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