JAMES GREIG SMITH, M.A., M.B., C.M. ABERD., F.R.S.E.

SUPPLIED AND EDITED

BY LEWIS S. MCMURTRY, M.D.,

LOUISVILLE, KY.

AT the funeral service of James Greig Smith, on June 1, 1897, in the church at Redland Green, the presence of a large number of mourners, including doctors, students, nurses, and personal friends, gave eloquent testimony to the widespread feeling of regret that, at the early age of forty-three, his lifework should have come almost suddenly to an end. His death had been the one topic of conversation among all ranks in and around the city, for he had made himself a reputation which had placed him in the front rank of his profession, and his work had brought him into contact with a very large circle of friends and patients. The illness which led to the fatal end was so short that the news of his death was a terrible shock to many who had not heard even that he was ill, and this, added to the sense of loss which it was felt that the neighborhood had sustained, intensified the grief which was manifested on all sides.

Although apparently possessed of much physical vigor, Greig Smith was by no means a man of strong bodily health. He suffered frequently from various developments of the rheumatic diathesis, having had acute articular rheumatism badly at least twice. Three years ago he had an attack of pneumonia, which impaired his strength for some weeks, and, perhaps, to a slight degree, permanently. On the morning of Monday, May 24th, he felt some pain in the left side of the chest, but attached no importance to it, thinking it rheumatism of the intercostal muscles. During the day he went to a consultation in the neighborhood of Swindon, having for part of the journey to drive in an open carriage. In the evening, after his return to Clifton, he formed one of a dinner-party of congenial friends, to one of whom he remarked

that he thought he had mischief in his left lung. After dinner he seemed bright, but left early. In the course of the night he vomited, and had a rigor and a temperature of 103°. Early in the morning he was seen by Dr. James Swain, who heard pleuritic rubbing in the left infra-axillary area. Some few hours later, when Dr. Shaw and Dr. Swain saw him together, there was distinct impairment of resonance over the lower lobe of the left lung from the posterior border to the posterior axillary line. The pulse was extremely small and rapid, the dyspnea great, and the frequent cough brought away clear sputum brightly tinged with blood. On Tuesday night he had very little sleep, but on Wednesday morning he seemed rather better, and did not seem to lose ground through the day. In the early part of Thursday he was doing fairly well, but about noon he became somewhat suddenly worse, complaining of pain in the head, and he was extremely restless. At 3 P.M. the signs of lung consolidation were found to have increased considerably. During the next few hours he became dimmed in consciousness, and in the course of the evening Cheyne-Stokes breathing was gradually developed. At 11 P.M. he was barely conscious. Through the night he became steadily worse, and he died at ten minutes past eight on the morning of Friday, the 28th.

Now that his place is vacant we are left to ponder over his life's work, and try to learn the lessons which may be derived from his short but eminently useful career. That it has been exceptionally useful all will gladly admit, for he was a pioneer in many things, and those who were much associated with him have profited greatly by his example and have been roused by his enthusiasm to a higher level of professional work. It may be truly said of him that he left the world a little better than he found it.

James Greig Smith, the son of Mr. Duncan Greig Smith, was born at Nigg, a village a few miles from Aberdeen, on June 21, 1854. He received his early education at the Aberdeen Grammar School, a foundation of greater antiquity than the celebrated University of that city. Placed, on his entry in 1865, in the lowest or first class by the then rector, Mr. William Barrick, he passed up the classes year by year until he reached the fifth or highest in 1869. The numbers of the school at the time of Mr. Barrick's rectorship show in what reputation it was held as an educa

tional centre, for in 1865 there were 328 boys there. There are, unfortunately, no records in existence of the prizes or distinctions gained by the boys; but in 1869, on leaving school, Greig Smith's name appears sixth in a list which includes forty names placed in order of merit.

Leaving school, Greig Smith entered the University as an Arts student in the winter session of 1869-1870, gaining by open competition a bursary of £14 a year. During the time he studied the Arts he gained prizes in English, logic, and natural history, and in March, 1873, he graduated M.A., taking honors in natural science. In his medical studies his career was again marked with distinction, for he took the second prize in botany and the first in surgery, practice of medicine and medical jurisprudence, and finally graduated M.B., C.M., "with honorable distinction," in 1876. While a student he was clinical clerk to the then professor of surgery, Professor Pirrie, at the Aberdeen Royal Infirmary, and University Assistant to him, 1874-1875. A year later saw him House Surgeon at that institution.

With taking his degree his association with his University did not cease, for in October, 1881, he was appointed external or extra-professonial examiner in surgery and midwfery; but in April, 1883, on the ground of "the work being heavier than he expected, and occupying more time than he could spare," he requested the University Court to accept his resignation-a somewhat unusual course, but one to which the court gave its assent. It need hardly be said that his services were much appreciated; but we have it on the authority of one who knew him well that "his dignity as an examiner was sometimes imperilled by his sense of humor."

Always pleased to honor its fellow-countrymen, the Royal Society of Edinburgh, on March 5, 1883, elected him a Fellow, when his name was proposed by Professor Stirling, Dr. Ogilvie Will, Professor Lister, and Dr. Henry Marshall. In the same year he married Miss Adela Ashby, who, with their only child, a daughter, survives him.

After his short experience as resident at Aberdeen, Greig Smith was appointed, in June, 1876, Assistant House Surgeon to the Bristol Royal Infirmary, the patients of which had been moved in the previous September to premises in Colston Street, which

were used as a temporary hospital till October, 1876, while the Infirmary was undergoing sanitary renovation.

The Infirmary issued in 1879 its first and only volume of Reports. Of this, Greig Smith, who, after filling the posts of House Surgeon and Medical Superintendent, had then become Junior Surgeon to the institution, was the Surgical Editor. He contributed to it an elaborate paper on "The Pathology and Treatment of Chronic Osteo-arthritis," in which he dealt specially with the natural history of the pathological processes which lead up to the disease. This article, which was embellished with ten plates lithographed from his own drawings, is marked by that care of observation and literary finish which were prominent features in all his afterwork. It is also an excellent example of the endeavor which he made throughout the whole of his surgical career to constitute his practice a legitimate deduction from pathology. The volume contained some other noteworthy contributions from him, including an exhaustive surgical report, which, unfinished by Mr. R. W. Tibbits at the time of his death, was completed by Greig Smith with that analytical ability for which he was so greatly distinguished. In the three years after the reoccupation of the Infirmary-i. e., up to the time of the issue of the Reports there were no deaths from pyemia or erysipelas, although those diseases had claimed forty-three deaths in the two years and eight and a half months prior to the closing of the institution. Notwithstanding this immunity-which was not considered to be entirely due to the antiseptic method of Lister, then in vogue-the general death-rate was higher, and Mr. Greig Smith in this report dealt in a masterly way with the facts, which show that a high hospital-mortality is no evidence in itself of defective sanitation.

Greig Smith, soon after his coming to Bristol, was an active member of the Society under whose auspices this Journal is issued. In 1878 the British Medico-Chirurgical Society published a first volume of Transactions, including within the range of its record much of the work done from 1874 to 1878. The volume contains two contributions from Greig Smith. communication which he made to the Society in October, 1877, on the evening of his election, dealing with two cases of acute miliary tuberculosis. This was illustrated with microscopic specimens and drawings from his facile pencil, and with some detail he

The first was a

traced anatomically the course of infection in these cases.

This

paper and also one on "Hemorrhage into the Pons and Medulla" are both illustrated in the volume of Transactions, which also contains a contribution which he made, in November, 1877, to a debate on "The Treatment of High Temperature of the Body," in which he gave an account of the results of treatment by cold baths and quinine in thirty-two cases in which each had been employed.

From this time onward Greig Smith was a frequent contributor to the work of the Society. In April, 1879, he read in outline the paper "On Osteo-arthritis," which was printed in full in the Infirmary Reports. In September of the same year he showed a patient on whom he had successfully performed his operation for extroversion of the bladder and epispadias. In January, 1881, he read an important communication "On the Histology of Fracture and the Formation of Callus." This, which, somewhat amplified, was published in the Journal of Anatomy and Physiology, he was always accustomed to look back upon as the best work he ever did. It was an admirably-written paper, marked by careful and laborious work done in the laboratory by himself, rather than showing an extensive knowledge of the work done by others in the same department; but it illustrates in this respect his well-known characteristic of self-reliance. He paid very little attention to the opinions of others, unless they were confirmed by his own observations. He relied upon his own work, and was guided entirely by his own experiment and research. In the following March he gave particulars of two cases in which he had done Bigelow's recently-introduced operation of litholapaxy. Taking as a foundation the case of a patient with multiple sarcomata, he brought forward, in November of the same year, the result of his careful and original investigations on the pathology of these tumors. In February, 1882, he reported a gastrostomy which he had done in a case of epithelioma of the esophagus.

In July, 1883, the first number of The Bristol Medico-Chirurgical Journal was issued. Greig Smith put into the new venture all his professional and literary influence, and for it he worked hard; and although he felt bound to relinquish the editorship in 1892, he never ceased to take a cordial interest in its welfare, and from time to time still wrote for it, and in this number containing