Biography of James Syme
Though he never earned a medical degree, James Syme was a dominant figure in Scottish surgery throughout his career, remembered for some innovative and daring surgical procedures. He was one of the early advocates of ether anaesthesia in 1847, and he was also the inventor of the waterproof material mackintosh.
Syme spent most of his boyhood in his fathers country house in Fifeshire, and in 1817 became a pupil of Dr. John Barclay (1758-1826) at the extramural school at Surgeon's square. Before he began his medical study, Syme studied medicine at the university, where he discovered a method by which rubber (caoutchouc) could be dissolved invented the technique for dissolving rubber in a solvent and using it for making a fabric into waterproof laminates. His solvent consists of rubber dissolved in a coal-tar naphtha solution. Syme submitted his discovery to the editor of the Annals of Philosophy, but for various reasons publication was delayed. During the interim, the Scottish chemist Charles Macintosh (1766-1843), learned of the method, elaborated on it, developed it further, and patented it for commercial purposes. As a result, the Mackintosh raincoat was born and Syme, who took little interest in commercial matters, lost an inestimable fortune.
In 1818, Syme entered a position at his cousin, Robert Liston (1794-1847), who had his own surgical practice in Edinburgh, and even had his own dissection room, of which Syme became prosector. In 1820 he became medical superintendent in the Fever Hospital, where he himself fell gravely ill with typhus. In 1821 he was elected house surgeon in the Royal Infirmary, in 1822 a member and 1823 fellow of the Royal College of Surgeons. Within a short time Syme had made himself a name, both as surgeon and a master anatomist at the Liston institute. It was here, in 1823, he conducted the first exarticulation of a hip (Edinburgh Medical and Surgical Journal, 1824).
One major problem facing Liston and Syme was the lack of bodies for investigation. Most of the cadavers in Edinburgh ended up with John Barclay or the Monros, at the time represented by Alexander Monro, tertius (1773-1859), last in line of the famous Monro dynasty. Therefore, both Liston and Syme were forced to do some grave robbing to supply their new school with adequate dissection material. Together Syme and Liston performed many operations that have since been shown to have historical precedent.
By 1823 the once close friends had become bitter enemies. Their personal relationship had become so acrimonious that when Syme applied for the surgeonship of the Royal Infirmary, the managers declined to appoint him for fear that his feud with Liston would be carried into the classroom.
With Dr. John Mackintosh (–1837), Syme establish a medical school of his own, in which he taught anatomy and surgery from 1825. He soon abandoned anatomy, however, due to the difficulties in obtaining bodies, and devoted himself exclusively to surgery. Most of the difficult, dangerous operations carried out during the early nineteenth century were performed in the humble homes of poor patients. The surroundings were unfavourable; modern conveniences were few. Syme, desperately in need of a private hospital, attracted students in such numbers – some 250 – that in 1829 he was able to commence the establishing of a surgical clinic of his own. This private clinic was recognized by the Royal College of Surgeons of England.
His growing reputation was enhanced by the publication in quick order of another important paper on excision of elbow joints (1829) and his monumental Treatise on the Excision of Diseased Joints (1831).
In 1833 Syme was appointed Regius Professor of clinical surgery at the University of Edinburgh, replacing James Russell (1755-1836), who retired. Syme had actually made an agreement with his predecessor to pay him a pension if he resigned. Syme now had established himself in the premier surgical chair in Edinburgh, he had been placed on the staff of the Royal Infirmary, and his surgical and academic reputations were secure.
When Robert Liston moved to London, Syme also succeeded Liston as surgeon to the Royal Infirmary. Syme and Liston were reconciliated in 1840, mainly on the initiative of Liston.
The teaching of clinical surgery in Edinburgh took on a new meaning with Syme's accession to the professorship. Bedside teaching and student access to the patients were considered integral to his method:
- "To bring the cases one by one into the room, where the students are comfortably seated, and if the patients have not been seen by the surgeon beforehand, so much the better; then ascertaining the seat and nature of their complaints, he points out their distinctive characters.
Having done this so everyone present knows the case under consideration, the teacher, either in the presence of the patient, according to circumstance, proceeds to explain the principle of treatment, with his reasons for choosing the method preferred; and, lastly, does what is requisite in the presence of his pupils.
The great advantage of this system is that it makes an impression at the same time on the eye and ear, which is known by experience to be more indelible than any other, and thus conveys instruction of the most lasting character."
In February 1848, following the death of Liston, Syme succeeded Liston as professor of clinical surgery at University College Hospital in London. This post became a brief one, however, as Syme returned to Edinburgh, resuming his position as professor of clinical surgery, after only a few weeks in office, probably because he did not like life in London.
In accordance with the new charter of the Royal College of Surgeons of England, Syme became one of the first 300 members elected by its council.
A less known pioneering effort of James Syme was the Burn-House at the Royal Infirmary, Surgeons Square, the first ever hospital for burns. This made possible a strict isolation of patients with heavily infected burn wounds.
In 1853 Joseph Lister became Syme's house surgeon, and in 1855 he became engaged to Syme’s eldest daughter, Agnes. It is said that Lister was the only individual with whom Syme never quarrelled. Syme lived at No. 9 Charlotte Square, where his son-in-law Joseph Lister lived 1870-77.
Syme was, with Nikolai Ivanovich Pirogov (1810-1881), the important European surgeon to adopt ether anaesthesia in surgical operations. He was also an early supporter of the concept of antiseptics as taught by his pupil and son-in-law, Lord Lister.
He retired in 1868, suffered an attack of partial paralysis in 1869, and died the following year.
Syme was one the leading surgeons in his time. Famous for "his" amputation, he also explored alternatives to amputation, but where these were necessary he tried to minimise the damage caused by removing as little diseased tissue as possible and even experimented with reconstruction through what is today known as 'plastic surgery'. If not much occupied by theory, he had a healthy, one could say audacious and cold-blooded approach, a dextrous operator with thorough anatomical knowledge.
- As in the case of thriving plants, it is of more consequence that the roots of your character should strike deep in public confidence than that there should be a premature production of flower, or fruit.
Edinburgh Medical Journal. 1867, 13: 197.
It is as difficult to bring a boy up to be a medical man as it is to educate him for a bishop.
Quoted by W. K. Pyke-Lees in Medical Ethics, Chapter II.
Four and a half pounds tumour of the jaw
In 1828, Syme performed one of the most remarkable operations carried out in the Royal Infirmary of Edinburgh during the early decades of the 19th century. The patient was Robert Penman, who had an enormous tumour, believed to be an osteosarcoma, of the lower jaw that produced severe disfigurement of his face.
Three years earlier Liston had seen the patient and judged the tumour to be inoperable. Later, he had been pursued to see doctors George Ballingall (1780-1855), professor of Military Surgery in the University of Edinburgh, and his colleague John Abercrombie (1780-1844), then recently appointed physician to the King in Scotland, in a joint consultation.
When Ballingall and Abercrombie in 1828 invited Syme to see Penman, Syme was still in his late twenties and not yet appointed to the staff of the Royal Infirmary. However, he had gained a considerable reputation in the city as a particularly bold operating surgeon. He carefully examined the patient, and the operation to remove the tumour was carried out on the 7th July by Syme with the assistance of Ballingall.
Syme operated without the benefit of an anaesthetic, to completely remove the tumour. The patient not only survived the operation, but also remained in excellent health for many years afterwards. The operation was performed with the patient sitting in an ordinary chair, and in all took twenty-four minutes,
“but all this time was not employed in cutting, as I frequently allowed a little respite, to prevent exhaustion from continued suffering. The patient bore it well, and did not lose more than seven or eight ounces of blood. His breathing was never in the slightest degree affected”.
The patient did not lose more than seven or eight ounces of blood. He recovered well, and the dressings were removed on the third day. During this period he was fed through a funnel with a curved tube directly into the pharynx. Five weeks later he was seriously thinking of resuming his occupation. Penman lived for another thirty years after the operation.
Penman’s tumour weighed four and a half pounds when operated.
Seventeen years after the operation, Syme was stopped in the street by the patient. He informed him that he had initially worked for a few years in Coldstream as a bootmaker, and then emigrated to New York, where he had remained for ten years, and that he had returned home to Scotland on a short visit. More interestingly, Syme noted that he was “no less surprised than pleased to see how little the operation had injured either his appearance or articulation. Careful inspection, indeed, was requisite to enable an ordinary observer to detect any thing peculiar in either of these respects”. In 1855, Lord Lister, noted that Penman's "deformity" had been wonderfully masked by a bushy beard.
“The mouth was placed diagonally across the face, and had suffered such monstrous distortion as to measure fifteen inches in circumference. The throat of the patient was almost obliterated, there being only about two inches of it above the sternum, so that the cricoid cartilage of the larynx was on a level with that bone. When the tumour was viewed in profile it extended eight inches from the front of the neck. It completely filled the mouth, and occupied all the space below it, from jaw to jaw. The tongue was thrust out of its place, and lay between the teeth and cheek of the right side. The only portion of the jaw not implicated in the disease was the right ramus and base of the same side, from the bicuspid teeth backwards. The tumour, where covered by the integuments, was uniformly very firm, and for the most part distinctly osseous. The part which appeared through the mouth was a florid, irregular, fungous-looking mass of variable consistence, from which an alarming haemorrhage had occasionally occurred; and for the last three or four weeks there had been almost daily a discharge of blood to the extent of one or two ounces. Notwithstanding the great bulk of the tumour, the patient could move his jaw pretty freely in all directions...”
The operation was performed with the patient sitting in an ordinary chair, and in all took twenty-four minutes, “but all this time was not employed in cutting, as I frequently allowed a little respite, to prevent exhaustion from continued suffering. The patient bore it well, and did not lose more than seven or eight ounces of blood. His breathing was never in the slightest degree affected”.
Case of osteo-sarcoma of the lower jaw, removed by James Syme, Esq. F.R.C.
Edinburgh Medical and Surgical Journal 1828, 30: 287.