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A BLOOD-TRANSFUSION PUMP

A. R. JORDAN.Buckland Hospital, Dover.

SIR,—The blood-transfusion pump described by Mr.Martin in your issue of Nov. 13 is not, I fear, a newinvention. I made a similar pump during the war, butI cannot claim to have invented it, for the idea was

suggested to me by Mr. Molesworth, of Folkestone, who,in his turn, had seen something similar in France forextracting blood from donors’ veins (with a revolution-counter indicating the fee in francs !).The principle is, of course, based on the common

practice of " milking " the tube, but the action with arotating roller is much quicker and more powerful.I can testify to its value and believe it saved at leastone life.

Moreover, it leaves no excuse for the dangerousDractice of blowinsr down the air-inlet tube.

CROSS-MATCHING OF BLOOD IN PRESENCE OFDEXTRAN

C. C. BOWLEYDirector

I. DUNSFORDSenior Scientific Officer.

Regional Transfusion CentreSheffield.

SIR,—We note with interest Dr. Marston’s satisfactoryexperience when using the Sheffield albumin techniquefor difficult incompatibility tests following dextrantransfusions (Oct. 2). -

This technique will not always overcome these diffi.culties. In such cases the indirect Coombs test on the

patient’s serum with the donor red cells proves veryeffective.

ADOPTION OF CHILDREN

SIR,—On Oct. 2, under Medicine and the Law, youreport that the Departmental Committee on the Adoptionof Children have made what you call " an importantrecommendation " that applicants wishing to adopta child should be required to give an undertaking tobring the child up in the knowledge that he is adopted.

Surely this is a very wrong recommendation ? Sixteenyears ago I adopted one of my daughters, and my wifeand I have been careful to make no distinctions betweenour own children and the adopted one. All our children

get the same boarding-school education and fly out fromEngland in rotation to spend the summer holidays withus in Africa. Sometimes they come singly and sometimestogether, depending on what I can afford. Looking backover the years I cannot say that one child has been morebother to me- than another except perhaps that we had tobottle-feed the adopted one whereas the other two werebreast-fed. There have been occasions when someonehas remarked that the adopted child was " the imageof its mother " or again when someone more observanthas asked " why has one of your children got browneyes when the other two have blue eyes ? " ; but on thewhole the three children have been accepted as brotherand sisters. In later years I have had to tell the head-mistress that one of my daughters is adopted, and shehas cooperated fully. For years now the girls have beenaccepted at school as sisters who " don’t look alike "but otherwise there is no comment. The adopted daughteris intelligent, a good mixer, and hockey captain. She willhave no great difficulty in getting on in the world whenshe leaves school.

If I had had to bring the child up in the knowledge ofher different birth there would have been difficulties anddistinctions from the first. For example, would my Indianayah have treated the adopted baby with the sameaffection and care she gave to the others ? During thewar years when I was a prisoner and my wife had to doa job, leaving the care of the children very largely in thehands of my Indian servants (who are still with me aftertwenty years), would the " little cuckoo in the nest "

have suffered from no distinctions ? Would the childhave been happy to know she was of different parentage ’Would she have liked to know she was illegitimate ?

I have discussed the matter with some of my medical

colleagues and I have received support for my contentionthat an adopted child should not " compulsorily " bebrought up in the knowledge of her parentage. To mymind this is an individual matter which depends oncircumstances. -

COLONIAL MEDICAL SERVICE.

1. Birmingham Gazette, Oct. 28, 1954.

Medicine and the Law

Criticism of New Transfusion SetsA WOMAN of 40 died on Oct. 14 in Dudley Road

Hospital, Birmingham, from shock and haemorrhageafter an operation during which she had had two blood-transfusions. At an inquest on Oct. 27 1 it was suggestedthat faulty blood-transfusion apparatus was partlyresponsible. Prof. J. M. Webster, Home Office patholo-gist, said that death had been accelerated by coronary andcerebral air embolism and he thought that air hadentered the circulation through the transfusion apparatus,which was of a new pattern issued in June.

Dr. R. E. Lee, consultant anaesthetist, said in evidence thathe felt so strongly about the new transfusion sets that hewrote to the Ministry of Health to ask that they be withdrawn.The old type of blood-giving set, he added, had proved com-pletely satisfactory. With the new sets, he had seen airdrawn in at the top of the chamber : "it made a hissing noiseand fortunately the theatre was quiet." He agreed thatseveral modifications had been made, but he did not thinkthese had been successful.

Dr. Elizabeth Hoult, consultant anaesthetist at DudleyRoad Hospital, said she had-not heard of anyone who likedthe new apparatus. The junior staff at the hospital had beenso concerned about its possible dangers that they had writtento the medical staff committee about it.

Dr. Walter Weiner, director of the regional transfusionservice, said that extensive trials had shown that the newsets were satisfactory. But he agreed that the test sets hadbeen hand-made, and that the mass-produced sets were farless efficient. The components ’were. supplied by the Ministryof Health.

In his summing-up, the coroner suggested that the mass-produced sets might not have been given the necessary testingbefore they were introduced.

The jury was told that the Ministry of Health had beenwarned in September that the apparatus was dangerousand that on Oct. 18, four days after the woman’s death,the Ministry advised that the apparatus should be with-drawn. The jury returned a verdict of accidental death,probably due to the faulty apparatus.We understand that the new transfusion sets will not

be re-issued until modifications have ensured that theywill be satisfactory under all conditions.

Insanity : Continuity of TreatmentA voluntary patient in a mental institution broke his

leg and was sent to a general hospital for about fourmonths until recovery from the fracture was sufficientfor him to return to the institution. Could he be saidto have been under continuous care and treatment as avoluntary patient for the purposes of the Mental Treat-ment Act, 1930 The question was important becausethe Matrimonial Causes Act, 1950, enables a petition fordivorce to be brought on the ground that the respondentis " incurably of unsound mind and has been con-

tinuously under care and treatment for a period of atleast five years immediately preceding the presentationof the petition." The conditions of such care and treat-ment are narrowly defined in the 1950 Act, but treatmentunder the Mental Treatment Act as a voluntary patientsuffices if it follows without any interval a period of

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detention in pursuance of an order under the Lunacy andMental Treatment Acts.

Mr. and Mrs. Swymer were married in 1918. In 1925 hewas admitted to a mental hospital pursuant to a receptionorder and remained under care and treatment until December,1951, when he was discharged as relieved and readmitted onthe same day as a voluntary patient. In January, 1953, hebroke his leg and was admitted to the Southern Hospital,Dartford, as an inpatient, remaining there until May when hereturned to the mental hospital. The Commissioner who

originally tried the case dismissed the wife’s petition, butlast week the Court of Appeal reversed the decision.lThe Lord Chief Justice said that there was no doubt that

the husband was incurably insane, and the Court had toconsider whether the fact that he was sent to be treated forhis broken leg at a general hospital which was not an approvedplace under the 1930 Act caused a breach in the care andtreatment so that the period of five years’ continuous treat-ment had been broken. He had been a voluntary patientsince his reception as such in December, 1951, and was still avoluntary patient when he was taken to the Southern Hospital.The question was whether he was then receiving treatment assuch. Lord Goddard thought he was. He was still on thebooks of the mental hospital, and reports on him were requiredby and sent to the superintendent of that hospital, who hadnot in any way abandoned him or his treatment. His Lord-

ship could find nothing in the 1930 Act to require that alltreatment must be given within the curtilage of the approvedinstitution. Otherwise, if a voluntary patient were to go outfor a walk or to take any exercise outside the curtilage of theinstitution, it would follow that the period of care and treat-ment was ended-which was an absurd result. A patientcould be granted leave or sent on holiday as part of treatment,as had been done in the present case. In his Lordship’sopinion, the temporary absence of a voluntary patient forconvenience of nursing him for a physical, as distinct from a

, mental, injury did not break continuity of treatment.

So Mrs. Swymer obtained her divorce. Cases of thissort will always turn on precise facts, but Lord Goddard’sjudgment shows that the courts will take a broad view

, of what constitutes continuity of treatment.

Doctor’s Name Removed from Medical List

After an inquiry in Manchester on Sept. 21 the NationalHealth Service Tribunal decided that the name ofDr. Alan McKerlie should be removed from the medicallist of Lancashire Executive Council and should not beincluded in any corresponding list kept by any otherexecutive council under part 4 of the National HealthService Act, 1946.The complainant was Lancashire Executive Council. Man-

chester City Executive Council, on whose medical list alsothe respondent’s name was included, took no part in the

proceedings. The statement of complaint included allegationsthat the respondent had failed to render to a patient all properand necessary treatment ; had frequently failed to attendand/or treat patients at the places where and the hours whenhe had undertaken to do so ; had, " in breach of an impliedobligation on his part in that regard, failed to conduct himselfin a manner befitting his professional status and employ-ment " ; and had on three occasions been convicted by theManchester City -Magistrates’ Court. ’

The tribunal found that the respondent had during the pastthree or four years become increasingly addicted to drink ;he frequented licensed premises to an extent which wasIncorapatible with his position as a professional man. He hadbeen repeatedly absent from his surgery at the times whenhe had undertaken to be present, and had failed to answercalls made to him by his patients ; and he had failed in theserespects without making any adequate arrangements for adeputy to act for him. " The root cause of the whole matterL4 drink.... All sense of responsibility on the part of therespondent appears to be entirely lacking."Dr. Mc kerlie has not appealed against the decision,

and accordingly the Minister of Health has directed thatthis shall take effect, and that Dr. Mc Kerlie’s name shallnot be included in any executive-council list until thetribunal or the Minister directs otherwise.

1. Times, Nov. 13, 1954.

Obituary

CHARLES GEORGE LEWIS WOLFB.A. Manitoba, M.D. McGill, Ph.D. Camb.

Dr. C. G. L. Wolf, honorary consulting biochemist tothe United Cambridge Hospitals and for many years amember of the Cambridge borough and county councils,died on Nov. 9 at the age of 82.He was born at Niagara Falls, Canada, and began his

academic studies at the University of Manitoba, wherehe was first medallist in the natural sciences in 1890.He continued his medical studies at McGill Universitywhere he qualified in 1894, and the following year hewas appointed demonstrator in chemistry there. But in1896 he came to Europe and he spent the next two yearsat the universities of Cambridge and Wiirzburg.

In 1899 he was appointed to the staff of CornellUniversity Medical College in New York, later becomingassistant professor and head of the department of

physiological chemistry. He held this post till 1911,when he returned to Cambridge, at first to work inGowland Hopkins’s laboratory, and later in his ownlaboratory at Addenbrooke’s Hospital. During the1914-18 war he served with the R.A.M.C. in France,where he was for a time in charge of a base hygienelaboratory. He was twice mentioned in despatches.During the war he also became a member of the bacterio-logical committee of the Medical Research Council. Afterthe war he joined the council’s scientific staff, and hecontinued to work at Addenbrooke’s, where he wasappointed honorary biochemist in 1921. The same yearhe received the degree of PH.D. from the University ofCambridge. A colleague writes : " Dr. Wolf had an exten-sive knowledge of the literature of his subject, and he wasan energetic and most careful laboratory worker whopaid scrupulous attention to technique. During his activeprofessional life he carried out a great deal of originalresearch in biochemistry and in physiological subjects,the results of which appeared in the numerous scientificpapers which he published."

In later life Dr. Wolf became interested in municipalaffairs, and he was a member of the Cambridge BoroughCouncil from 1936 to 1946. He served on many com-mittees, and was a former chairman of the public-healthcommittee. He was also a member of the CambridgeCounty Council from 1937 to 1946. He took an activepart in this work, especially in education and publichealth.

In 1910 he married his cousin, Josephine RebeccaTallerman. She died in 1949 and there were no childrenof the marriage.

WILLIAM JAMES BURNSM.B. Edin., F.R.C.P.E.

Dr. W. J. Burns, who died on Nov. 8 in an Edinburghhospital, was born at Dalrymple, Ayrshire, where hisfather was a schoolmaster. During the first world war heserved in the Royal Flying Corps as a pilot and he latergraduated in medicine at Edinburgh in 1923. Afterhouse-appointments at Ayr County and HeathfieldHospitals, he became an assistant in general practice inGrimsby and from 1927 till 1937 he had a -practice inWorkington, Cumberland. In 1934 he contractedtuberculosis, against which he fought courageously forthe next twenty years. During long spells in hospital, hestudied ornithology and medicine, and during a con-valescence in 1943 he became a member of the RoyalCollege of Physicians of Edinburgh. He was electedfellow in 1949. For a short time he was assistant super-intendent of Glenlomond Sanatorium, Fife, and medicalsuperintendent of Lochmaben Sanatorium, Dumfries.He was a vice-president of the Tuberculosis Society ofScotland. For the past few years he had served as chestphysician to the Ministry of Pensions and as a memberof a pneumoconiosis panel and medical referee to theDepartment of Health. It was a source of great satis-faction to him that he lived to see the day when sufferersfrom his disability could be cured in the early stagesby modern chemotherapy. He is survived by his wifeand daughter. T. s.