Thursday 2 June 2022

Kids, killers and the Catholic Church

I’m waiting for a Catholic bishop somewhere in America to deny communion to a Republican member of Congress of Catholic faith, for their role in the killing of nineteen children in Uvalde Texas. There are sixty-two Catholic legislators to choose from, ten in the Senate, fifty-two in the House of Representives.

This unlikely thought occurs to me only because this is how the Archbishop of San Francisco, the Most Reverend Salvatore Cordeolene, has chosen to punish Nancy Pelosi for opposing the criminalizing of abortion. I have no idea if Pelosi actually fears losing her place in Heaven, but the archbishop must intend to deny her the means of salvation. This is a lot worse than being blackballed at the club.

Of course none of those sixty-two Republican politicians have shot any children. They have merely failed to take action to reduce the supply of assault weapons to psychopaths. But Pelosi is not being excommunicated for having had an abortion herself or for performing one, merely for championing the rights of women in America, eighty percent of whom are not Catholics, to decide to have one without anyone calling the police.

Naively, I continue to be shocked whenever a Catholic spokesman claims the moral high ground on any issue relating to the care of children, born or unborn. Given the role played by so many princes of the Church, for longer than anyone can remember, in overseeing and enabling the abuse of children, I feel they should all take a vow of silence on questions of motherhood and the nurturing of infants. But of course the moral high ground is their natural habitat. For the Catholic Church, privileged access to eternal truths is the unique selling point. No one ever said it was a democracy.

To this extent, in preaching to America the archbishop is on more solid ground than Justice Clarence Thomas.

Speaking at a Judicial Conference in Atlanta, Thomas said that the Supreme Court ‘can't be an institution that can be bullied into giving you just the outcomes you want.’ Commenting on the angry response to the overturning of Roe v Wade, he warned that ‘We are becoming addicted to wanting particular outcomes, not living with the outcomes we don't like.’ 

Strangely, he sees the desire for popular freedoms as a form of 'addiction' and, in spite of his own enormous power, experiences democratic pressure as 'bullying'. One of six practising Catholics among the nine Justices, Thomas seems to have deluded himself into thinking that he is a member of the College of Cardinals, whose job it is to pass down to the ignorant laity the divinely inspired word.  

Friday 30 July 2021

Dr Samways Writes to the Editor

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.[1] 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 PublishingUntil the end of September applying the code PROMO25 gains a 25% reduction on individual purchases.

[1] Stanley Spencer: Travoys arriving with wounded at a dressing station at Smol, Macedonia, September 1916, painted in 1919, Imperial War Museum 

[2] Tom Treasure: Dr Samways Writes to the Editor: the Life and Times of an Exceptional Physician, Cambridge Scholars Publishing, 2021

Friday 12 February 2021

Enemies of the people

We’ve been rivetted by live coverage of Trump’s second impeachment trial, marvelling at the incompetence of his attorneys, who are effective only in muddying the issues, and wondering what could possibly persuade Republican senators to acquit him in the face of such overwhelming evidence.

On reflection, the incompetence is not so surprising. Even if Trump didn’t have a long history as a terrible client, incapable of following a legal strategy, keeping his mouth shut and paying his fees, this case would be one to avoid. Any lawyer with integrity or an eye to a professional future might hesitate to get mixed up in it. And so Trump is left with anything but the brightest. Some Trump-supporters have criticized the performance of the defence team, but without going so far as to acknowledge that anyone would struggle to defend the indefensible.  

Meanwhile, the Democratic impeachment managers have achieved three significant things. They’ve laid out the full horror of what happened, linked the actions of the mob inextricably to Trump’s words, and presented the Republicans consistently as fellow-victims rather than co-conspirators.

The last of these shows how tightly disciplined they are. The opposition condemned this trial in advance as a partisan attack by Democrats against a Republican President and continue to deflect criticism of Trump by impugning the integrity of individual Democrats. In response, the impeachment managers have said nothing about four-and-a-half years of craven apologetics for Trump from the GOP, nothing about the hundred or more House Republicans who persisted in voting to overturn the election result even after the desecration of the Capitol, nothing about Senator Hawley’s clenched-fist support for the mob. Instead, they have reminded us that principal among the targets was Vice-President Pence and have held up as heroes the Republican officials around the country who resisted illegal pressure from the White House and protected the democratic process in the face of threats of violence against them and their families.     

Similarly they have steered clear of any suggestion that individual members of the Capitol police were sympathetic to the insurrection and made no mention of the likelihood that black demonstrators would have been shot long before they got anywhere near the Senate chamber. They have focused instead on the heroic actions of police officers and the injuries they suffered. 

They have spoken throughout with reason enlivened by passion and tempered by empathy. They have embraced their Republican colleagues and presented Trump not as a product of his party but as the leader of a criminal faction. And yet, in spite of all this, insiders predict that most Republicans will vote to acquit him. How can this be?

The pragmatic support for Trump from constitutional conservatives and evangelical Christians was always based on a crude bargain – they turned a blind eye to his grotesque unfitness for office and he gave them the judges they wanted. As for the corporate class, they tolerated his antics as long as they got their tax breaks. But he’s no longer President and those bargains are over.

So what’s left? For some elected Republicans, fear has always been key, the fear of being verbally attacked and ridiculed, of losing support and funding and being primaried out of office. This fear remains. And the dangers are no longer merely loss of status and income. Increasingly those who speak out against Trump face credible death-threats.  

What about the more positive inducements? The Trumpian beast remains a huge force. Some Senators are clinging on for the ride. A few must imagine themselves jockeying the beast all the way to the White House. But it’s a fickle creature. Until Trump demanded the impossible of him, Mike Pence was abjectly loyal, but they came for him with a gibbet anyway. 

In the New Yorker footage of the insurrection, one of the most enlightening moments, for me, was when some of the rioters found Ted Cruz’s desk. I was struck by the brittleness under the bravado, the sense of identities dependent on the perceived treachery of others. Cruz’s reputation survived this moment of scrutiny, but it’s clear that it would take only one misstep for him to become the next enemy of the people.

GREEN HELMET: Here look.

VOICE 2: Ted Cruz’s objection to the Arizona…

GREEN HELMET: His objection! He was gonna sell us out all along.

VOICE 3: Really?

VOICE 4: What?

GREEN HELMET: Look. Objection to counting the electoral votes of the State of Arizona.

VOICE 5: Can I get a photo of that?

MAGA CAP: Wait, no, that’s a good thing. That’s OK.

GREEN HELMET: All right, all right.

MAGA CAP: He’s with us. He’s with us.


VOICE 7: There’s gotta be something in here we can fucking use against these scumbags.

Monday 15 June 2020

Is the age of Aquarius finally dawning?

I’ve got history with Edward Colston. Sort of. Colston Hall was where I was supposed to be one evening in the summer of 1970. I was 16. With my younger brother Wilf, I was on an orchestral course based at Bristol University. The National Youth Orchestra were in town for a concert at Colston Hall so we were all given the evening off to attend. But on the way, I saw a poster for an American show called Hair at the Bristol Hippodrome, so I sloped off and saw that instead.

I’m sure the National Youth Orchestra played well. Wilf, who was more talented than me as well as being more dutiful, would later join them for a couple of years and go on to study music at Cambridge. But I think I had the more memorable evening. 

Now Colston Hall is being renamed and Colston’s statue has been pulled down from its plinth and dumped in the Avon. History is being erased. It’s like 1984 all over again. Which is strange because it seems as if, right now, a lot more people know who Edward Colston was than did a couple of weeks ago. I don’t think it worked that way when Winston Smith pushed a newspaper cutting tainted with thoughtcrime down the memory hole. So erased isn’t the right word. Rewritten is what I mean. History is being rewritten

Which would definitely be a bad thing if the existing version of history were beyond improvement or dispute, the work of historians finished for good, no more writing needed. Bewigged, frock-coated Colston was “one of the most virtuous and wise sons” of the city, according to the plinth. It didn’t mention that he made the bulk of his fortune from the slave trade and rose to become Deputy Governor of the Royal African Company, which held a monopoly in England on the transport and sale of African slaves. That inscription needed some rewriting. 
Ann Yearsley, by Joseph Grozer, after  Sarah Shiells - NPG D4452But is it fair to judge poor old, rich old Edward Colston by today’s standards? This would be a good question, if we were going to dig up his bones and put them on trial for crimes against humanity. But this is just a question of who goes on the plinth, who, out Bristol’s countless sons and daughters, should be elevated in bronze. Surely, no one is entitled in perpetuity to loom above us in the public square. 

How about giving Ann Yearsley a go (pictured above), a self-educated milkwoman and author in 1788 of A Poem on the Inhumanity of the Slave-Trade? Or Paul Stephenson, Bristol's first black social worker, who organised the 1963 bus boycott to lift the bar on non-white drivers and conductors? Or Jamaican-born Princess Campbell, who studied nursing in Bristol and fought discrimination to become Britain's first black ward sister in 1974?

When I took down my poster for Hair at the Hippodrome from my bedroom wall, I wasn’t erasing history, just making space for something I liked better.

Portrait of Ann Yearsley by Joseph Grozer, after Sarah Shiells mezzotint, published 1787 
© National Portrait Gallery, London

I wrote four years ago about the statue of Cecil Rhodes at Oriel College, Oxford

Tuesday 12 May 2020

The plot sickens

There are so many people to feel sorry for, but today I’m thinking about novelists. I’m thinking particularly about the novelist (a male one, as I picture him) who had planned one quick final edit of his state-of-the-nation epic before clicking send – and then this! I imagine his cry of anguish echoing the words of Prince Charles, whose long-awaited wedding to Camilla had to be postponed when Pope John Paul II died: Why does everything always happen to me?! 

The Independent on Sunday called my first novel 'zeitgeisty', which was nice. It helped that I’d written it, from first thought to last word, in a year, and even so I felt I was only hanging on to reality by my fingernails. Since then I’ve chosen to write about the past, which is relatively stable, or the future which – if you’re lucky – hasn’t happened yet. At the best of times, contemporary reality is a moving target. If nothing else turns up to make nonsense of your plot, some development in how we communicate is likely to.

Novels with contemporary settings published in the near future will include coronavirus if only because it will seem weird to leave it out. For a while novels will fall into three categories: pre-covid fiction, surviving from an innocent age, in which we will notice with a pang of nostalgia how unconsciously people used to mingle and how carelessly they hugged and kissed and shouted into each other’s ears at parties, covid fiction, which will deal with the thing itself, and finally, if we survive that long, the post-covid kind, in which the virus will go unmentioned because no one needs to mention it.

The material for covid fiction is, of course, all around us in tales of bereavement, heroism and profiteering. Families are separated and lovers divided. A scientific advisor to the Government secretly breaks his own social-distancing rules to entertain his married lover. And all of this against a shifting backdrop in which what was previously unimaginable becomes mundane. A few days ago I watched from my second floor window as a normally mild-mannered gent exploded in rage at a passing jogger and pushed him off the pavement. A month ago I would have thought the old man had gone mad or suffered some unforgivable betrayal. But all I think now is, you know, bloody jogger, what does he expect?

And this week, in case we were afraid of running out of plot lines, we’re being teased with the possibility of expanding from households into bubbles. It makes sense. The neighbourly mingling of, say, six people is only slightly riskier than the familial mingling of two separated households of three each. As long as we remain strictly monogamous in our bubbling. Oh yes, from an epidemiological perspective it makes perfect sense. But socially it’s a complete nightmare.

There’s a piece of dialogue I remember from a 1970s Dennis Potter play about a group of seven-year-olds getting up to mischief one summer afternoon in the Forest of Dean. The play was called Blue Remembered Hills. Grown-up actors took the parts of the children. I can’t recall who played Audrey, but Angela was Helen Mirren. The bit that for some reason pops into my head went like this:

Audrey: Angela, will you be my best friend?
Angela: I’m best friend to lots and lots.

Ah yes, the delights of childhood! And we can enjoy them all again. Like a disillusioned Audrey, I can already imagine how many people would honestly love to bubble with me and Leni but unfortunately are already committed to bubbling with someone else.

Saturday 28 March 2020

United in isolation

Until a few months ago a lot of British people, to the complete bafflement of a lot of other British people, seemed to have embraced the notion that we were fighting a war. Standing alone against a continental invasion, this plucky island nation was taking back control. But unlike World War 2, far from uniting us this war was tearing us in half.

Now we know what it feels like to face a real enemy, not one with tanks and bombers, but an enemy nonetheless that we must unite to defend ourselves against.

It’s hard to imagine that so recently all some of us could think about was Brexit. What was breaking our hearts was the looming reality of leaving. That has now been pushed out of the news by Covid-19. For the time being, the free movement of people across Europe is a theoretical issue. Whatever the state of Brexit negotiations, London is no longer a destination for the Italian barista wanting to improve her English, because she’s stuck at home in lockdown. The young British opera singer excluded from European opera houses isn’t performing anywhere, except in his flat, singing through the walls to his neighbours.

But this pandemic will pass and Brexit will remain, limiting all kinds of arguably even more important things, such as the free movement of research scientists, shared access to scientific funding, and pan-European strategies for coping with crises such as this. And we will still have to deal with the impact of Brexit on our National Health Service.

One of the painful paradoxes of the Battle for Brexit was that ordinary Leavers and Remainers were united, if in nothing else, in their shared concern that the NHS should thrive. The leaders of the Brexit campaign turned reality on its head to make NHS funding the principle benefit of leaving, knowing how much our health service is loved and valued, knowing also that, in truth, its assets and marketable activities, long coveted by predatory capitalists, would become a major bargaining chip in any post-Brexit trade talks with the USA.

In Britain we’ve been rolling back the state for 40 years. New Labour applied the brakes, but the onward pressure has been towards ever more private ownership. In all that time, no party has ever campaigned with a promise to privatise our health care. But the champions of the free market have done their best to prepare the ground by starving it of funds. We’re all now paying for that.

We’ve known for a long time that nurses are underpaid, that everyone’s overworked, and that the whole system functions at the limits of what it can manage, exploiting the dedication and goodwill of the employees. Now we know that the most basic equipment needed to deal with an epidemic isn’t available. For decades we’ve stockpiled nuclear weapons in the hope that we’d never have to use them. Why not protective clothing? Why not, in a prosperous country such as this, an inbuilt excess capacity of beds and equipment, with a generous provision for sabbaticals so that the pool of trained workers is greater than the normal need?

Because it’s not as if we couldn’t have seen this coming. Apart from the warnings from scientists, there have been enough actual viral outbreaks in recent years to alert politicians and policymakers to the dangers. And yet here we are.

As I struggle to look on the bright side, three thoughts to occur to me.

First, I’m thinking about poverty, homelessness and social deprivation. We’ve lived with these things forever, but, during my lifetime, more acutely since governments began hacking away at the welfare state. We’re used to politicians expressing concern, or not, pointing out that resources are limited, that since there’s no magic money-tree we all have to tighten our belts, that raising taxes would discourage enterprise and be bad for the economy.

And then Covid-19 arrived. The government flirted briefly with a libertarian response. We were going for ‘herd immunity’ – a science-y way of saying, ‘Let’s do nothing’. Perhaps in the radical right-wing circles where people take pride in thinking the unthinkable, this looked like an attractive option. Death would come disproportionately to the old, the sick and the economically unproductive, and the impact on share prices would be minimized. But images of overwhelmed hospitals in southern Europe were emerging to remind us that even such a passive exercise in eugenics would require operatives on the ground – doctors and nurses working relentlessly and under stress, often at the cost of their own health, and having to make impossible judgements about who to treat and who to abandon.

The ‘herd immunity’ approach was rapidly replaced with a set of old-fashioned socialist interventions. Perhaps it will be just a bit harder after this to argue that we must impose austerity on the poor to protect the investments of the wealthy because there's no alternative.  

Secondly, looking ahead beyond this pandemic, a greater danger continues to threaten us. The planet is still heating up and the oceans continue to rise. Well, who knew until a couple of weeks ago, that it was possible to intervene in the global market to the extent of stopping planes from flying? What else will we discover we can do?

Thirdly, there's this new sense of social cohesion. The other week, back when panic buying was a thing, a woman queuing ahead of me at the supermarket check-out turned and said darkly, ‘This could get ugly.’ Well it hasn’t yet. Now we queue all down the street, six feet apart, waiting politely to be invited in.  

Few of us can follow the epidemiological details, but we seem to have understood that getting through this is a collective endeavour. While the most vulnerable must be shielded, for most of us this is not principally about self-protection. We may not know much about exponential curves, but we seem to have grasped that this is one we want to flatten, reducing its height by extending its duration. It’s likely that before a vaccine is available more of us will get the virus than not. But if we form an orderly queue, there’s a better chance that those who are badly affected will receive the treatment they need. 

After all the efforts by politicians over the years to persuade us that we are essentially economic units competing in the marketplace, in this crisis we instinctively understand that we’re in it together.

See also: Five arguments for public healthcare

Thursday 20 February 2020

Barr humbug

Yesterday’s London Evening Standard gets to American news on page 24. According the headline: Angry law chief “threatens to quit” over Trump tweets on cases. There’s a photo of Attorney General William Barr with a caption in bold that reads: “Great integrity”. [1]

At first glance it looks as if the Attorney General, a man of great integrity, is threatening to resign to protect the justice system from Trump’s interference.

I’m not a professional journalist and I don’t follow the US political scene all that closely, but it looks to me as if the Standard has swallowed the spin and missed the story. If you’re alert to quotation marks, you may want to quibble with my assessment, but sometimes quotations marks are not enough. Has the Attorney General actually threatened to quit or has he only “threatened to quit”? And after months of acting as Trump’s henchman, does he have a shred of actual integrity left? That word came out of Trump’s mouth, which means that as a character reference it’s worse than useless, but you have to reach paragraph eight to know that.

The Standard’s story begins: America’s top law officer is considering resigning after Donald Trump ignored his warning to stop tweeting about Justice Department cases, according to reports today. That last phrase is another way of disowning responsibility for the rest of the sentence, but not enough to actively question its truthfulness.

Image result for William Barr picturesThe second paragraph tells us that Barr took a public swipe at the president, saying that the President’s interference had made it “impossible” for him to do his job. And yet here he is, still, sort of, doing it.

The most telling sentence in the article draws directly on a report in the Washington Post: “He has his limits,” the newspaper quoted one person close to Mr Barr as saying. The trouble is that when it comes to colluding with the President to help his criminal friends and harass his political opponents we are yet to discover Barr’s limits, and a person close to Mr Barr is the last sort of person you would expect to acknowledge that. 

It’s not until paragraph seven that we hear that Barr’s threat has already been withdrawn by a Justice Department spokeswoman: “The Attorney General has no plans to resign.” So what's left of the story?  

If this report appeared on a Fox News website I’d know what to make of it. But the Evening Standard is surely not in Trump’s pocket. What accounts for it then?

[1] To avoid confusion, quotations from the Standard are in italics throughout this post. All quotation marks are theirs.