- Email: [email protected]
A TAX ON KNOWLEDGE
235 the, medical record officers. This dependence upon the lay staff, while testifying to their zeal and efficiency, seems in some cases to have reached a point where the main responsibility for the accuracy of records is placed upon the layman. In these medical record officers the medical staff may find valuable auxiliaries, but nothing will be gained by a confusion of functions. Distasteful as paper work may often be to the medical man, these
records provide essential material for medical education and the efficient working of the National Health Service. OBSERVER. CHARMS
SiB,—One
but
can
Dillon that psychology our
ideal, and
we
wholeheartedly on a
agree with
Dr.
scientific basis ought to be
must all share
fully his
aversion to
procedures resembling-or imitating-the methods of superstition. But we must admit the metaphysical aspect of the human personality : that is, the deep"
"
rooted desire for the belief in the supernatural and unexplainable, for the ceremonial and magical. Whether we like this aspect of personality, or deplore it as atavism and superstition, we cannot afford to ignore it. In some people an approach on these lines-whether in the or cause of morality health-promises better and speedier results than the employment of logical and scientific concepts. In most people, indeed, this " metaand may be stronger than physical " aspect is strong, the capacity for the " intelligible " ; and in these the psychosomatic function responds better to magical than to scientific approaches. This has been abundantly illustrated by the appeal-and even therapeutic efficiency -of sacred wells, spiritual healings, and the less dignified activities of various quacks and therapeutic eccentrics. If we wish to be sincere we cannot ignore the large number of cures, where scientific medicine had previously failed, by these healers and methods. As a psychiatrist with twenty years’ experience I find more people fit for magical methods than for modern psychotherapy. We may regret that this is so, especially since we average psychiatrists cannot perform such miracles ; our training has made us unfit to use them, and our reputation as scientific psychiatrists inhibits the patient’s belief in our magical powers. But I doubt whether any real harm is done by practitioners who feel able to apply them in selected cases. People helped by such primitive means may be more superstitious than intellectual, but they are not necessarily less happy or less reliable and humane. It is unlikely that pure science and logic will ever dominate human and social life. While regretting "
this, we must be content to fight prejudice and
super
stition where it is obviously antisocial, and tacitly " metaphysical aspect of the human accept the it brings advantages. I hope where personality Dr. Dillon will forgive my spirit of compromise. S. LOWY. Harley Street, W.1. "
ATOMIC DEFENCE
SiB,—Your admirable summing up, on July 24, of the implications of accepting the inevitability of atomic warfare constitutes a challenge to medical men which is both urgent and grave. It is clear that unless there is firm determination to grasp the opportunities which still exist to ensure the p.eace, we must abandon all our cherished hopes and plans for improving the health and wellbeing of the nation ; for once weallow ourselves to accept the idea of war, all our energies must be bent to making what provision we can to limit the effects of the disaster. How little can be achieved by way of medical relief for the victims of atomic warfare, and at what enormous cost in organisation, manpower, and material, is clearly to be seen from the articles you quote. But the choice which confronts us is not one between " making defence henceforward the chief end and aim of our existence " and neglect of the necessary measures of defence. Mercifully, the choice still lies between the path to war and a return to the path of peace. So long as such a choice exists-and time is short-surely the answer of our profession must be to take our stand for peace. JOHN B. ATKINS. Pontyclun, Glam. ’
M.R.C.P. EXAMINATION SiR,—I think the time has
come for the Royal College to devise a method of assessing the.. clinical acumen of candidates for the M.R.C.P. in some better and fairer way than at present. Everybody is aware that the " luck of the case " is practically 70 % of the examination, There is an element of luck in every and surely a time will soon come when examinations will be superseded by some other method of testing. Till then examinations are necessary. In the membership examination the cases shown are varied in type. Some are quite simple, and some are made very simple by the kindliness of the patient ; but others are complicated and bristle with difficulties, especially when the time allotted is hardly- sufficient to take a history, examine all the systems, and do the necessary urine tests. No candidate sitting this examination will ever grudge getting a difficult case, but he will certainly have a grudge when his friend, who is perhaps only half prepared for the examination, gets away with it merely because of the simplicity of his cases or because he has heard about the cases from someone who has been asked to examine them the day before. The cases are often repeated from day to day and from examination to examination, though perhaps there is no remedy to this. But then why attach such importance to this qualification ? I suggest some better method of clinical testing should be devised. If the final pass percentage is 16%, about 60 % of the candidates should be- weeded out by stiff papers which should be corrected before the clinical examination; and the balance of 30 % (which will amount to 180 if 600 enter) should be given a very searching clinical test. Several cases should be shown, and the censors should watch how the candidates tackle the cases. Of course, the same number of examiners and hospitals as at present should be utilised to enable this type of clinical examination to be conducted. The pruning to the required percentage could be done in this and the next two rounds.
of
Physicians
examination ;
,
M.R.C.P.
MOVEMENT OF THE DIAPHRAGM AFTER OPERATION Howkins SiB,—Mr. says in his Hunterian lecture, published in your issue of July ,17, that postoperative diaphragmatic inhibition does not necessarily occur on the same side as the abdominal incision, as found by Rees Jones. An investigation which is now proceeding, tends to show that the postoperative pulmonary changes occur on the same side as the subdiaphragmatic air-bubble. The changes are usually most pronounced where the quantity of intraperitoneal air is large. The right hemidiaphragm being higher than the left is a reason for the air to collect on the right. Added to this, of course, is the fact that the majority of incisions are on the right. In midline gynaecological incisions the intraperitoneal air appears to be held under the omentum and in many cases does not reach the subdiaphragmatic area. It is unfortunate that Mr. Howkins’s X-ray plates have not been reproduced more clearly. ANGUS SMITH Hon. Anæsthetist. Charing Cross Hospital, London. A TAX ON KNOWLEDGE
SiR,-I noted with interest the leading article in your issue of July 10. I have been carrying on a correspondence with the Departmental Claims Branch on this subject since April, though I am still not clear on some points. I find that the British Medical Association library is unable to supply quite a proportion of the original literature that I require, and I wished to apply for fellowship of the Royal Society of Medicine. I did not consider, however, that I could really afford yet another subscription, and I therefore inquired as to the possibility of claiming for this and various other subscriptionse.g., to The Lancet, British 3-,medical Journal, and Lewis’s Library. Mr. Justice Rowlatt’s judgment makes it clear that these are not admissible under the present wording of Schedule E. From the wording of Schedule D, however, I take it that they are admissible for civilian
236 This is surely .an unjustmable practitio,aeZa. and one .effort should be hrade
anomaly
to ajter.which every Although it is not esseoiiajl to subsefibe to various journa,I;in order to obtain or retain one’s CQl)1.missJon, it is essential to subscribe im order to, keep- D&aiaonaibly up to date,, which any self-respecting! doetor-must Lo. Moreover, in man.y .appointments in the Services, as in my present one, there is, compa.raUve professional isola-
tion, thestimulating effect of discussion with colleagues is sadly missed, and it ’.:is more. than ever necessary -to-
attempt to-redress the balance with 1 hope
additional reading. thaA you will not allow this matter to, rest. SURGEON LIEUTENANT. CARS FOR DOCTORS
SiR,—The present unsatisfactory--. situation in respect of doctors’ -cars can well be illustrated by my own case. To save,myself nvehours’ daily in -buses, I -bought a pre.war car early this summer at an inflated price, having had it expertly exa-rnined Srst. However; itis, an old car and the parts are;inevitably. worn; so far I have had to, replace the crown wheel and pinion, the front springs, and the battery, well as-many smaller repairs over three months. It is than I can afford, but there is no alternative. I live in a.wealthy area where.new cars are commoner on the,roads than old ones, and I often wonder how the priority system makes this possible. The other day I went to view another second-hand car which the owner was selling, having just acquired a new Austin A 40 Devon -Saloon-the very car I have on ordå with a B.M.A. priority. The man explained that he had no priority, being an or’dinary businessman, but.-that he had waited " a long time-over 18 months." INDIGNANT. as
more
EMETINE FOR VARIOUS INFECTIONS SIR,—Emetine has long been known as an effective agent for ameebic abscess of the liver.It has also been used for pulmonary abscesses ; and where improvement has been achieved, this has been accepted as proof of an amaebic origin.. But I found that emetine can also be very effective against non-amoebic liver abscesses, and this led me to try it against many other septic infections. My results, of which only a small part has hitherto been
published,l
satisfactory and often
have been very
rather
surprising. In each ’of 9 cases of virulent furuncle of the lip, most of them very severe, which were treated with emetine, prompt recovery ensued. In- 4 cases of traumatic purulent meningitis the cerebrospinal fluid. became sterile after a few days’ treatment; 3 cases were definitely cured, while 1 died six weeks afterwards in consequence of a brain abscess.All of 20 cases of severe biliary infection responded to emetine ; - in some no other treatment was used, while in others surgical treatment had been undertaken and had proved insufficient. In many cases of severe purulent peritonitis (mostly of appendicular or traumatic origin) and of gaseous gangrene, and in some cases of brain abscess, very good results were obtained. Emetine is sometimes highly effective against infections due to penicillin-resistant organisms-notably, Bact. coli and Pseudomonas pyocyanea-particularly where. penicillin cannot be applied -directly or when its action is by thick abscess membrane or much necrotic impeded tissue.2 With infected- mice Bernoulli experimentally confirmed my clinical results. Of10 animals infected with Staphylococcus aureus and treated with emetine, 6 were still alive ten days afterwards, whereas of the untreated animals none survived more than five days. In vitro the bactericidal action of emetine- was observed to be. slight, but the bacteriostatic action was longcontinued. Fischer and Almasy4 have- lately studied the effect of emetine on the metabolism of Oidium albican-s. Further experimental and clinical investiE. MELCHIOR. gations are desirable. Surgical Clinic of the Nümune Hastanesi, Ankara. ,
has
1. Melchior, E. Schweiz. med. Wschr. 1943, 73, 385; Ibid, 1946, 76, 1054; Pr. med. 1946, 53, 729; Ars Med. 1947, 37, 299; Ann. Univ. Ankara, 1947, p. 229. 2. Florey, H. W. Experientia, 1946, 2,160. 3. Bernoulli, P. Schweiz. Z. Path. Bakt. 1944, 7, 525 ; Ibid, 1945, 8, 96. 4. Fischer, H., Almasy, F. Helv. physiol. pharm. Acta, 1946, 4, 423.
NEGOTIATING BODY FOR
PUBLIC-HEALTH
MEDICAL OFFICERS refer to the’- advertisement in your issue SIR,—I of in connexion with the appointment of medical July’ 24’
officer of health for the county borough of Reading. It states that the appointment is subject to the conditions of service promulgated by the National Joint Council for Local Authorities’ Administrative, Professional, This gives the Technical, and .Clerical Services. impression that the National Joint Council, which is the negotiating riiachiriery, for certain categories of localgovernment officer, includes local-authority medical officers ’within its purview. This is not so, and I should be,glad if you would -permit me, through your columns, to correct any such impression which may have formed in the minds of your readers. The British Medical Association is recognised by the Ministry of Health and the Associations -of Local Authorities as the negotiatirig body for public-health medical officers, and until the new salary scales and conditions of service are negotiated, the Askwith Memorandum, as revised, is the only agreement which applies to medical officers. Furthermore, the Association is not represented on the National Joint Council and was not consulted in the formulation of the latter’s scheme. CHARLES HILL British Medical Association, Tavistock Square, London, W.C.1. Secretary.
** * We published the advertisement, without omisso that possible applicants should be aware of Dr. Hill is, the attitude of the Reading corporation. of course, entirely right in holding that conditions of service for doctors in public health, as in other branches of - the National Health Service, should be negotiated with representative medical organisations. So far as the medical profession is concerned, conditions of service promulgated by the National Joint Council haveno validity.—ED. L. sions,
-
AN OBSTETRIC EMERGENCY SERVICE
SIR,—It is with particular interest and pleasure that I have read your article (July 24) on the Ayrshire Emergency Domiciliary Service. Mention is made in it of the attempt to replace the amount of blood or plasma transfused by encouraging the relatives of recipients to donate blood. This scheme has been developed by Dr. de Soldenhoff, not only in the emergency service, but in .his hospital work at the Ayrshire Central Hospital, Irvine. During the past nine months Ayrshire Central Hospital has used blood and plasma equivalent to 325 blood donations ; in the same period 182 donations have been made under the replacement scheme, representing 56 % replacement. This work has- been carried out by the medical and nursing staff of a busy obstetric hospital, and reflects great credit on all concerned. It shows how much and the can be achieved in replacing blood used; scheme might well be developed in all large hospitals. Such contributions are of great value to the regional transfusion service, not only by keeping the blood banks adequately stocked, but also by showing how much the hospital appreciates any help which is given by the transfusion service. DOROTHY NELSON Organising Secretary, Glasgow and West of Scotland 15, North Portland Street, Blood Transfusion Service. Glasgow, C.I. DAME AGNES HUNT
IN supplement to our annotation last week J. M. M. writes : " Dame Agnes Hunt wrote a delightful little book called This is My Life in which,she records her own victory over pain and recurring disability, and the steps that led up,to the founding of Baschurch Home in 1900. This brave story, which appeared in 1938, ought to be republished,No splendid vision this open-air hospital,’ she says with simple truth ; and these words serve to remind us of her two greatest qualities. The first was genius for improvisation. Agnes Hunt did not bother much about the distant scene, but she The knew with unerring intuition the next step.
prompted
records provide essential material for medical education and the efficient working of the National Health Service. OBSERVER. CHARMS
SiB,—One
but
can
Dillon that psychology our
ideal, and
we
wholeheartedly on a
agree with
Dr.
scientific basis ought to be
must all share
fully his
aversion to
procedures resembling-or imitating-the methods of superstition. But we must admit the metaphysical aspect of the human personality : that is, the deep"
"
rooted desire for the belief in the supernatural and unexplainable, for the ceremonial and magical. Whether we like this aspect of personality, or deplore it as atavism and superstition, we cannot afford to ignore it. In some people an approach on these lines-whether in the or cause of morality health-promises better and speedier results than the employment of logical and scientific concepts. In most people, indeed, this " metaand may be stronger than physical " aspect is strong, the capacity for the " intelligible " ; and in these the psychosomatic function responds better to magical than to scientific approaches. This has been abundantly illustrated by the appeal-and even therapeutic efficiency -of sacred wells, spiritual healings, and the less dignified activities of various quacks and therapeutic eccentrics. If we wish to be sincere we cannot ignore the large number of cures, where scientific medicine had previously failed, by these healers and methods. As a psychiatrist with twenty years’ experience I find more people fit for magical methods than for modern psychotherapy. We may regret that this is so, especially since we average psychiatrists cannot perform such miracles ; our training has made us unfit to use them, and our reputation as scientific psychiatrists inhibits the patient’s belief in our magical powers. But I doubt whether any real harm is done by practitioners who feel able to apply them in selected cases. People helped by such primitive means may be more superstitious than intellectual, but they are not necessarily less happy or less reliable and humane. It is unlikely that pure science and logic will ever dominate human and social life. While regretting "
this, we must be content to fight prejudice and
super
stition where it is obviously antisocial, and tacitly " metaphysical aspect of the human accept the it brings advantages. I hope where personality Dr. Dillon will forgive my spirit of compromise. S. LOWY. Harley Street, W.1. "
ATOMIC DEFENCE
SiB,—Your admirable summing up, on July 24, of the implications of accepting the inevitability of atomic warfare constitutes a challenge to medical men which is both urgent and grave. It is clear that unless there is firm determination to grasp the opportunities which still exist to ensure the p.eace, we must abandon all our cherished hopes and plans for improving the health and wellbeing of the nation ; for once weallow ourselves to accept the idea of war, all our energies must be bent to making what provision we can to limit the effects of the disaster. How little can be achieved by way of medical relief for the victims of atomic warfare, and at what enormous cost in organisation, manpower, and material, is clearly to be seen from the articles you quote. But the choice which confronts us is not one between " making defence henceforward the chief end and aim of our existence " and neglect of the necessary measures of defence. Mercifully, the choice still lies between the path to war and a return to the path of peace. So long as such a choice exists-and time is short-surely the answer of our profession must be to take our stand for peace. JOHN B. ATKINS. Pontyclun, Glam. ’
M.R.C.P. EXAMINATION SiR,—I think the time has
come for the Royal College to devise a method of assessing the.. clinical acumen of candidates for the M.R.C.P. in some better and fairer way than at present. Everybody is aware that the " luck of the case " is practically 70 % of the examination, There is an element of luck in every and surely a time will soon come when examinations will be superseded by some other method of testing. Till then examinations are necessary. In the membership examination the cases shown are varied in type. Some are quite simple, and some are made very simple by the kindliness of the patient ; but others are complicated and bristle with difficulties, especially when the time allotted is hardly- sufficient to take a history, examine all the systems, and do the necessary urine tests. No candidate sitting this examination will ever grudge getting a difficult case, but he will certainly have a grudge when his friend, who is perhaps only half prepared for the examination, gets away with it merely because of the simplicity of his cases or because he has heard about the cases from someone who has been asked to examine them the day before. The cases are often repeated from day to day and from examination to examination, though perhaps there is no remedy to this. But then why attach such importance to this qualification ? I suggest some better method of clinical testing should be devised. If the final pass percentage is 16%, about 60 % of the candidates should be- weeded out by stiff papers which should be corrected before the clinical examination; and the balance of 30 % (which will amount to 180 if 600 enter) should be given a very searching clinical test. Several cases should be shown, and the censors should watch how the candidates tackle the cases. Of course, the same number of examiners and hospitals as at present should be utilised to enable this type of clinical examination to be conducted. The pruning to the required percentage could be done in this and the next two rounds.
of
Physicians
examination ;
,
M.R.C.P.
MOVEMENT OF THE DIAPHRAGM AFTER OPERATION Howkins SiB,—Mr. says in his Hunterian lecture, published in your issue of July ,17, that postoperative diaphragmatic inhibition does not necessarily occur on the same side as the abdominal incision, as found by Rees Jones. An investigation which is now proceeding, tends to show that the postoperative pulmonary changes occur on the same side as the subdiaphragmatic air-bubble. The changes are usually most pronounced where the quantity of intraperitoneal air is large. The right hemidiaphragm being higher than the left is a reason for the air to collect on the right. Added to this, of course, is the fact that the majority of incisions are on the right. In midline gynaecological incisions the intraperitoneal air appears to be held under the omentum and in many cases does not reach the subdiaphragmatic area. It is unfortunate that Mr. Howkins’s X-ray plates have not been reproduced more clearly. ANGUS SMITH Hon. Anæsthetist. Charing Cross Hospital, London. A TAX ON KNOWLEDGE
SiR,-I noted with interest the leading article in your issue of July 10. I have been carrying on a correspondence with the Departmental Claims Branch on this subject since April, though I am still not clear on some points. I find that the British Medical Association library is unable to supply quite a proportion of the original literature that I require, and I wished to apply for fellowship of the Royal Society of Medicine. I did not consider, however, that I could really afford yet another subscription, and I therefore inquired as to the possibility of claiming for this and various other subscriptionse.g., to The Lancet, British 3-,medical Journal, and Lewis’s Library. Mr. Justice Rowlatt’s judgment makes it clear that these are not admissible under the present wording of Schedule E. From the wording of Schedule D, however, I take it that they are admissible for civilian
236 This is surely .an unjustmable practitio,aeZa. and one .effort should be hrade
anomaly
to ajter.which every Although it is not esseoiiajl to subsefibe to various journa,I;in order to obtain or retain one’s CQl)1.missJon, it is essential to subscribe im order to, keep- D&aiaonaibly up to date,, which any self-respecting! doetor-must Lo. Moreover, in man.y .appointments in the Services, as in my present one, there is, compa.raUve professional isola-
tion, thestimulating effect of discussion with colleagues is sadly missed, and it ’.:is more. than ever necessary -to-
attempt to-redress the balance with 1 hope
additional reading. thaA you will not allow this matter to, rest. SURGEON LIEUTENANT. CARS FOR DOCTORS
SiR,—The present unsatisfactory--. situation in respect of doctors’ -cars can well be illustrated by my own case. To save,myself nvehours’ daily in -buses, I -bought a pre.war car early this summer at an inflated price, having had it expertly exa-rnined Srst. However; itis, an old car and the parts are;inevitably. worn; so far I have had to, replace the crown wheel and pinion, the front springs, and the battery, well as-many smaller repairs over three months. It is than I can afford, but there is no alternative. I live in a.wealthy area where.new cars are commoner on the,roads than old ones, and I often wonder how the priority system makes this possible. The other day I went to view another second-hand car which the owner was selling, having just acquired a new Austin A 40 Devon -Saloon-the very car I have on ordå with a B.M.A. priority. The man explained that he had no priority, being an or’dinary businessman, but.-that he had waited " a long time-over 18 months." INDIGNANT. as
more
EMETINE FOR VARIOUS INFECTIONS SIR,—Emetine has long been known as an effective agent for ameebic abscess of the liver.It has also been used for pulmonary abscesses ; and where improvement has been achieved, this has been accepted as proof of an amaebic origin.. But I found that emetine can also be very effective against non-amoebic liver abscesses, and this led me to try it against many other septic infections. My results, of which only a small part has hitherto been
published,l
satisfactory and often
have been very
rather
surprising. In each ’of 9 cases of virulent furuncle of the lip, most of them very severe, which were treated with emetine, prompt recovery ensued. In- 4 cases of traumatic purulent meningitis the cerebrospinal fluid. became sterile after a few days’ treatment; 3 cases were definitely cured, while 1 died six weeks afterwards in consequence of a brain abscess.All of 20 cases of severe biliary infection responded to emetine ; - in some no other treatment was used, while in others surgical treatment had been undertaken and had proved insufficient. In many cases of severe purulent peritonitis (mostly of appendicular or traumatic origin) and of gaseous gangrene, and in some cases of brain abscess, very good results were obtained. Emetine is sometimes highly effective against infections due to penicillin-resistant organisms-notably, Bact. coli and Pseudomonas pyocyanea-particularly where. penicillin cannot be applied -directly or when its action is by thick abscess membrane or much necrotic impeded tissue.2 With infected- mice Bernoulli experimentally confirmed my clinical results. Of10 animals infected with Staphylococcus aureus and treated with emetine, 6 were still alive ten days afterwards, whereas of the untreated animals none survived more than five days. In vitro the bactericidal action of emetine- was observed to be. slight, but the bacteriostatic action was longcontinued. Fischer and Almasy4 have- lately studied the effect of emetine on the metabolism of Oidium albican-s. Further experimental and clinical investiE. MELCHIOR. gations are desirable. Surgical Clinic of the Nümune Hastanesi, Ankara. ,
has
1. Melchior, E. Schweiz. med. Wschr. 1943, 73, 385; Ibid, 1946, 76, 1054; Pr. med. 1946, 53, 729; Ars Med. 1947, 37, 299; Ann. Univ. Ankara, 1947, p. 229. 2. Florey, H. W. Experientia, 1946, 2,160. 3. Bernoulli, P. Schweiz. Z. Path. Bakt. 1944, 7, 525 ; Ibid, 1945, 8, 96. 4. Fischer, H., Almasy, F. Helv. physiol. pharm. Acta, 1946, 4, 423.
NEGOTIATING BODY FOR
PUBLIC-HEALTH
MEDICAL OFFICERS refer to the’- advertisement in your issue SIR,—I of in connexion with the appointment of medical July’ 24’
officer of health for the county borough of Reading. It states that the appointment is subject to the conditions of service promulgated by the National Joint Council for Local Authorities’ Administrative, Professional, This gives the Technical, and .Clerical Services. impression that the National Joint Council, which is the negotiating riiachiriery, for certain categories of localgovernment officer, includes local-authority medical officers ’within its purview. This is not so, and I should be,glad if you would -permit me, through your columns, to correct any such impression which may have formed in the minds of your readers. The British Medical Association is recognised by the Ministry of Health and the Associations -of Local Authorities as the negotiatirig body for public-health medical officers, and until the new salary scales and conditions of service are negotiated, the Askwith Memorandum, as revised, is the only agreement which applies to medical officers. Furthermore, the Association is not represented on the National Joint Council and was not consulted in the formulation of the latter’s scheme. CHARLES HILL British Medical Association, Tavistock Square, London, W.C.1. Secretary.
** * We published the advertisement, without omisso that possible applicants should be aware of Dr. Hill is, the attitude of the Reading corporation. of course, entirely right in holding that conditions of service for doctors in public health, as in other branches of - the National Health Service, should be negotiated with representative medical organisations. So far as the medical profession is concerned, conditions of service promulgated by the National Joint Council haveno validity.—ED. L. sions,
-
AN OBSTETRIC EMERGENCY SERVICE
SIR,—It is with particular interest and pleasure that I have read your article (July 24) on the Ayrshire Emergency Domiciliary Service. Mention is made in it of the attempt to replace the amount of blood or plasma transfused by encouraging the relatives of recipients to donate blood. This scheme has been developed by Dr. de Soldenhoff, not only in the emergency service, but in .his hospital work at the Ayrshire Central Hospital, Irvine. During the past nine months Ayrshire Central Hospital has used blood and plasma equivalent to 325 blood donations ; in the same period 182 donations have been made under the replacement scheme, representing 56 % replacement. This work has- been carried out by the medical and nursing staff of a busy obstetric hospital, and reflects great credit on all concerned. It shows how much and the can be achieved in replacing blood used; scheme might well be developed in all large hospitals. Such contributions are of great value to the regional transfusion service, not only by keeping the blood banks adequately stocked, but also by showing how much the hospital appreciates any help which is given by the transfusion service. DOROTHY NELSON Organising Secretary, Glasgow and West of Scotland 15, North Portland Street, Blood Transfusion Service. Glasgow, C.I. DAME AGNES HUNT
IN supplement to our annotation last week J. M. M. writes : " Dame Agnes Hunt wrote a delightful little book called This is My Life in which,she records her own victory over pain and recurring disability, and the steps that led up,to the founding of Baschurch Home in 1900. This brave story, which appeared in 1938, ought to be republished,No splendid vision this open-air hospital,’ she says with simple truth ; and these words serve to remind us of her two greatest qualities. The first was genius for improvisation. Agnes Hunt did not bother much about the distant scene, but she The knew with unerring intuition the next step.
prompted