Archive for the ‘Book Reviews’ Category

Medical Classics: A Doctor’s Occupation, by John Lewis.

Review by Aidan M. O’Donnell.  BMJ 2009; 338: b2603.

In this poignant memoir, Dr. John Lewis gives us a frank and emotive account of life spent under German Occupation in the Channel Islands during the Second World War.

Lewis arrived in Jersey in 1935 and became a partner in a busy general practice. Towards the outbreak of war, many islanders began to leave for the mainland. Lewis was able to get off Jersey on one of the last boats, together with his pregnant wife. His partner had promised to remain to take care of their patients. When they reached his family home in Wales, Lewis received a telephone call to say that, without warning, his partner had panicked and abandoned the island and their patients.

Lewis did not know how many doctors remained on Jersey, but did know he had patients who needed him. With her agreement, he left his wife in Wales and took the decision to return, “honour bound” to care for his patients. He was trapped on Jersey for the next five years.

Lewis worked as a doctor throughout the Occupation. He describes many poignant events, such as watching all the diabetics on the island, kept together in one ward at the hospital, die one at a time after the insulin ran out. He became the head of the Jersey Maternity Hospital, which delivered about two thousand babies during the Occupation, with “only three maternal deaths”. Lewis was forced to visit his patients by bicycle, and covered about 30 miles per day. On one occasion he repaired an arterial bleed in a patient’s thigh without gloves, disinfectant, or anaesthetic, with the patient’s husband burning a book one page at a time to provide the only light available.

Lewis applied great ingenuity to circumventing the restrictions and shortages imposed by the Occupation. When commodities such as coffee, soap, petrol, and alcohol became very difficult to come by, Lewis preserved roasted chickens in glass jars, made soap from pig fat, kept bees for honey, and brewed cider from apples. He hid a radio inside a disused chimney breast, and bricked and plastered it in. He was able to listen to the news through an earphone kept hidden in the fireplace. When keeping a radio carried the death penalty, his was never found. In his words, “I imagine the set is there still.”

It was several years before a Red Cross mail sack arrived with news that Lewis was the father of a healthy boy, whom he did not see until he was five years old.

Lewis wrote his memoir forty years after Liberation. He could not bring himself to recall the events sooner. With great poise, and without rancour or bitterness, he recounts episodes of astonishing brutality; unsung, selfless heroism, and unbearable deprivation, which he witnessed and bore with tremendous fortitude. His account is “the chronicle of a man, left on his own, at the most important time of his life, who survived the Occupation with his health and sanity relatively intact- and of how he did it.”

Lewis J. 1982. A Doctor’s Occupation. London, New English Library.

Copyright © Aidan O’Donnell 2009.
This article first appeared in the British Medical Journal in 2009.
Unauthorised reproduction prohibited.

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Medical Classics: The Faeces of Children and Adults, by P. J. Cammidge.

Review by Aidan M. O’Donnell.  BMJ 2009; 338: b984.

Alfred Kinsey is best known for his famous works on sexual behaviour. However, the late Stephen Jay Gould admired him most for his earlier work, a definitive study of gall-forming wasps of the genus Cynips. Kinsey covered 18,000 miles to collect more than 300,000 individual specimens. Gould argued that Kinsey’s rigorous methods and scrupulous attention to detail lent him impeccable scholastic credentials, which made his later work on sexuality unshakeably solid.

Harvard’s only copy of Kinsey’s great wasp monograph contains this graffito: “Why don’t you write about something more interesting, Al?” As an undergraduate, I was disappointed to find that Kinsey wrote about sexuality with every bit as much academic detachment as he had no doubt applied to his wasps.

Kinsey was not alone in devoting an enormous amount of scholarly focus to the study of a small area of interest. In 1914, Percy John Cammidge of London published his unsung opus, The Faeces of Children and Adults. He was commissioned to write a translation of a German work on the subject by John Wright & Sons, a Bristol publisher who went on to publish the British Journal of Surgery. However, on “mature consideration” Cammidge deemed the German work inadequate, and resolved to undertake a work of far wider scope.

Empirical observation is a cornerstone of basic science. Cammidge arranged for samples to be sent from all over the world: “When the specimen has to be sent a long distance, especially in hot weather, it may be preserved by mixing it with a little formaldehyde. I have obtained satisfactory results from specimens from India, America and Australia.” He was insistent, however, that his specimens must not be contaminated with urine.

Having obtained his material, Cammidge performed macroscopic inspection, microscopic examination, bacteriological and chemical analysis. His descriptions were richly detailed and evocative. In constipation, “smaller masses, having a faceted surface, and resembling the dejecta of sheep, are sometimes seen.” He described how the oral administration of calomel turns the stools green; senna or gamboges turns them yellow; kino colours them red; haematoxylin violet, and methylene blue imparts “a bluish-green tint”.

Much of the book is given over to lengthy details of his chemical methods, and descriptions of his microscopic observations, but he also commented at length upon diet: “The copious drinking of water with meals should not be practised indiscriminately and certain pathological conditions would be a distinct contraindication.” “It may be stated as a fact that [alcoholic drinks] should be avoided by all persons under the age of thirty years, except in pathological conditions.” Condiments and spices “are most useful in the aged and feeble” but “an abuse of such substances gives rise to catarrh of the stomach and causes hyperaemia of the liver.” As a purgative, Cammidge recommended “semi-solid paraffin”, given “between bread as a sandwich”.

One of Cammidge’s aims was to deduce the processes of digestion by examining the faeces in the context of a known diet. Unfortunately for him, advances in physiology soon rendered his work obsolete, but his book still merits attention from the historian, and perhaps deserves a measure of wider recognition for its scope and detail.

Spare a thought for Cammidge, toiling in his laboratory amid his rainbow-coloured but odoriferous trophies, contemplating his unappetising lunch. His dissertation is a comprehensive masterpiece of analytical methods, rigorously applied. One can only wonder, however, if he ever got the chance to write about something more interesting.

Cammidge PJ. 1914. The Faeces of Children and Adults. Bristol, John Wright & Sons.

Gould SJ. 1985. The Flamingo’s Smile. London, Penguin Books.

Copyright © Aidan O’Donnell 2009.
This article first appeared in the British Medical Journal in 2009.
Unauthorised reproduction prohibited.

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Medical Classics: Essays on the First Hundred Years of Anaesthesia, by W. Stanley Sykes.

Review by Aidan M. O’Donnell.  BMJ 2008; 337: a794.

In many departments where I have worked, there is a shelf in the library which contains old, dusty books about the history of anaesthesia. Browsing one day, I picked up one old book, and found I could not put it down.

Dr. William Stanley Sykes was an anaesthetist in Leeds before the Second World War. He was captured and held as a prisoner of war in Greece for some years. At the end of the war he returned to civilian life to find anaesthesia had evolved in the intervening years, and he considered his skills to be obsolete. He decided to retire, and devote his life to the study of anaesthetic history and equipment. From his studies, he began to write essays about points which interested him as he went along.

What followed was a collection of essays of enormous erudition. Sykes usually wrote about what interested him, but sometimes what impressed him or angered him. The topics were discursive, and seemingly random, but by deviating from well-trodden paths of the history texts, Sykes unfailingly gave us a fresh angle. Amid some of the essays are occasional entertaining digressions, including brief accounts of his own experience as an anaesthetist in the prison camp, and some astonishing case histories, such as David Livingstone’s own account of his mauling by a lion.

Sykes ferreted out many original documents and sources in his endeavours to set the record straight. He showed that chloroform was used as an anaesthetic six months before James Young Simpson anaesthetised his dinner guests with it, and that the word “anaesthesia” appeared in print over a year before Oliver Wendell Holmes thought he invented it. He told us about many failed ideas and dead ends: neither rectal ether nor subcutaneous oxygen made it widely into practice, although curare managed it after a somewhat shaky start.

Sykes was unrelenting in his condemnation of what he saw as inefficiency, stupidity or ignorance. About one particular dangerous-looking device, Sykes wrote “It is not stated how long this machine was in use before it blew up.” In another chapter, he asked in exasperation: “Is there any device in the whole of anaesthesia which has not killed somebody?”

But where he found excellence, Sykes was quick to praise. Of Joseph Lister he wrote: “He did not gain his position of unchallenged pre-eminence by making piddling little improvements… Instead he completely remodelled the whole of operative surgery and changed it from a crude and dangerous handicraft into an expanding and much safer science.”

The first volume of Essays was published in 1960. A second followed shortly after Sykes’ sudden death in 1961. Some unpublished material was collected into a third volume by Dr. Richard Ellis and published in 1982. Sykes’ unusual approach, scholarly excellence and uncompromising forthrightness of tone make his Essays a stimulating and enjoyable read, and you might even find a copy beneath the dust in your own anaesthetic library.

Sykes WS. 1960. Essays on the First Hundred Years of Anaesthesia. (2 vols) Edinburgh, Churchill-Livingstone.

Sykes WS, Ellis RH (ed). 1982. Essays on the First Hundred Years of Anaesthesia. (vol. 3) Edinburgh, Churchill-Livingstone.

Copyright © Aidan O’Donnell 2008.
This article first appeared in the British Medical Journal in 2008.
Unauthorised reproduction prohibited.

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