Sir David Waldron Smithers was a former professor of radiotherapy at the University of London. The younger son of the redoubtable parliamentarian, Sir Waldron Smithers, he was educated at Charterhouse and Clare College, Cambridge, and qualified in medicine at St Thomas’s in 1933. His initial ambition was to be a cardiologist, and in 1937 he became an assistant in radiology at the Royal Cancer Hospital, with the objective of gaining experience in radiology to further his career in cardiology.
The duties of the radiology assistants at the Royal Cancer Hospital at that time included the administration of X-ray treatment at the behest of the surgeons. Smithers soon realized the untapped potential of ionizing radiation in the treatment of cancer and decided upon a career in radiotherapy, becoming one of the pioneers of this new specialty as it separated from diagnostic radiology. The radium and X-ray treatment departments were amalgamated in 1939 under his directorship. He was appointed to the London University chair of radiotherapy at the Institute of Cancer Research in 1943.
Many years later Smithers wrote in his memoirs about the domination of hospital practice in the 1930s by a "small band of occasionally-visiting surgeons whose word was law", which is hard to imagine today. He was in fact one of the leaders of the changes in medical practice that were essential before modern coordinated cancer services could develop. His first proposals on taking up the chair were for the establishment of multi-disciplinary joint consultation clinics, full consultant status for radiotherapists and tumour site specialization within the disciplines of surgery and radiotherapy. All three were fiercely opposed by most of the surgeons at the time, but Smithers had an ally in Cecil Joll, the chairman of the medical committee (which met in Harley Street!), and was successful in getting his first two proposals accepted. Sub-specialization was firmly rejected at that time, and in fact only implemented very gradually over the next fifty years.
One of the factors in Smithers’ decision to become a radiotherapist was the progress in medical physics under the leadership of Val Mayneord, which provided the technical and dosimetric background for advances in radiotherapy. Together they pioneered the use of artificial radioactive isotopes in medicine in Britain. Among their achievements was the first patient with metastatic thyroid cancer to be treated with radioactive iodine in 1949; she was known to be alive and well forty years later.
In the years after the Second World War they felt there was a need for a new hospital devoted to the application of nuclear physics to medicine. Smithers worked tirelessly to achieve his goal and eventually a site was found for what was to become the new Surrey branch of the Royal Marsden Hospital. It was opened in 1963. He chaired the building committee and paid meticulous attention to every detail. Among his ideas was the layout of the tables of the dining-room, arranged to allow casual conversation between different groups of staff. The siting, and indeed the very existence, of the new hospital was, and remains, controversial. Nevertheless it rapidly evolved from its original concept to become a major cancer treatment and research centre. He invited Gordon Hamilton-Fairley [Munk’s Roll, Vol.VI, p.215] to join him and together they were at the forefront of advances in the treatment of Hodgkin’s disease and testicular tumours in the 1960s and 1970s. He disliked what he felt was the reductionist approach of much of the cancer research at that time, and believed that physicians were ideally suited by their training to become the next generation of cancer specialists, thereby playing a major part in encouraging the development of the new specialty of medical oncology.
Smithers was a member of the council of Royal College of Physicians. Among his many other assignments he was president of the Faculty of Radiologists, president of the British Institute of Radiology, chairman of the cancer advisory committee of the Ministry of Health, a member of the council of the Royal College of Surgeons and a member of the Central Health Services Council.
Despite all his achievements, those of us who were privileged to train under his guidance remember him mostly for his humanity. His patients were always his first priority, ahead of all his other commitments. He insisted that patients were treated as people and that he and his firm know not only about their diseases, but also about their personal and family problems. He would have a photograph of every patient pasted in the front of the case-notes, to remind him of their personalities before greeting them in out-patients or on a ward round. He would often visit inpatients in the evening to be able to talk to them alone, away from the hurly-burly of ward rounds. He made a point of getting to know all the staff in the hospital and greeting them by name, from colleagues to porters. Nevertheless, he could be severely critical of doctors who did not meet his exacting standards. He showed great insight into what we now call ‘alternative’ medicine, and was twice asked by the Ministry of Health to investigate clinics abroad that had been the subject of media publicity because of their claims of success of unusual cancer treatments. His conclusion to his report on the Ringberg Clinic in 1971 remains pertinent today and epitomizes his philosophy: "if all doctors were good doctors, if all doctors treating cancer had a wide experience of malignant disease, and if patients received the best available therapy at a stage when they could most be helped, there would be less inclination for them to seek help abroad."
Smithers had many interests outside medicine. He loved foreign travel and delighted in entertaining overseas visitors, both in his department and at his family home in Kent; photographs were an essential feature of the entries in his visitors’ book. He was a regular broadcaster and a keen rose-grower. When he retired from medical practice in 1973 he began a new career as an author, writing books on subjects as diverse as the history of Kent, Jane Austen and doctors as authors. He followed his grandfather and father in being knighted for public service. His wife Gwladys Margaret died in 1992 after a long and happy marriage. They had a son and a daughter.
As I write Smithers’ former office at the hospital he created is in the process of being gutted to make way for a pharmacy extension and a shop in the foyer, under the direction of managers who send e-mail messages but are rarely seen, while the doctors’ offices are being moved into a staff residence building no longer needed. All of this epitomizes the changes in our hospitals over the past thirty five years. It is to be hoped that at least some of the humanity that he personified may survive in our Health Service in the next millennium.
J M Henk
[The Independent, 5 Aug 1995; The Times, 29 July 1995; The Daily Telegraph, 29 July 1995; Brit.med.J., 1995,311,942]