There now came the first crisis in Simpson's medical career. After his father's death he felt that having obtained his qualification to practise it was his duty to relieve his family of the burden of supporting him through more extended studies. After due deliberation he applied for a small appointment which would have served as a nucleus for private practice, that of parish surgeon to a small village on the banks of the Clyde. Those in whose hands the appointment lay were not impressed with his fitness for the post, and he was not elected, "I felt," he afterwards said, "a deeper amount of chagrin and disappointment than I have ever experienced since that date. If chosen, I would probably have been working there as a village doctor still." Although such a commencement might have delayed his ultimate rise to eminence, it cannot be agreed that it could possibly have prevented it. It was at this crisis that what he tenderly referred to as "the ceaseless love and kindness of a dear elder brother" came to his rescue, and by Alexander's or, as he affectionately called him, "Sandy's" help, he returned to Edinburgh to resume his studies in the winter session, 1830-31. His other brother, David, had started in business as a baker at Stockbridge, close to Edinburgh, and James boarded with him there for a time. His qualification enabled him to become assistant to a Dr. Gairdner in dispensary practice, a class of work he had had some experience of in the previous year while staying with Dr. Girdwood at Falkirk during the summer. Dr. Gairdner was much struck with Simpson's abilities, which he stated, "promised the most flattering expectations." In the course of his first experiences of actual practice he became impressed with the necessity for a knowledge of obstetrics, and therefore attended lectures on the subject by Dr. Thatcher, an extra-mural teacher of repute, who subsequently applied for the University chair of midwifery when Simpson was the successful candidate.