James Syme

James Syme, an Edinburgh surgeon, was to become pre-eminent among British surgeons. As a student he had devised and published a method of using rubber solution to waterproof silk, but the patent was denied him by a Mr. McIntosh from Glasgow. Syme went on to become the leading surgeon of his day in Edinburgh’s golden age of surgery. He was a master of surgical technique, a rival of Liston, a contemporary of Simpson and father-in-law and mentor of Joseph Lister.

James Syme was the son of John Syme, an Edinburgh solicitor. After education at The Royal High School he enrolled in Edinburgh University at the age of 16 where he came under the influence initially of Thomas Hope, the Professor of Chemistry who had discovered the element strontium. Syme was stimulated to experiment with the distillation of coal tar which led him to discover a solvent for white rubber. This he used to treat silk and make it waterproof. His researches were published in the Annals of Philosophy but it was a Glasgow chemist, Charles McIntosh, who was able to patent the idea and immortalise his name.

Syme enrolled in medicine at the extramural school, where one of his teachers was the surgeon Robert Liston (qv) who had by that time established a reputation for speed and dexterity of surgical technique. This early friendship with Liston was to have a profound influence on Syme’s future although that friendship was to turn to rivalry and then to enmity. Syme went on to succeed Liston as a lecturer in the extramural school where he established a formidable reputation as a teacher, attracting upwards of 250 students to his class. Along with William Sharpey (qv) he visited Paris where he attended Lisfrank’s course on operative surgery and attended ward rounds with Dupuytren. At the age of 24 he reported the first successful amputation at the hip joint. Before he was 30 his reputation as an operating surgeon was formidable and this led to jealously and friction with Liston. Perhaps because of this Syme was unsuccessful in his application to join the staff of The Royal Infirmary. He therefore set up his own private hospital. At Minto House, in what is now Chambers Street, Edinburgh, he established a 24 bed surgical hospital with an operating theatre and lecture theatre. Here his surgical reputation grew. He carried out operations for aneurysm, extensive resections for tumours of bone of the maxilla the mandible and the tongue all of which served to enhance his reputation as surgeon and teacher.

In 1833 he was elected to the Regius Chair of Clinical Surgery in Edinburgh defeating Liston, perhaps because the latter refused to pay the retiring Professor the customary allowance of £300 per year paid for life by the successor. Syme joined an array of surgical talent in the Infirmary including Lizars, Liston, William Ferguson and Sir Charles Bell. The last three all became London surgeons distinguished in their generation. Liston had taken on the Chair of Surgery at University College, London, and on his death in 1847 Syme succeeded him. For a number of reasons, practice in London did not suit him and he returned to Edinburgh as Professor of Clinical Surgery five months later. One of his pupils was Joseph Bell (qv), model for Sherlock Holmes, whose own observations on Syme will be characteristically accurate. Bell wrote “his operating was devoid of flourish and dash. He was not very rapid and not very elegant. But on the other hand he was absolutely free from fuss and worry; all idea of self, his own dexterity and appearance was evidently banished when he took the knife into his hand. He thought of nothing but the patient and the best, not the most rapid nor the showiest, nor the easiest, but the best way of relieving him”.

His operating style and his brevity were summed up by his assistant, Peddy: “he never unnecessarily wasted a word, a drop of ink or of blood……..”

The teaching methods which he established in Edinburgh were to have a profound influence for decades. His short trip to London had produced a dislike of the teaching methods where a group of students followed their Chief around the ward, relying on chance remarks when they stopped at each bed. He preferred to “bring the cases one by one into a 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 complaint. Having done this so that everyone present knows the case under consideration the teacher, either in the presence or absence of the patient according to circumstance, proceeds to explain the principles and the treatment with his reasons for choosing the method preferred.” This innovative style of teaching attracted students of surgery from all over the country and among these was the young Joseph Lister. Lister had planned a tour of continental surgical centres after graduation in London, but was so enthralled by Syme and his teaching that he stayed in Edinburgh and was appointed House Surgeon by Syme in 1854. Two years later he married Syme’s daughter, Agnes, and continued as his father-in-law’s assistant until his appointment as Professor of Surgery in the University of Glasgow in 1860. He remained close to Lister throughout his life and in his last clinical lecture in 1868 with characteristic vision he predicted that the new principle of antisepsis promoted by his son-in-law would revolutionise the practice of surgery. His death in 1870 brought to an end an exciting and innovative era which saw great change in the practice and teaching of surgery and paved the way for even greater change which was to follow as surgery entered the antiseptic era. Lister’s tribute to his father-in-law was fitting “The hostility which he excited in the few was greatly outweighed by the friendship which he expired in the many”.