595 its recommendation to those who use the test frequently, as in hand surgery or leprosy. The teeth of the comb provide very suitable pressure-points. N. H. ANTIA. Tata Department of Plastic Surgery, Balaram Building, Sir J. J. Group of Hospitals, Bombay 8. LEAD ABSORPTION AND LEAD POISONING SIR,— Your leading article 1 points to several problems associated with chronic exposure to lead as well as with the diagnosis of lead poisoning. Most noticeable by its absence, however, was the failure to mention the use of estimates of body lead stores, as determined in bone,2 for evaluating these problems. As has been well described, the bony skeleton is the predominant site for lead storage. Consequently, it is a most suitable sampling site for determining lead stores and thus for answering questions suggested both in your leading article and elsewhere. For example, do lead -stores differ in a population not exposed to lead as compared to a population from a highly industrialised community, and how does this relate to " chronic lead insult " ? 3 What is the relation of lead stores to lead poisoning? Are increased lead stores closely related to the biological effects of lead ? What relation, if any, exists between lead stores and continued exposure to an industrial lead hazard ? These are a few of the pertinent problems which have scarcely been examined. Not only do they require considera- tion, but they may possibly be answered by an assessment of idetal lead levels. M. P. WESTERMAN. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, Bone biopsy has uses postmortem and in diagnosis, and is possibly justifiable in clinical research. It is not suitable for routine lead control in industry. Bone-lead levels provide additional data on lead absorption, but give no information on the long-term effects of absorption, which at all but the highest levels are unknown.—ED. L. DOUBLE-WRAPPED STERILE PACKS SIR,-In their interesting article (Aug. 27, p. 469) Dr. Speers and Professor Shooter demonstrate clearly the dangers of contamination of the contents when a single-wrapped. pack is opened. They suggest that contamination is due to organisms on the outer surface of the pack being thrown into the air during the opening of the pack. This interpretation of their finding is almost certainly correct, for when a pack dusted lightly with fluorescent powder is opened under ultraviolet illumination the powder can be easily seen to rise into the air and then fall on to the contents. Even with careful opening dust can still be seen to settle on the contents of a single- wrapped pack.4 The use of a fluorescent powder such as anthracene provides a simple but elegant technique for examining new forms of packing for their ability to prevent bacteria-laden hospital dust from being transferred to the pack contents during opening, as well as being useful for teaching purposes; and it has the advantage over coloured powders such as charcoal or dye that it is almost invisible under ordinary conditions of illumination, thus more closely simulating hospital dust. R. J. FALLON. Department of Pathology, Ruchill Hospital, Glasgow N.W. 1. Lancet, 1966, i, 1307. 2 Westerman, M. P., Pfitzer, E., Ellis, L. D., Jensen, W. N. New Engl. J Med. 1965, 273, 1246. 3 Patterson, C. C. Archs envir. Hlth, 1965, 11, 344. 4 Fallon, R. J. Lancet, 1963, ii, 785; Hosp. soc. Serv. J. 1965, 75, 453. FIRST-AID FOR HÆMORRHAGE Dr. P. J. HORSEY (Wessex Neurological Centre, Southampton General Hospital) writes: " I fully support Major Scott’s enthusiasm for the first field-dressings and shell-dressings used by the Armed Forces. I have tried unsuccessfully to obtain these through civilian channels, and would be interested to know if they are available. They would make ideal dressings for doctors to carry in their cars." Obituary WILLIAM JOHN TULLOCH O.B.E., M.D., Hon. D.Sc. St. And. Prof. W. J. Tulloch, who held the chair of bacteriology at the University of St. Andrews for over 40 years, died in hospital in Hampshire on Aug. 26. He was 78 years of age. The son of Henry Tulloch, of Dundee, he graduated M.B. from the University of St. Andrews in 1909, and soon after- wards joined the bacteriological department of the College of Medicine at Newcastle upon Tyne. In 1912 a ship arrived there with suspected cases of plague which Tulloch was able to confirm by blood-culture. In describing the outbreak in these columns he urged that this method should be used more extensively. His own prompt use of it probably averted an outbreak which might have paralysed a great port. During the 1914-18 war he was a member of the War Office committee on study and control of tetanus; and, when the importance of prophylactic administration of antitetariic serum was recognised, he made a valuable contribution to the main- tenance of adequate supplies of the serum. For this work he was appointed o.B.E. After the war he became lecturer in bacteriology in the University of St. Andrews, and he was appointed to the chair in 1921. Of these early years J. C. relates: " When I became assistant to Tulloch in 1927 his laboratory consisted of some converted rooms in an old building next to the medical school. The accommodation was limited, the teaching laboratory occupying a third of the total floor-space. Assistance was also limited. There were two technicians, an animal boy, a typist, and, later, a second qualified assistant. We carried out much diagnostic and routine work for the Dundee Royal Infirmary, the venereal-diseases clinic, the local infec- tious-diseases hospital, and the city public-health department. " Tulloch possessed abounding energy and enthusiasm. He loved his subject, and despite the class and routine duties and other demands on his time he managed to carry out a good deal of original work. He was a lucid and -stimulating lecturer. Thoroughly practical in outlook, he had little patience for cur- rent speculations and hypotheses which he considered unjusti- fied by the available facts. His tea-time commentaries on items in the literature which had aroused his interest or scorn were fascinating. He was an excellent raconteur with a great sense of humour, and his collection of laboratory tales and anecdotes of notable bacteriologists seemed inexhaustible. One of his interests was the improvement of media for isolation of fasti- dious organisms such as the gonococcus, Hœmophilus pertussis, and Brucella abortus-the last from guineapigs injected with milk samples submitted for routine testing. He spent a good deal of effort in attempting to duplicate an oleo-vaccine with which he had succeeded in protecting guineapigs against sub- sequent infection with tubercle bacilli. He was especially interested in the application of bacteriological and serological methods to epidemiological problems, and he revelled in col- laborating with Dr. W. L. Burgess, medical officer of health for Dundee, in the investigation of outbreaks of gastrointestinal infection, most of which were due to salmonellas. I well remember his disappointment when, on return from holiday, he learned that an extensive milk-borne Gaertner outbreak had been dealt with in his absence." 1. Tulloch, W. J. Lancet, 1913, ii, 1318.
Transcript
595
its recommendation to those who use the test frequently,as in hand surgery or leprosy. The teeth of the comb providevery suitable pressure-points.
N. H. ANTIA.
Tata Department of Plastic Surgery,Balaram Building,
Sir J. J. Group of Hospitals,Bombay 8.
LEAD ABSORPTION AND LEAD POISONING
SIR,— Your leading article 1 points to several problemsassociated with chronic exposure to lead as well as with thediagnosis of lead poisoning. Most noticeable by its absence,however, was the failure to mention the use of estimates ofbody lead stores, as determined in bone,2 for evaluating theseproblems. As has been well described, the bony skeleton is thepredominant site for lead storage. Consequently, it is a mostsuitable sampling site for determining lead stores and thus foranswering questions suggested both in your leading article andelsewhere. For example, do lead -stores differ in a populationnot exposed to lead as compared to a population from a highlyindustrialised community, and how does this relate to " chroniclead insult " ? 3 What is the relation of lead stores to lead
poisoning? Are increased lead stores closely related to thebiological effects of lead ? What relation, if any, exists betweenlead stores and continued exposure to an industrial leadhazard ?These are a few of the pertinent problems which have
scarcely been examined. Not only do they require considera-tion, but they may possibly be answered by an assessment ofidetal lead levels.
M. P. WESTERMAN.
Department of Medicine,University of PittsburghSchool of Medicine,
Pittsburgh, Pennsylvania 15213,
Bone biopsy has uses postmortem and in diagnosis, andis possibly justifiable in clinical research. It is not suitable forroutine lead control in industry. Bone-lead levels provideadditional data on lead absorption, but give no information onthe long-term effects of absorption, which at all but the highestlevels are unknown.—ED. L.
DOUBLE-WRAPPED STERILE PACKS
SIR,-In their interesting article (Aug. 27, p. 469) Dr.Speers and Professor Shooter demonstrate clearly the dangersof contamination of the contents when a single-wrapped. packis opened. They suggest that contamination is due to organismson the outer surface of the pack being thrown into the airduring the opening of the pack. This interpretation of theirfinding is almost certainly correct, for when a pack dustedlightly with fluorescent powder is opened under ultravioletillumination the powder can be easily seen to rise into the airand then fall on to the contents. Even with careful openingdust can still be seen to settle on the contents of a single-wrapped pack.4The use of a fluorescent powder such as anthracene provides
a simple but elegant technique for examining new forms ofpacking for their ability to prevent bacteria-laden hospital dustfrom being transferred to the pack contents during opening,as well as being useful for teaching purposes; and it has theadvantage over coloured powders such as charcoal or dye thatit is almost invisible under ordinary conditions of illumination,thus more closely simulating hospital dust.
R. J. FALLON.
Department of Pathology,Ruchill Hospital,Glasgow N.W.
1. Lancet, 1966, i, 1307.2 Westerman, M. P., Pfitzer, E., Ellis, L. D., Jensen, W. N. New Engl.
J Med. 1965, 273, 1246.3 Patterson, C. C. Archs envir. Hlth, 1965, 11, 344.4 Fallon, R. J. Lancet, 1963, ii, 785; Hosp. soc. Serv. J. 1965, 75, 453.
FIRST-AID FOR HÆMORRHAGE
Dr. P. J. HORSEY (Wessex Neurological Centre, SouthamptonGeneral Hospital) writes: " I fully support Major Scott’senthusiasm for the first field-dressings and shell-dressings usedby the Armed Forces. I have tried unsuccessfully to obtainthese through civilian channels, and would be interested toknow if they are available. They would make ideal dressings fordoctors to carry in their cars."
Obituary
WILLIAM JOHN TULLOCHO.B.E., M.D., Hon. D.Sc. St. And.
Prof. W. J. Tulloch, who held the chair of bacteriologyat the University of St. Andrews for over 40 years, died inhospital in Hampshire on Aug. 26. He was 78 years of age.The son of Henry Tulloch, of Dundee, he graduated M.B.
from the University of St. Andrews in 1909, and soon after-wards joined the bacteriological department of the Collegeof Medicine at Newcastle upon Tyne. In 1912 a ship arrivedthere with suspected cases of plague which Tulloch was ableto confirm by blood-culture. In describing the outbreak inthese columns he urged that this method should be usedmore extensively. His own prompt use of it probably avertedan outbreak which might have paralysed a great port.During the 1914-18 war he was a member of the War Office
committee on study and control of tetanus; and, when theimportance of prophylactic administration of antitetariic serumwas recognised, he made a valuable contribution to the main-tenance of adequate supplies of the serum. For this work hewas appointed o.B.E.
After the war he became lecturer in bacteriology in theUniversity of St. Andrews, and he was appointed to thechair in 1921. Of these early years J. C. relates:
" When I became assistant to Tulloch in 1927 his laboratoryconsisted of some converted rooms in an old building next tothe medical school. The accommodation was limited, theteaching laboratory occupying a third of the total floor-space.Assistance was also limited. There were two technicians, ananimal boy, a typist, and, later, a second qualified assistant. Wecarried out much diagnostic and routine work for the DundeeRoyal Infirmary, the venereal-diseases clinic, the local infec-tious-diseases hospital, and the city public-health department.
" Tulloch possessed abounding energy and enthusiasm. Heloved his subject, and despite the class and routine duties andother demands on his time he managed to carry out a good dealof original work. He was a lucid and -stimulating lecturer.Thoroughly practical in outlook, he had little patience for cur-rent speculations and hypotheses which he considered unjusti-fied by the available facts. His tea-time commentaries on itemsin the literature which had aroused his interest or scorn were
fascinating. He was an excellent raconteur with a great sense ofhumour, and his collection of laboratory tales and anecdotes ofnotable bacteriologists seemed inexhaustible. One of hisinterests was the improvement of media for isolation of fasti-dious organisms such as the gonococcus, Hœmophilus pertussis,and Brucella abortus-the last from guineapigs injected withmilk samples submitted for routine testing. He spent a gooddeal of effort in attempting to duplicate an oleo-vaccine withwhich he had succeeded in protecting guineapigs against sub-sequent infection with tubercle bacilli. He was especiallyinterested in the application of bacteriological and serologicalmethods to epidemiological problems, and he revelled in col-laborating with Dr. W. L. Burgess, medical officer of health forDundee, in the investigation of outbreaks of gastrointestinalinfection, most of which were due to salmonellas. I wellremember his disappointment when, on return from holiday, helearned that an extensive milk-borne Gaertner outbreak hadbeen dealt with in his absence."
1. Tulloch, W. J. Lancet, 1913, ii, 1318.
596
During this period Tulloch’s most important work wason the serodiagnosis of smallpox.. He was a close friend of M. H. Gordon, who had obtained aflocculation reaction with rabbit antivaccinia serum and
extracts of a limited number of samples of variola and alastrimcrusts. In the spring of 1927 an outbreak of mild alastrimoccurred in Dundee. Tulloch obtained vaccinia-agglutinatingserum from Gordon, but the supply was scanty and he used itonly in cases presenting real difficulties in diagnosis. Materialcollected from other patients was stored for later examinationwhen antivaccinia serum had been prepared and tested byTulloch. The initial results were encouraging. In 1928 out-breaks in Dundee, Arbroath, and South Shields providedmaterial for further investigation.2 A grant from the M.R.C.enabled this work to be continued, and this firmly establishedthe specificity and diagnostic value of the vaccinia-variolaflocculation reaction.3 During the 1939-45 war his constantinterest in epidemiology enabled him to help the Department ofHealth for Scotland in its arrangements for the control of war-time epidemics. When about the end of the war Dundee wasvisited by a severe epidemic of diphtheria, Tulloch and hiscolleagues were able to show that the unusual variant of theCorynebacterium diphtheriœ which was prevalent had a peculiaraptitude to breaking through the immunity arising fromprophylactic immunisation. Similar observations were madeabout the same time in Gateshead by Hartley and his colleagues.This valuable contribution to epidemiology was published in1950.4 Professor Tulloch retired from his chair in 1962.
J. W. McL., to whom, with J. C., we are indebted formuch of the material for this biography, has sent the fol-lowing personal appreciation:
" Many men as they grow older are inclined to mistrust newideas and methods unfamiliar to them in their earlier work. Itwas not so with Tulloch; his mind remained peculiarly open tonew ideas and he was able to command the energy required totest them and to adopt what was valuable to the daily work ofhis laboratory for the hospital and public-health services. Anotable example of this was seen in his application of the methodof complement fixation in the diagnosis of gonorrhoea in whicha deep lesion had been developed and infected exudate was notavailable. At about the same time with the help of his youngercolleague, Craigie, he was exploring the value of immunologicalmethods in the differentiation of smallpox and chickenpoxusing the formation of precipitates in mixtures of pock-crustextracts and the sera of patients.
" Tulloch did not take life too solemnly, and much of hiswork was brightened by a mischievous and even puckish senseof humour as when he had a chart drawn up for the entertain-ment of his clinical colleagues which demonstrated that thepeak period of the year for the consumption of rhubarb andstrawberries and hence oxaluria coincided in a startling waywith that in which the greatest number of urines were sent infor investigation for tuberculous infection.
" Examining with him for a many years I came to value twothings especially. One was his wide range of knowledge ofinfectious diseases especially those peculiar to tropical countries.The second was the kindly way in which he sought to put thecandidate at ease. He was a man of strong religious conviction,and this may well have been the source of his many-sidedgenerosity to those who worked with him, his capacity to givehimself without stint to such tedious investigations as the sourcesof cases of food-poisoning, and his sympathetic handling ofstudents. He belonged to the old school of professors whoconsidered teaching their first responsibility, and for young menand women contact with a keen man whose mind ranges widelyover his subject and beyond it must surely be one of the bestthings in university education."
BRIAN GERARD CONRAD ACKNERM.D. Cantab., F.R.C.P., D.P.M.
Dr. Brian Ackner, consultant physician to BethlemRoyal Hospital and the Maudsley Hospital, died on
Aug. 29 at the age of 47.He was educated at Rugbv and Cambridge and obtained
his clinical training at (iuy’s Hos-pital. He graduated M.B. in 1942,and two years later he took theM.R.C.P. He had already joined theR.A.F., and by 1945 he held therank of wing commander and wascommand neuropsychiatrist to theR.A.F. Middle East and Mediter-ranean Forces. The same year hetook the D.P.M.
After demobilisation he came tothe Maudsley Hospital, and in1948 he was appointed physician toBethlem Royal Hospital and theMaudsley Hospital. In 1950 hebecame honorary consultant in
psychological medicine to Ham-mersmith Hospital, and two years
later he was appointed lecturer in psychological medicine at thePostgraduate Medical School.
In 1961 he was elected F.R.C.P. and he was later a memberof the college’s nomenclature of disease committee and
honorary secretary of its committee on psychological medicine,Ackner was engaged continuously in clinical research. The
effect of emotional change on vasomotor activity in the wakingstate and asleep, the natural history of depersonalisation, andthe sedation threshold were problems to which he gave closeattention. He and his colleague, the late Arthur Harris, madea study of the efficacy of insulin treatment of schizophreniawhich played a large part in causing the method to be generallydiscarded.Ackner was active in the affairs of the Royal Medico-Psycho-
logical Association, especially in their education committee,for which he prepared an entirely new version of the well-known Handbook for Mental Nurses. He played a prominentpart in the subcommittees of the General Nursing Councilconcerned with mental nursing. He was also a member of thecouncil of the Section of Psychiatry of the Royal Society ofMedicine.Two years ago, at the request of his colleagues and of the
board of governors, he gave up most of his clinical and teach-
ing duties to devote himself, with characteristic energy, todeveloping plans for a new ward block at the Maudsley Hos-pital. As the key member of the planning group set up for thispurpose, he visited hospitals in Scandinavia and NorthAmerica, and he acquired a remarkably penetrating grasp ofthe special needs of psychiatric hospital design. In conformitywith current trends, he related this to the development ofcommunity services for the area served by the hospital.
A. L., to whom we are indebted for this biography,adds the following personal lines :
" Brian Ackner had exceptional qualities as a clinician,teacher, and planner. He took a broad view of the scope andpurpose of psychiatry, and proved a stimulating guide andteacher for postgraduate students. Forceful and determined,he set himself high standards of professional attainment anddevoted himself to the fulfilment of his clearly stated aims.His death at such an early age is a loss to the hospital he servedand to the causes he strove to further."
S. T. writes:" Brian Ackner held a unique post at the Postgraduate
Medical School in that he was responsible for the psychiatricservices though only a part-time member of staff. Over the
years he proved himself to be an ideal appointment for such -’post, and he will be missed by his colleagues here who foun-4
Barr
597
him so willing to cope with all the problems which arose innnecdon with patients already being treated at the hospital.His particularly warm and outgoing personality combinedwith an immense capacity for hard work made him an extremelySuable member of the community, and there is no doubtthat his willingness to take on far more work than was reason-able contributed to his untimely death. No-one who got toniow him well will forget his amazing thoroughness andattention to detail. His own department was one of the bestrun in the hospital and it was always a pleasure to visit it
knowing what a warm welcome would be waiting."Dr. Ackner leaves a widow, a son, and a daughter.
JAMES LAWSONB.Sc., LL.D. St. And., M.D. Edin., F.R.C.P.E.
Dr. James Lawson, who died on Aug. 29, was a retiredphysician who as a member of the university court
played a leading role in the development of the medicalschool of St. Andrews University.He was born at Newport-on-Tay in 1891, and was edu-
cated at Merchiston Castle School, Edinburgh, from whichhe went to St. Andrews University, graduating B.SC. in 1912.In the 1914-18 war he first served as a dresser, but he wasrepatriated to complete his medical course at Edinburgh,where he graduated M.B. in 1915 before returning to Franceto serve with the R.A.M.C. After the war he worked forsome years in Tor-na-Dee Sanatorium in Aberdeenshire withhis uncle David Lawson who was a pioneer of the sanatoriumMtment of tuberculosis in Scotland. James Lawson tooktiiiM.D. in 1920, and became M.R.C.P.E. in 1921, but theiliozss and death of his father led him to leave medicine forthe business world. During the 1939-45 war, however, hewent back to the R.A.M.C. and served as a lieut.-colonelpersia.After the war, as a senior doctor and respected business
man, his services were greatly sought after in an administra-tive capacity. He was an original member of the Eastern
: Regional Hospital Board, and he did valuable work in mobilis-ing available resources for the treatment of tuberculous
patients. He was a member of St. Andrews University Court fors 20 years, and he was also a member of the Scottish Hospital
Endowments Research Trust from 1954 to 1964. Thesecontributions to medicine and to teaching were recognisedby his election as F.R.C.P.E. in 1952 and the award of anhonorary LL.D. St. Andrews in 1951.
1. H. writes:
"Athletic in his youth, when he played rugby for his
universities, James Lawson maintained a keen interest in sporttill failing health in his latter years prevented full participation.A member of the R & A, he was for some years on the rules-of-golf committee of that body: he was a keen shot and askilful angler, and a most generous and genial host."His energy and vision made a remarkable contribution
to the development of the medical school. Starting with the: institution of whole-time clinical chairs in medicine, surgery,
and obstetrics, he pressed in innumerable ways for expansionof staff, improved hospital and teaching accommodation, andi research facilities. The present high standing of St. Andrews
University Medical School in Dundee is in large measuredue to him."
J. A. B. has sent the following personal appreciation:1. 1 met Jimmie Lawson in 1942 when we were both lodgers
n the mess of 25 General Hospital at Bangor, Co. Down.He was commanding the convalescent depot with kindly:ff.Clency and a nice disregard of regulations, but casual con-’ ration showed that though he had not practised for manyars he had kept a lively interest in the newer knowledge of7-,iicine, From there he went to command convalescentdepots first in Staffordshire and finally in Teheran where hemade a host of Iranian friends. After the war I saw him only
occasionally but every meeting was a great joy. His interestsand enthusiasms were many and real and his kindnesslimitless. Six years after he knew of his illness he caught twosalmon in his favourite river, the Deveron, and none of theothers got a thing’. He could tell fascinating stories of theintricacies of modern commerce. For many years he was oneof the regents of St. Andrews University and for him this wasno sinecure. He thought long and earnestly about the pro-blems of the modern university and especially of medicaleducation. I saw him last this April more or less bedridden,but with his mind and his eyes as bright as ever. Now he hasgone and I am not the only one who has lost a very dearfriend." "
Dr. Lawson leaves a widow and a son.
JOHN RIGBYT.D., M.B. Manc., D.P.H.
Dr. John Rigby, a general practitioner at Chorley,Lancashire, for over 45 years, died on Aug. 9 at the ageof 75.He studied medicine at Owens College (later Manchester
University) and the Rotunda Hospital in Dublin. Aftergraduating M.B. in 1915 he served in France and Germany,where he was twice wounded, and he remained in the Army ofOccupation of the Ruhr. He entered general practice with hisfather, and he was the fifth successive generation of his familyto practise in Chorley. By studying after surgery hours hetook his D.P.H. in 1926. In addition to his general practice hewas medical officer to the Chorley rural district council, HeathCharnock Isolation Hospital, and the Royal Ordnance factoryat Euxton. For many years he was a police surgeon, work thatdeeply interested him, and surgeon to the Chorley St. JohnAmbulance Brigade for which he was made a serving brotherof the Grand Priory of St. John of Jerusalem. He joined theTerritorial Army when it was re-formed in 1920 and eventuallyhe became a lieut.-colonel.
L. H. writes:" Always keenly interested in mechanical gadgets, and guns
in particular, Rigby was a good shot. The little time he sparedfrom his practice was mainly spent in his garden in which hetook a great pride, and also with his bees. Perhaps the besttribute to his memory is the name he was known by-Dr.John-and this is how he would wish it ".
Dr. COLMAN O’DOHERTY, consulting radiologist to theWestminster Hospital and the Brompton Hospital,London, died on Sept. 4 at the age of 70.
