James Spence achieved distinction as Professor of Surgery in the University of Edinburgh, President of the Royal College of Surgeons of Edinburgh and Surgeon to the Queen in Scotland,. His textbook “Lectures of Surgery” became a standard in its day. Despite these considerable achievements Spence is remembered by contemporaries for his implacable opposition to the principles of antisepsis being promoted by his contemporary, Joseph Lister; and, despite his undoubted contributions to surgical anatomy and a reputation as a meticulously neat surgeon, he is remembered by contemporaries as a melancholic demeanour which earned him the unkind nickname “Dismal Jimmy”.
James Spence was born in South Bridge, Edinburgh, a view yards from the present site of the Royal College of Surgeons of Edinburgh. After education at the High School of Edinburgh, he entered University and then the extra mural School of Medicine in Edinburgh. He went on to obtain the licence of the Royal College of Surgeons of Edinburgh in 1832. His initial experience in medicine was as a doctor on an East India Company ship to Calcutta. On return to Edinburgh he set up in practice in Rankeillor Street. At the same time he began to demonstrate anatomy in the University under Munro Tertius. By all accounts, these were unhappy times. The teaching of anatomy in Edinburgh University under Munro Tertius had declined both in reputation and in student numbers. Despite this, Spence made useful contributions to surgical anatomy. His paper entitled “Remarks on the Sources of Haemorrhage after Lithotomy” was based on careful dissection of that region and he was able to make detailed recommendations about the surgical procedure to reduce the problem of post operative bleeding. He wrote a further paper on “The anatomy of the 8th pair of nerves”, a study which was probably inspired by Sir Charles Bell, at that time Professor of Surgery in the University and the leading surgical anatomist of his day. The death of Sir Charles Bell in 1841 was almost certainly the stimulus which led him to leave the University to teach anatomy in the extra mural School. He began to teach anatomy at No 1 Surgeons’ Square and moved to surgical practice to the New Town. During his time the anatomy instruction at Surgeons’ Square was regarded as the best in the country and he became an authority on the anatomy of hernia and lithotomy, and of the head and neck and great vessels. He prepared anatomical specimens and those which he prepared of the hand and foot are regarded as masterpieces of their time. A contemporary account gives an insight into his commitment and his personality “While others were going out to dinner or to places of amusement, Spence might be seen walking up the Bridges on his way back to the evening work in the dissecting room; and many summer evenings were thus spent in solitary devotion to anatomy and surgical pathology”.
From teaching of anatomy he moved on to give systematic lectures in surgery, initially at the extra mural school at 4 High School Yards and latterly in Surgeons’ Hall.
His biographers depict him as a careful, meticulous, but conservative surgeon. A contemporary account gives insight into his personality, probably obsessional and perhaps depressive. “Before the operation Mr Spence was nervous, pre-occupied and over strung. Not brilliant, nor rapid ….. but careful, accurate, with every step pre-arranged and every anatomical detail expected recognised and noted. Perhaps not so calm or fertile as Syme, not so brilliant as Ferguson but Mr Spence was a successful operating surgeon”.
He was appointed to the Chair of Surgery in the University in 1864. His contemporary, Joseph Lister, had promoted the theory of antisepsis and introduced catgut into surgery. Spence was dismissive of both innovations. Goodlee, in his life of Lister, describes a now famous incident in which Spence obtained some of Lister’s carbolised cat gut from Dr Lawrie, Professor Syme’s house surgeon. Spence used this to tie the right common carotid artery but the patient died three days later and Spence, in his report of the case to the Lancet, described sepsis in the wound on which he blamed the cat gut. Dr Lawrie, with a temerity that would make later generations of house surgeons shudder, wrote to the Lancet suggesting that the failure was attributable to Spence’s technique rather than to the cat gut. Spence was understandably outraged and brought about Dr Lawrie’s dismissal. Syme sprang to his young colleague’s defence in the correspondence of the Lancet and the incident, according to Goodlee, stimulated Lister into continuing further development of carbolised cat gut suture for the rest of his career.
Spence’s conservatism was further demonstrated in the battle of the sites between 1864 and 1869. He opposed the move of the Royal Infirmary from Surgeons’ Square to the much larger site in Lauriston Place but, eventually the view of Syme prevailed and the new Royal Infirmary opened in Lauriston Place in 1879. A similar debate about the future site of the Royal Infirmary was conducted over two decades in the 20th century.
Spence went on to become President of the Royal College of Surgeons of Edinburgh and was Surgeon in Ordinary in Scotland to Queen Victoria. He is remembered as much for a melancholy, even lugubrious demeanour which earned him the nickname of “Dismal Jimmy”. MacGillivray, in his Harveian oration of 1912, recalls an occasion when “we met Spence with his most dismal expression, all clothed in black and crepe”. Yet Spence’s textbook “Lectures on Surgery” became a standard, widely regarded as a model of clarity. Spence died in 1882 and was buried in Grange Cemetery, Edinburgh.
