In April of last year, during the
first lockdown, I spent a few days staring into my screen at a painting by
Stanley Spencer of a WW1 army dressing station in Macedonia.
I was working on a poem. I’d written that the surgeon was “equipped with ether and
antiseptics, scalpels, catgut, gauze…” The reference to ether bothered me. I liked
it for its sound and rhythm, but worried that chloroform might be more
historically accurate.
I did what I often do when I’m
struggling with a medical question, or with something relating to statistics or
animal husbandry or spreadsheet software or how to cook fish or the migration of
birds. I emailed my brother Tom.
From
the fishing village just up the coast from Boulogne to which, with his Irish
passport, he has retired from surgery, though not from the pursuit of science,
he responded within a few hours. What he sent was unexpectedly detailed – a series
of letters, published in the BMJ from September 1918 to June 1923, debating the
rival claims and relative dangers of these two anaesthetics.
The most persuasive
among the correspondents was a Dr Samways. I was vaguely aware that Tom was
writing a book about Samways, but this was my first close encounter with the
engaging figure he had been moved to pluck from obscurity. [2]
My concern was quickly settled.
Both substances were used during this period and each had its champions. Ether
was cruder with more harmful side effects but chloroform more likely to be
lethal if carelessly administered. Ether could stay in my poem, though Samways
favoured chloroform:
Mishaps occur with the sharp
scalpels of surgeons, which blunt ones would have avoided. Why not use blunt
ones? Because, though they escape mishaps, they bruise the tissues, cause
after-troubles not less tragic though less spectacular, and embarrass the
surgeon. Chloroform, too, is a sharp-edged knife, but, personally, I have found
it, in every way, a more convenient and more controllable anaesthetic… (page 150)
For much of his professional life,
Samways ran a general practice in Mentone on the French Riviera, but in 1914 he
had left France for Exeter in the South of England to work in one of the new
War Hospitals. Here, among other things, he served as an anaesthetist. His
attitude to the chloroform-ether debate is characteristic. Use whichever is
best for the patient – best during surgery but also in the longer term when the
surgeon has moved on – and train the practitioner to use it properly.
His letters on many subjects,
written to the medical journals over a period of 40 years, draw on available
evidence as well as personal experience, employ metaphors and analogies not as
rhetorical flourishes but to clarify arguments, and are consistently concerned
with humane patient care.
Samways was a generalist of the
best kind. He turned his hand, and his mind, to many things, but always wanting
to learn for himself and to improve how things were done. Writing about ambulances
during these war years, he complains that “many… are a mechanical disgrace,
with half the body overhanging behind low back wheels, thus providing a maximum
of discomfort for the unfortunate occupants” (p 183). In treating deep entry
wounds, where it’s necessary to clean the wound and drain infection outwards
from the furthest inner point, he designs his own elongated instrument to make
this possible. Never off-duty, on leave in London he observes soldiers with
their arms in splints, too many of them set in the wrong position for the best
long-term outcome.
He expresses concern for the
psychological wellbeing of patients, as well as their physical comfort. Accustomed
to the way oxygen is administered in France, he is shocked to see that, in England,
“a terrifying cylinder, recalling a trench mortar, is brought to the bedside,
and, after much struggling with cocks, ice-cold oxygen is supplied to [the
patient’s] lungs. The oxygen should first be passed into rubber bags in another
room, and left to warm to a reasonable temperature before it is taken to the
bedside” (page 151).
His career as a general practitioner
in a provincial resort in France was, itself, a pragmatic exercise in making
the best of what life made available. When he earned an MD at Guy’s Hospital
for his research into rheumatic heart disease, and particularly mitral stenosis,
his future as a specialist seemed assured. But his progress was derailed by a
diagnosis of tuberculosis, probably as a result of time spent in the
post-mortem room studying diseased hearts.
Following a common practice for
sufferers who could afford it, Samways boarded a slow steam ship for a voyage
around the world. He reported later that the best part was being ashore in
Western Australia. Having experienced the discomfort over many months of cold
damp air, he decided that the warm dry climate of southern France would do him
more good. He acquired an additional MD from the University of Paris and opened
his practice in Mentone.
It’s possible that his
experiences at sea informed his later attitude to the fresh air fetish:
Is it not time more
discrimination were shown by the medical and nursing professions in the
advocacy and employment of fresh air?... Some friends of mine were lately
present at a concert given to the patients at the Brompton Hospital. So great
was the draught that music put down on the piano was actually blown off, while
two assistants were required to hold in place any piece of music which was
being played. (p. 143)
As early as 1898, Samways foresaw
the possibility of a surgical cure for mitral stenosis. In the 1920s, long
after he had given up any prospect of becoming a cardiologist, he was writing
letters to the BMJ from France, correcting more eminent correspondents on the
mechanism of the heart. But the kind of mechanical intervention he envisaged would
not be achieved during his own lifetime.
In his many disputes, Samways
seems to be in the right more often than not. But it’s typical of Tom that he
is reluctant to blame historical figures for their misconceptions. In an
eye-opening chapter on the persistence into the twentieth century of routine bloodletting,
he argues that “there is no harm in being aware of just how wrong doctors can
be in the hope their present-day counterparts, and I include myself, will be
more reflective.”
An alert critical mind, a
restless search for knowledge and an openness to the possibility that things
could be done better are qualities shared by the subject of this book and its
author.
Dr Samways Talks to the Editor is available
direct from Cambridge Scholars Publishing. Until the end of September applying the code PROMO25 gains a 25%
reduction on individual purchases.
Stanley Spencer: Travoys
arriving with wounded at a dressing station at Smol, Macedonia, September 1916, painted
in 1919, Imperial War Museum
