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GUY’S HOSPITAL

To the Editor of THE LANCET

SiR,-May we be permitted, through the hos-pitality of your columns, to renew our appeal onbehalf of the extension fund of Guy’s Hospital.Through the generosity of the public some f:200,000of the 500,000 originally appealed for has beenreceived or promised conditionally since July, 1936,-coming from people in every walk of life in a warm-hearted response to the hospital’s call for help, andenabling us to complete the arrangements for thefollowing :-

£

Every effort has been made to keep down expenses,and we are pleased to state that the inclusive costof the appeal to date is only 5-8 per cent.We are sincerely grateful for the generous response

with which our appeal has met, and which has

encouraged us to renew our efforts to raise the

remaining 316,000 necessary for the essential

rebuilding and completion of the following :-. f

It is a natural sequence of events that an increaseddemand on the services of the hospital necessitates alarger nursing staff and, in consequence, an increaseddomestic staff. The extension of the wardmaids’hostel will not only ensure the necessary additionalaccommodation but will enable the centralisation ofthis service within the hospital’s precincts.The surgical block is the original hospital built by

Thomas Guy in 1725. In the interests of economyits rebuilding has been delayed again and again, andthe whole question deferred until urgency demandsaction. The hospital architect, moreover, reportsthat the outer walls are beginning to sink. This callsfor immediate measures if the whole of the surgicalwork is not to be seriously curtailed or even stopped.

Our present maintenance cost is approximatelyE221,000, which is the lowest possible figure at whichwe can economically maintain our huge organisation,the size of which has been determined by thedemands made upon our services. Our assuredincome amounts to 69,000, leaving us with a deficitof £ 152,000 per annum to be obtained from voluntarysources. In recent years this sum has not beenobtained, and in consequence an annual deficit hasaccumulated to a debt of serious proportions.The time has now come when it is essential, if we

are to maintain the high standard of our services, toenlarge and rebuild our present departments. So

many appeal to us for help-and for the sake of

humanity and future generations it is imperativethat the service we give must be in accordance withthe highest traditions of modern medicine and

surgery. If the money for this appeal is forthcomingthen the services of Guy’s will continue ; but if wefail in our efforts it is more than probable that it willbe necessary to curtail those services which we areso happy to give, and for which there is an ever-

increasing demand. Although we are a London

hospital, our work is not confined to the metropolis- 42.18 per cent. of our patients come from the rest

of the British Isles, and our doctors, dentists, andnurses are serving in every part of the Empire.

Experience makes us appreciative of the insistentdemands made upon the pockets of so many at thepresent time ; but we would give every assurancethat any response, however small in measure, will bemost gratefully received, and will convince us thatthe splendid work of Guy’s is not without recognitionfrom the British public.We are, Sir, yours faithfully,

GOSCHEN,President of Guy’s Hospital;

NUFFIELD,Treasurer of Guy’s Hospital;

ALFRED BEIT,Chairman, Extension Fund Ap peal Committee ;

EBBISHAM,Vice-chairman, Extension Fund Appeal Committee ;

ERIC G. WALEY,Chairman, Standing Appeal Committee.

SULPHANILAMIDE AND PENTOTHAL

To the Editor of THE LANCET

SIR,-Since the recent increase in the use of sul-phonamide preparations, an anaesthetic risk has arisenwhich I have not yet seen mentioned in the medicalpress. It is recognised that in certain individuals thesimultaneous exhibition of sulphanilamide and drugscontaining sulphur may cause sulphsemoglobinaemia.As the molecule of Pentothal sodium contains a

sulphur atom and the drug is given intravenously, itseems probable that trouble may arise if it is givento a patient who is receiving sulphanilamide.

I am, Sir, yours faithfully,C. LANGTON HEWER.

A STANDARD FOR PREMATURITY

IN the course of a periodical revision of the well-known clinical report of Queen Charlotte’s MaternityHospital, the definition of prematurity came up fordiscussion. It was decided to refer this matter tothe British Psediatric Association and to the sectionof the study of disease in childhood of the RoyalSociety of Medicine. These two bodies nominated a

joint committee consisting of Dr. Norman Capon,Dr. Helen Mackay, Dr. Kenneth Tallerman, and Dr.Alan Moncrieff. After due consideration this com-mittee suggested a definition based upon a standardof 5-llb. or under, and the result of their deliberationswas circulated to various interested bodies, includingthe Royal College of Physicians of London and theBritish College of Obstetricians and Gynsecologists.Neither of these two organisations was fully satisfiedwith the wording of the definition and a joint com-mittee was set up consisting of Sir Ewen Maclean

(B.C.O.G.), Sir Arthur MacNalty (R.C.P. and Ministryof Health), Prof. W. W. Jameson (R.C.P.), Prof.Fletcher Shaw (B.C.O.G.), Dr. Hector Cameron(R.C.P.), Dr. Percy Stocks (R.C.P. and General

Register Office, Somerset House), and Dr. Moncrieff(R.C.P.). This committee came to the conclusionthat it was impossible to define prematurity satis-factorily, but with regard to the purposes for whichthe proposed definition would be used they agreedthat some standard was desirable. They thereforeput forward a recommendation which was afterwards

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somewhat modified, and the final proposal reads asfollows :-

" That in conformity with the standard in inter-national use an infant whose birth-weight is 6 lb.(approximately 2500 grammes) or less, shall be con-sidered, for the purpose of comparison of records,

as either immature or prematurely born, according asthe estimated period of gestation is full time or less."

It is hoped that this standard will now be utilisedby all maternity institutions, public health authorities,and others concerned with the new-born baby, sothat comparison of results will be possible.

OBITUARYW. H. MAXWELL TELLING, M.D., F.R.C.P. Lond.

Dr. Maxwell Telling died of cerebral haemorrhageat his home in Leeds on April 28th at the age of 63.For several years his health had given cause foranxiety, but he refused to regard himself as a sickman, and continued to carry on his activities-medical, social, scientific, and educational-untilthree days before his death.Walter Henry Maxwell Telling was born in Surrey,

educated at Camberwell Grammar School, andentered Guy’s Hospital where he had a brilliantcareer. He graduated in 1898 and took the goldmedal at the M.D. Lond. in 1901. After holding at

Guy a residentobstetric andother appoint-ments Tellingwent to Leeds (atthe age of 25) asresident medicalofficer at theGeneral Infirm-

ary, to whichhe remainedattached all hislife. He becameassistant physi-cian in 1903,physician in 1912,and consultingphysician in 1933.He was also phy-sician to severalof the smaller hos-pitals in the sur-rounding area.

He was electedF.R.C.P. in 1913but took no activeshare in the

affairs of the College, preferring to devote hisinterests to the medical life of his adopted town.During the late war he acted as divisional medicalofficer at the 2nd Northern General Hospital with therank of lieut.-colonel.At the General Infirmary Telling established a

reputation as a sound and inspiring clinical teacher.From the start his energies were directed to the

improvement of clinical teaching, and the highstandard of medical education in the Leeds school ofmedicine to-day owes much to his work and his

example. He was a wise, careful, and conscientiousphysician, full of common sense and understanding,and had the ability to create, to foster, and to

encourage these qualities in students. As a teacherhe was insistent on careful and systematic observationand on a clear setting out of results obtained. Onthe facts thus well marshalled and recorded hewould bring to bear a mind logical and reasonable,and a diagnosis would appear simply, naturally, and(as it seemed) inevitably. At the bedside he hadlittle use for text-book medicine.

Telling was not content, however, just to improveexisting methods ; he was a reformer with a progres-sive outlook, and he originated changes which haveproved beneficial both to the hospital and to theschool. Early in his career, with the help of the lateJ. F. Dobsth, he set up at what was then the Womenand Children’s Hospital a separate children’sclinic, to be transferred later to the General Infirmarywhere it became a department with a specialistphysician. He also had a share in the formationof a dermatological department which now has twophysicians attached. His work in improving thenurses’ curriculum of instruction, in forming thenurses’ training school, and in getting the Universityto grant a diploma in nursing, will always beremembered. In the University he held in successionthree chairs : in 1923 he was appointed professor oftherapeutics, in 1925 he succeeded to the chair ofmedicine, and on his retirement from the latter heaccepted the chair of forensic medicine. He was

peculiarly fitted for the forensic chair ; he enjoyedmedico-legal work, and was highly esteemed as anexpert witness. In his practice he was keen onpsychological medicine and was recognised as an

authority. He did not contribute much to medicalliterature, but what he wrote was important; his

paper on diverticulitis remains a classic.

Maxwell Telling was a strong personality, oftenacious opinion, persuasive in argument, relentlessand sometimes possibly unreasonable in opposition.But he was a genial and generous friend, witty andentertaining in company, a delightful after-dinnerspeaker, and one who enjoyed the good things of lifewhen he could share them with others. In his homehe had many interests. He was a great lover ofhis garden, which he made into a thing of beautyand charm, and here he spent most of his leisuretime. He was also a knowledgeable collector of china,of which he possessed many valuable specimens. Hetook a great joy in entertaining his friends, amongstwhom were many well-known members of musicaland artistic circles, and as a host his genial personalitywas seen at its best. His worth to the communitywas recognised a few months ago when he was madea justice of the peace for the city of Leeds.Two of Maxwell Telling’s friends write of the

impression he made upon his contemporaries. One

says : " His early death deprives Leeds of a formidableand impressive public figure, a rare combination ofzeal and diligence with a gracious, kindly, and urbanenature. If the latter aspect of his character was notimmediately evident it was hidden only by thefervour with which he threw himself into the work athand. For many years he devoted himself withintense industry to the advancement of medicinein the West Riding ; he was a bold and self-confidentpioneer, advocating reforms which are now so muchincorporated in the Leeds medical tradition that itseems incredible they could ever be the subject ofcontroversy. First and foremost he was an alertand learned physician, but his energies overflowedfreely into all kinds of activities in philosophy, law,