James Syme (1799–1870), a great surgeon who promoted proctology

Conclusion

Syme was an honest man whose judgment was based upon his keen observations in a busy practice. He was a sound, depend able surgeon in the finest sense of the word, who preached and practiced a high quality of proctology. He showed independent thinking as he spoke out against the belief that hemorrhoidal bleeding was beneficial and against the fashionable belief that rectal strictures were a common cause of constipation.

Following the precepts of Boyer, Syme regarded a fissure as an ulcer, described the symptoms so accurately that they could be used for teaching medical students today, and called attention to the sentinel pile. He modified Boyer’s treatment of the fissure; Syme did not cut the muscles as Boyer did. He advocated the ligature treatment of internal hemorrhoids and excision of external hemorrhoids. Syme’s management of anal fistulae was sound by current standards.

Syme wrote forthrightly, stated facts positively, and seldom, if ever, left the reader in doubt about his opinion. He did little theorizing, but showed that he had studied the writings of the leading surgeons of his times.

Although other Edinburgh-trained surgeons (Russell, Liston, Lizars, Fergusson) had published books on general surgery containing chapters on rectal diseases, Syme’s book has historical importance as the most significant treatise devoted to proctology emanating from the University of Edinburgh. It is noteworthy because the best teachings on proctology of the Edinburgh School of Surgery were presented in one book.