists of a series of essays y H. Cambridge graduates. One of these essays is by W. Bra^, of London. F.R.S., Quain Professor of Physics in the University In speaking of the X-rays and their application to me " were discovered in Ilc^n^ 9 and surgery, he says: The rays if science Suppose that in 1894 the surgical profession had asked We are 0 could furnish the powers just described. trym*> cou av reverse what actually happened, and to see if things ' . ow, taken place as they did through the looking-glass I51 Byrom Bramwell in the first place we cannot imagine how the profession would come to think of making such a request. No one at that time had ever conceived the possibility of being able to do a thing which was uncommonly like seeing through a door. It would have been classed with vision of that penetrating kind if it had been proposed, and considered as incompatible with known facts . . . There was nothing to make anyone think of asking for such a thing as X-rays." But Simpson did this. He did not, of course, suggest how it could be done, but he did suggest and foretell that it would be done.* " Simpson's course of lectures was a model for the clearness with which the theoretical department was kept detached from, yet made to fit in with, the practical, whilst the attention of the class was always enlivened by exquisitely apposite anecdotes told." On one felicitously occasion, when lecturing on the effects of example and habit on the nervous system and visceral derangements, he mentioned the case of a nervous middle-aged man who married late in life. During the first " pregnancy his wife had obstinate morning sickness." The husband was so poor affected and upset that every time his wife he vomited, vomited too. But this was not all: during the second and subsequent pregnancies, the wife, as of course often happens, had no morning sickness, but the husband had been so with her impressed sickness during the first pregnancy that the during second and subsequent pregnancies he did the have vomiting. (I heard the same story attributed to the celebrated American neurologist, Weir-Mitchell.) On another when occasion, lecturing on the possible effects of heredity on twin he births, mentioned the case of a gentleman whose wife on two successive occasions presented him with twins. After the second twin a birth good deal of unpleasantness the wife occurred; blamed the husband, and the husband blamed the the wife; dispute went on so long and was so bitter that the domestic peace threatened to be seriously and permanently perturbed. But, said Simpson, this gentleman was of an and enquiring investigating mind, so he got into with a relationship servant?she had twins ; this settled the the husband then question; frankly admitted that it was his fault.

* His Miss Eva " biographer, Simpson, says (page 95), He even in his lectures fortells the recent of the discovery Rcentgen rays, thirty-five years before it occurred." !52 Professors in my Student Days

Simpson's work may be considered under different heads : Obstetrics and Gynecology.?Simpson " adopted obstetrics when it was the lowest and most ignoble of our medical arts ; he left it a of science numbering among its professors many the most distinguished of our modern physicians." Anesthetics.?Simpson introduced chloroform to the notice of the profession in November 1847, but he was not, and never claimed to be, the discoverer, as the public sometimes think, of general anaesthetics; an American dentist, Morton, had introduced as ether for dental purposes in 1846. As soon Simpson heard of the ether, he immediately began experiment- ing with it, and in January 1847 began to employ it in midwifery practice. He was consequently the first to employ anaesthetics in midwifery. At the end of March 1847, Simpson an he had published important paper in which he stated that employed ether in midwifery practice, and had given it to between forty and fifty patients with complete success. c must consequently have attended forty or fifty obstetric cases in two months. This shows the extent of his practice in obstetrics. As I have already stated, Simpson had an enormous medica er practice as a consulting physician; but I need not furt allude to his work as a general physician. Hospitalism.? Quite early in his career, in the year i845> Simpson was much struck by the fact that out of eighteen major amputations performed in the Edinburgh Royal Infirmary, on y e was two patients had got well. From that date onwards, constantly thinking about the subject and trying to find means 1S to prevent this huge surgical mortality. In 1847, ^ino was evidently much occupied with what subsequent y voca the name of' Hospitalism,' and, in 1848 we find him a construe ^ the abandonment of the present system of hospital in large blocks and the erection of villages of sma co g which could easily be pulled down, and which ^vou & ' facilities for the isolation of cases." It was with t e o Je morta 1 trying to prevent the sepsis and great surgical y he introduce that . occurred in every large hospital , a en e wire sutures and ligatures. Acupressure was con 1 excellent results, and would no doubt have been^ be used in surgical practice had not Lister's antiseptic plan treatment rendered it unnecessary. . _ as Arrhtz- Work outside Medicine: as an Antiquarian in his career, 1841, ologist, and as a Historian, etc.-Quite early !53 Byrom Bramwell when he was 30 years of age, Simpson directed his attention to leprosy, and later published a book entitled Antiquarian Notes on Leprosy and Leper Houses in Scotland and England. It was a big work, comprising nearly 500 references, and must have involved an enormous amount of research; he also published many other archaeological works?Archaeology, its Past and its Future Work (1861); Ancient Sculptures on the Walls of Caves; Roman Medicine Stamps; British Archaic Sculptures, etc. Social Reformer and Religious Revivalist.?During the last few years of his life he directed his attention to these subjects, and often preached to large public congregations. Simpson's brain presented some remarkable appearances. At the post-mortem examination, the organs all showed a marked degree of fatty degeneration ; there was an aneurism of the heart the size of a pigeon's egg. The great vessels at the base of the brain were atheromatous and much dilated ; the internal carotids and basilars were two or three times the normal size (I have always wondered whether this was entirely the result of disease, or whether owing to the large demands which Simpson's very active brain made on the circulation, the large arteries at the base of the brain may not have been " physiologically wider than the normal). The convolutions of the cerebrum were remarkable for their number, depth, and the intricate nature of their foldings; they were packed and twisted on each other in such a manner that many were dwarfed, and failed to reach the surface; the plethora of grey matter occasioned by this arrangement was most evident in the anterior lobes and islands of Reil." Let me in say passing, that we know very little about the function of the convolutions forming the island of Reil. I would suggest it as a subject well worthy of investigation and research.

Many of the men, Gentlemen, whose mental and medical qualifications I have described were very forcible personalities? strong-willed men, great controversialists, keen fighters. I may illustrate this point by extracts from some of their obituary notices. Syme and Simpson.?In the British Medical fournal, July 1870, p. 21, it is stated?"Mr Syme 'expressed his dis- ' ' approbation of acupressure in a very emphatic manner' at *54 Professors in my Student Days a clinical lecture. After stating that he had not interfered in what he considered useless innovations in obstetric practice, ' he says, It appears that my example in this respect has not been followed, and that, in a pamphlet recently published, I have been charged, not only with ignorance of my profession, but with want of good faith in teaching it. Such vulgar insolence I treat with the contempt it deserves.'" Then, accord- ing to Miss E. Simpson's Biography of her father, "with firm teeth hand, compressed, and altogether a most determined and savage expression, he tore the pamphlet in two, and gave the fragments to his Assistant to be consigned to the sawdust box with other surgical remains." I was not myself present on this occasion, but my friend, Dr John A. MacDougall, to whom I am indebted for some of the stories I have told you, tells me that it created great excitement, and that Simpson's lecture-room the next morning was crowded with students and doctors anxious to hear what reply he would make. Dr MacDougall tells me that Simpson came into the lecture-room with his usual beaming smile, cai rying a copy of Syme's text-book on the Principles of Surgery m his hand; his answer was a single sentence from this text- " book. Gentlemen, he said, Torn arteries do not bleed, torsion does no harm." Bennett and Syme.?Professor Bennett wrote a letter to the British Medical Journal (July 1870) with reference to Mr Syme's fitness for the Presidency of the General Medical Council; after specifying certain particulars, he goes on to say " that in Edinburgh he (Mr Syme) must be recognised by all earnest investigators and teachers of medicine as one of the most determined and influential obstructors to its progress. This is much to be regretted, as there can be no doubt that his long standing in the profession, his reputation as a surgeon, his tact, ability, terseness, and, let me add, unscrupulousness in argument, give him very great influence in public assemblies." Simpson as a Fighter.?In the obituary notice of Simpson in the British Medical Journal (14th May 1870, p. 507), it is " stated : Born in the land of thistles, and nurtured in a city where controversy and partisanship attain portentous develop- ments, where elections are always fierce battles, and their intervals times not so much of peace as of preparation, it is not surprising that Sir James had enemies as well as friends. ' He had the repute of being a good hater' (I should myself i55 Byrom Bramwell say a good fighter, for however bitter a controversy may have been, Simpson does not appear to have harboured resentment, or ill-feeling after it was ended). We shall attempt no judgment or criticism on local or personal feuds, but shall merely remark that there is clearly something real in the influence of the northern air, and remind our readers that it was a Scotch dog of whom it is mentioned that he was moody and unhappy because 'he couldna' get eneugh o' fechtin'.' That Sir James was not more to blame than others we believe highly probable, to prove that he was less so, we are forced to leave to those who are better acquainted with the facts." The Medical Faculty in those days must have been a perfect bear-garden; fortunately, times have changed with regard to these fighting tendencies; I am quite sure this is not due to any change in the climate of Edinburgh, as the extract from the British Medical Journal which I have just quoted would seem to suggest; it must, I think, be due to alterations in the disposition, temperament, and character of the professors of the present day. Time does not allow me to say anything about the lecturers and teachers in the Extra-mural School whose names I have mentioned already (p. 135); many of them, like the professors in the University, were very able and distinguished men. Mr President and Gentlemen, I must apologise for speaking at such length; my only excuse is my extreme interest in the I I subject. hope have interested you; but, what is much more I important, trust that what I have said of these great men will stimulate as you, their example has certainly stimulated me, to try and follow in their footsteps, and in your day and to generation do what in you lies to maintain and, if possible, increase the credit and renown of our great University, of our celebrated Medical School, and of this venerable Royal Medical Society of Edinburgh.

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