A Tribute to Dr S.M.Lewis

Dr S.M.Lewis

Dr S.M.Lewis
BSc MD FRCPath DCP
1924 – 2018

The ICSH Board is saddened to hear of the passing of Dr Shirley Mitchell Lewis. In recent months ICSH Chairman, Dr Sam Machin, wrote a prologue on the outstanding achievements of Dr Lewis in the Laboratory Haematology profession. This tribute is posted in his honour.

A Tribute to Dr. Shirley Mitchell LEWIS

When I started training in haematology in 1972 my first task was to learn basic laboratory pathology skills, so I could take my turn on the on-call rota. To help learn these basic skills I was referred to the standard laboratory reference book “Practical Haematology” by Sir John Dacie and Dr S.M. Lewis (always known affectively as Mitch, short for his name Mitchell). This blue covered hard backed book was then in its Fourth Edition and had been published in 1968. The First Edition had apparently been initially published in 1950. This book has always served as a practical bench manual and each test that is described is accompanied by detailed explanations of the principle involved, reliability and clinical significance. As haematological practice has become more automated and sophisticated, the two main authors have continued describing simple screening tests, including the use of haemocytometer blood cell counting chambers and manual coagulation techniques in a laboratory water bath. Where appropriate simple screening tests have been outlined alongside more complex assays. Special attention has always been paid to standardization, quality control and other aspects of quality assurance. This book is now in its 12th edition, since February 2017, and continues the tradition of excellence with thorough coverage of all the techniques used in the investigation of patients with blood disorders. This has been organised by three new guest editors (as Dacie died in 2005, and Lewis has now completely retired due to chronic ill health) with about 20 additional authors, all of whom had been trained by Dacie and Lewis at the Royal Postgraduate Medical School of London University, based at the Hammersmith Hospital in west London.

In the preface of this standard, widely read text acknowledgement is given to the advice given over the various editions, from individual members of the expert panels of the International Council for Standardisation in Haematology (ICSH). ICSH had been founded by the then European Society of Haematology in 1963 and registered in the Netherlands in 1968, being recognised as an NGO by the WHO (World Health Organisation). Mitch Lewis was a founding member of ICSH and became its second President in 1982, a position he held with great distinction and boundless energy for 24 years, until 2006. One of his first published papers in this role in 1971 was “Determination of the Haemoglobin content of Blood” which he prepared on behalf of the WHO in co-operation with the Expert Panel on Haemoglobinometry of the ICSH. He has remained actively involved in this important subject throughout his working life. He organised ICSH participation into working groups of experts, who would meet at least annually as teams of scientific experts with international representation who would publish prime review guidelines and recommendations. These would later become widely read evidence-based documents. His most recent ICSH paper, of which he was a co-author was “ICSH review of the measurement of the erythrocyte sedimentation rate (ESR)” in Int.J.Lab.Hematol. 2011, 33(2):125-132. He also led the recruitment of affiliate members from international, regional and national haematological/clinical pathology societies, encouraging participation from developing countries. He also sought funding to support ICSH educational activities from Corporate Members, who were industrial corporate sponsors and instrument manufacturers who then often became actively involved in relevant scientific projects for their products.

I became his successor as President of ICSH in 2006 which was decided at a meeting of the executive group in London 2005 as shown in Fig 1. He is also shown at a later date with his wife, Ethel in 2013 attending the ICSH General Assembly (see Fig 2).

As well as the in-house training of new UK haematologists starting out as junior haematology staff, Dr Lewis attracted a large number of postgraduate students from all over the world, particularly from Europe, the Commonwealth countries and the Far East to study and learn the laboratory techniques and procedures they had introduced into their hospital practise. The training programme they had devised also led to continuing high standards in clinical research and numerous published prime review papers and publications. Mitch was also an inspiration to scientific, technical and support staff working in the laboratory environment. This led to Mitch in partnership with Victor Hoffbrand publishing in 1972 a book called “Tutorials in Postgraduate Haematology” which became the basic textbook for doctors revising for postgraduate examinations , particularly the second and final part of the Royal College of Pathologists final qualification, which became essential for appointment as a consultant haematologist. This text now known simply as “Postgraduate Haematology” is presently in its 7th edition and still widely read as a standard postgraduate text. Mitch was still actively writing as an editor up till the 1999 4th edition. Indeed it was a great honour when I was invited to contribute a chapter in three of the later editions. As well as being the prime author for these standard texts he developed and taught the haematological curriculum for the Diploma in Clinical Pathology or DCP at the Hammersmith Hospital, attracting a regular annual group of postgraduate students, to study and learn their basic techniques.

One of his main research contributions was in the development of quality assurance in the haematology laboratory. His technical staff at the Hammersmith Hospital developed the skills how to reliably preserve blood samples, so they could be repeatedly used and stored for the purpose of both internal and external quality control procedures. In general such reference materials, which had already been analysed, could then be analysed along with a batch of routine samples. With the introduction over the last few decades of several new automated blood cell count analysers, often using different new techniques of analysis from the basic Coulter principles, posed interesting challenges for how such preserved samples may change with age on storage. This required Dr Lewis to adapt his quality control material to allow for these innovations in technology. I believe he was a fundamental figure in setting up the NEQAS (national external quality assessment service) scheme in general haematology for Full Blood Count analysis. This was originally organized from the Hammersmith, before being set up as an independent unit at Watford Hospital. All registered laboratories in the UK are required to partake in such a scheme and it is excellent experience for individuals working towards their own individual continuing professional development and to achieve full annual laboratory accreditation. UK NEQAS (H) has become truly international and promotes harmonization by providing worldwide comparative data. This scheme has come a long way in the last 50 years or so mainly due to the initial hard work and perseverance of Dr Lewis in developing the basic skills of haematology laboratory practise.

Dr Lewis, usually accompanied by his wife Ethel, throughout his career travelled widely around the world and paid special attention to the needs, capabilities and skills of haematologists and their support staff in the developing countries. He was also always approachable by commercial manufacturers of haematological equipment, no matter how small or simple their idea was, to help, try out and improve their inventions. He became actively involved with the WHO particularly in their aims to improve the diagnosis and management of general anaemia, particularly in rural communities. After retirement he continued to develop simple diagnostic tools with colleagues, such as the modified Tallquist haematology chart which he changed on his version of a Hb card. He investigated dyes to reproduce the spectrum of colours on the card and also specified a standard quality of absorbent filter paper for the blood spot collection from finger prick samples. These had previously relied on a haemoglobin scale from 10-100 using waxed paper cards which were expensive, so one could determine approximate haemoglobin levels in blood. However the results may rely on the time of testing, whether it is very hot or humid or possibly the presence of an abnormal or unidentified abnormal Hb. But the results still tend not to be as reliable as a point of care haemoglobin meter. This is still an important aim of the recently set up Anaemia project of the WHO to use such a cheap, reliable system without the need for regular electricity, rechargeable batteries, fridges or sophisticated analysers.

When travelling around the world, particularly in the 60 and 70s, his wife Ethel was particularly vociferous and forceful in her support of anti smoking campaigns and legislation. They were both highly delighted to see the legally enforced smoking bans throughout the EU and North America in public places, offices and restaurants and on aeroplanes.

I have now also recently retired from all clinical and NHS practise but am still actively involved in teaching and university funded research, continuing as President of the ICSH. As one gets older, one inevitably becomes concerned about ones personal health and those of your family. The ability to work for many hours each day and travel extensively becomes restricted. As one travels around the world, I am frequently approached by foreign doctors asking after Dr Lewis, and about how he is and whether he is still travelling and working. The purpose of this monograph is to highlight what massive changes in haematological medicine Mitch Lewis has lived through and how he has continuously actively participated in developing laboratory practise worldwide to support widespread clinical activities. He has personally helped many physicians and scientists to practise better medicine. This has been a truly wonderful life long achievement.

Samuel J. Machin, FRCP FRCPath
Emeritus Professor of Haematology, University College London, UK

10th June 2018.

Fig 1: Dr Lewis with Dr Elkin Simson, Dr Sam Machin and Mr Terry Fawcett, University College London, 2005

Fig 1: Dr Lewis with Dr Elkin Simson, Dr Sam Machin and Mr Terry Fawcett, University College London, 2005

 

Fig 2: Dr Lewis at the ICSH General Assembly, Gerrards Cross UK, 2013.

Fig 2: Dr Lewis at the ICSH General Assembly, Gerrards Cross UK, 2013.