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DEATH FOLLOWING BLOOD TRANSFUSION
108 to be cerebral anaemia and occasionally passes on to loss of consciousness ; the giddiness in epidemic -vertigo suggests its origin in the semicircular canals, the slightest movement of the bed or the turning of the
head
small angle causing giddiness lasting a variable time. The time of the year when epidemic vertigo was common did not coincide with that during which influenza was prevalent. One would expect some cases of typical epidemic vertigo to occur in patients already infected with the virus of influenza, because we know that the virus lowers the resistance to many micro-organisms. It is probable too that the virus of the common cold renders the individual especially susceptible to whatever causes epidemic vertigo. I am, Sir, yours faithfully, 0. LEYTON. O. Portland-place, W., Jan. 8th, 1934.
through
a
DEATH FOLLOWING BLOOD TRANSFUSION
To the Editor
of
THE LANCET
SiR,-In the annotation under this heading in your issue of Jan. 6th the necessity for " matching " is stressed as even more important than grouping. In this connexion I should like to quote briefly a case of some interest. A patient was recently admitted to New Lodge Clinic in whom both the history and signs suggested the presence of a carcinoma of the bronchus. The outstanding feature of the case, however, was the extreme degree of anaemia that was present. The red cells numbered 1,500,000 per The c.mm. and the haamoglobin percentage was 18. patient was desperately ill, and it was decided to make an immediate attempt to overcome the ansemia by a series of transfusions before attempting any other investigations or treatment. A donor of the same group (Group IV) was obtained. It is always my practice to " match " before every transfusion, but in addition I also use a " time control " by
mixing the recipient’s serum with cells which are known to be incompatible. In this case I used as a control my On watching the recipient’s serum own cells (Group II). and the donor’s cells for ten minutes there was no sign of Had it not been for the time control, I should have proceeded forthwith to the transfusion. After the same interval there was no sign of clumping in the time control. I therefore waited. Signs of incompatibility only began to appear after 25 minutes in the time control, and by this time the same signs were present with the donor’s cells. Complete clumping was seen in both after 35 minutes. I happened to have available a second Group IV volunteer and I repeated the experiment with his cells. I obtained an exactly similar result. Five other Group IV donors were tested and in every case signs of incompatibility were detected. The interval before the onset of clumping varied, being 15, 30, 32, 34, and 35 minutes in the respective donors. Both the son and daughter of the patient belonged to the same group and in their case the blood was completely compatible, no clumping occurring after an interval of 40 minutes. Two transfusions were given, using the son and daughter No further as donors, without any untoward result. search for suitable donors was made, as by this time the diagnosis was established and the condition was obviously
incompatibility.
hopeless. There is no doubt that without the time control the first donor would have been regarded as suitable and the patient would have received a transfusion of incompatible blood in spite of matching. The use of the time control entails very little additional labour, and in this instance at any rate it averted the possibility of a disaster. Obviously cases of this must be excessively rarehave come across similar case in a series of over 100 transfusions. Nevertheless the chance of a disaster must exist without the employment of the control. I am, Sir, yours faithfully, JOHN VENABLES. New Lodge Clinic, Jan. 6th, 1934.
type no
MEDICAL NEWS University of London Graham Scholarship in Pathology.-The senate are about to make an election to this scholarship, which was founded to enable a young man to continue his pathological researches while acting as a teacher under the professor of pathology at University College Hospital. The scholarship
is tenable in the first instance for two years and is of an annual value of z300 ; it is not restricted to students of medical schools of the university. Applications must be made before Jan. 31st, and further particulars may be had either from the academic registrar, University of London, South Kensington, S.W.7, or from Prof. A. E. Boycott at University College Hospital medical school. At recent examinations the following were successful M.D.
.
Branch I. (Medicine).-F. E. Camps, Guy’s Hosp. ; E. H. Capelf, Middlesex Hosp. ; W. 1. Card, St. Thomas’s Hosp. ; V. P. de Zoysa, Univ. Coll. Hosp. ; E. H. Evans, Univ. Coll., Cardiff, and Univ. Coll. Hosp. ; Mary Fraser, Roy. Free Hosp. ; Bernard Halfpenny, Middlesex Hosp. ; C. H. S. Harris,* St. Bart.’s Hosp. ; Alison F. Z. Judd, Roy. Free Hosp. ; Nellie I. Lanckenau, Univ. Coll. Hosp. ; K. S. May, Charing Cross Hosp. ; R. G. Michelmore, London Hosp. ; N. S. Plummer, Guy’s Hosp. ; W. M. Priest, Univ. Coll. Hosp. ; M. D. Rawkins, St. Bart.’s Hosp. ; C. H. Rogerson, Guy’s Hosp. ; Ralph Stanford, London Hosp. ; W. R. Thrower, St. Bart.’s Hosp. ; W. J. Tindall, Univ. Coll. Hosp. ; and E. R. Williams, St. Mary’s
Hosp.
Branch IV. (bZidavifery and Diseases of Women).-J. D. S. Flew, Univ. Coll. Hosp. ; Evelyn E. Gourlay,Roy. Free Hosp. ; J. F. Hackwood, St. Thomas’s Hosp. ; J. C. Hatrick, Univ. Coll. Hosp. ; Elsie E. A. Ridley, Roy. Free Hop. ; and Patricia H. S. Shaw, Roy. Free Hosp. and St. Mary’s Hosp. Branch V. (Hygiene.-Cyril Banks, Univ. of Sheffield ; Ernest Grundy, Leeds Med. Sch. ; Dorothy M. Llewellin, Westminster Hosp. ; Laura H. Macfarlane, Roy. Free Hosp. ; Dorothy Makepeace, King’s Coll. Hosp.; C. M. Ockwell, Guy’s Hosp. ; R. H. Parry, Middlesex Hosp. ; and T. A. Seekings, Univ. Coll.
Hosp.
Branch F7. (Tropical Medicine).-D. J. T. Leanage, Univ. Coll. Hosp. and London School of Hygiene and Tropical Medicine. t Awarded a Mark of Distinction. * University Medal.
Royal College of Surgeons of England Forthcoming lectures.-The following lectures will be given on Mondays, Wednesdays, and Fridays during January and February : Jan. 15th and 17th, Prof. W. E. Le Gros Clark, on the evolutionary, origin of the primates ; Jan. 19th, Mr. L. R. Broster on the adrenogenital syndrome; Jan. 22nd, Mr. H. C. Edwards on diverticula of the duodenum and jejunum, and Jan. 24th, diverticula of the colon and vermiform appendix; 26th, Mr. Alan Brews on a clinical research on the radium treatment of carcinoma of the cervix uteri; Jan. 29th, Mr. Arnold Sorsby on retinal abiotrophy ; Jan. 31st, Mr. K. H. Watkins on the bladder function in low spinal injury ; Feb. 2nd, Mr. E. G. Muir on carcinoma of the prostate ; Feb. 5th, Mr. A. A. Davis on the presacral nerve-its anatomy, physiology, pathology, and surgery; Feb. 7th, Mr. J. M. Yoffey on the study of lymphoid tissue ; Feb. 9th, Mr. C. P. G. Wakeley on the surgery of the pineal gland ; Feb. 19th, Mr. Denis Browne on talipes equinovarus ; Feb. 21st, Mr. C. Bowdler Henry on aberrant third molars and their menace ; and on Feb. 23rd, Sir Thomas Dunhill on diaphragmatic hernia (non-traumatic). All the lectures will be given at the College at 5 r.mt. On Tuesday, Feb. 13th, at 4 P.M., Sir Cuthbert Wallace will deliver the Hunterian oration.
on
Jan.
Leverhulme Research Fellowships Elections to these fellowships will be made in 1934. They are intended for the assistance of experienced workers who are prevented by pressure of routine duties from undertaking investigations in any subject. Fellows will usually be required to work in connexion with some recognised centre of research. Applications should reach Dr. L. Haden Guest, the secretary, at Union House, St. Martin’s -le -Grand London, E.C. 1, not later than March 1st.
head
small angle causing giddiness lasting a variable time. The time of the year when epidemic vertigo was common did not coincide with that during which influenza was prevalent. One would expect some cases of typical epidemic vertigo to occur in patients already infected with the virus of influenza, because we know that the virus lowers the resistance to many micro-organisms. It is probable too that the virus of the common cold renders the individual especially susceptible to whatever causes epidemic vertigo. I am, Sir, yours faithfully, 0. LEYTON. O. Portland-place, W., Jan. 8th, 1934.
through
a
DEATH FOLLOWING BLOOD TRANSFUSION
To the Editor
of
THE LANCET
SiR,-In the annotation under this heading in your issue of Jan. 6th the necessity for " matching " is stressed as even more important than grouping. In this connexion I should like to quote briefly a case of some interest. A patient was recently admitted to New Lodge Clinic in whom both the history and signs suggested the presence of a carcinoma of the bronchus. The outstanding feature of the case, however, was the extreme degree of anaemia that was present. The red cells numbered 1,500,000 per The c.mm. and the haamoglobin percentage was 18. patient was desperately ill, and it was decided to make an immediate attempt to overcome the ansemia by a series of transfusions before attempting any other investigations or treatment. A donor of the same group (Group IV) was obtained. It is always my practice to " match " before every transfusion, but in addition I also use a " time control " by
mixing the recipient’s serum with cells which are known to be incompatible. In this case I used as a control my On watching the recipient’s serum own cells (Group II). and the donor’s cells for ten minutes there was no sign of Had it not been for the time control, I should have proceeded forthwith to the transfusion. After the same interval there was no sign of clumping in the time control. I therefore waited. Signs of incompatibility only began to appear after 25 minutes in the time control, and by this time the same signs were present with the donor’s cells. Complete clumping was seen in both after 35 minutes. I happened to have available a second Group IV volunteer and I repeated the experiment with his cells. I obtained an exactly similar result. Five other Group IV donors were tested and in every case signs of incompatibility were detected. The interval before the onset of clumping varied, being 15, 30, 32, 34, and 35 minutes in the respective donors. Both the son and daughter of the patient belonged to the same group and in their case the blood was completely compatible, no clumping occurring after an interval of 40 minutes. Two transfusions were given, using the son and daughter No further as donors, without any untoward result. search for suitable donors was made, as by this time the diagnosis was established and the condition was obviously
incompatibility.
hopeless. There is no doubt that without the time control the first donor would have been regarded as suitable and the patient would have received a transfusion of incompatible blood in spite of matching. The use of the time control entails very little additional labour, and in this instance at any rate it averted the possibility of a disaster. Obviously cases of this must be excessively rarehave come across similar case in a series of over 100 transfusions. Nevertheless the chance of a disaster must exist without the employment of the control. I am, Sir, yours faithfully, JOHN VENABLES. New Lodge Clinic, Jan. 6th, 1934.
type no
MEDICAL NEWS University of London Graham Scholarship in Pathology.-The senate are about to make an election to this scholarship, which was founded to enable a young man to continue his pathological researches while acting as a teacher under the professor of pathology at University College Hospital. The scholarship
is tenable in the first instance for two years and is of an annual value of z300 ; it is not restricted to students of medical schools of the university. Applications must be made before Jan. 31st, and further particulars may be had either from the academic registrar, University of London, South Kensington, S.W.7, or from Prof. A. E. Boycott at University College Hospital medical school. At recent examinations the following were successful M.D.
.
Branch I. (Medicine).-F. E. Camps, Guy’s Hosp. ; E. H. Capelf, Middlesex Hosp. ; W. 1. Card, St. Thomas’s Hosp. ; V. P. de Zoysa, Univ. Coll. Hosp. ; E. H. Evans, Univ. Coll., Cardiff, and Univ. Coll. Hosp. ; Mary Fraser, Roy. Free Hosp. ; Bernard Halfpenny, Middlesex Hosp. ; C. H. S. Harris,* St. Bart.’s Hosp. ; Alison F. Z. Judd, Roy. Free Hosp. ; Nellie I. Lanckenau, Univ. Coll. Hosp. ; K. S. May, Charing Cross Hosp. ; R. G. Michelmore, London Hosp. ; N. S. Plummer, Guy’s Hosp. ; W. M. Priest, Univ. Coll. Hosp. ; M. D. Rawkins, St. Bart.’s Hosp. ; C. H. Rogerson, Guy’s Hosp. ; Ralph Stanford, London Hosp. ; W. R. Thrower, St. Bart.’s Hosp. ; W. J. Tindall, Univ. Coll. Hosp. ; and E. R. Williams, St. Mary’s
Hosp.
Branch IV. (bZidavifery and Diseases of Women).-J. D. S. Flew, Univ. Coll. Hosp. ; Evelyn E. Gourlay,Roy. Free Hosp. ; J. F. Hackwood, St. Thomas’s Hosp. ; J. C. Hatrick, Univ. Coll. Hosp. ; Elsie E. A. Ridley, Roy. Free Hop. ; and Patricia H. S. Shaw, Roy. Free Hosp. and St. Mary’s Hosp. Branch V. (Hygiene.-Cyril Banks, Univ. of Sheffield ; Ernest Grundy, Leeds Med. Sch. ; Dorothy M. Llewellin, Westminster Hosp. ; Laura H. Macfarlane, Roy. Free Hosp. ; Dorothy Makepeace, King’s Coll. Hosp.; C. M. Ockwell, Guy’s Hosp. ; R. H. Parry, Middlesex Hosp. ; and T. A. Seekings, Univ. Coll.
Hosp.
Branch F7. (Tropical Medicine).-D. J. T. Leanage, Univ. Coll. Hosp. and London School of Hygiene and Tropical Medicine. t Awarded a Mark of Distinction. * University Medal.
Royal College of Surgeons of England Forthcoming lectures.-The following lectures will be given on Mondays, Wednesdays, and Fridays during January and February : Jan. 15th and 17th, Prof. W. E. Le Gros Clark, on the evolutionary, origin of the primates ; Jan. 19th, Mr. L. R. Broster on the adrenogenital syndrome; Jan. 22nd, Mr. H. C. Edwards on diverticula of the duodenum and jejunum, and Jan. 24th, diverticula of the colon and vermiform appendix; 26th, Mr. Alan Brews on a clinical research on the radium treatment of carcinoma of the cervix uteri; Jan. 29th, Mr. Arnold Sorsby on retinal abiotrophy ; Jan. 31st, Mr. K. H. Watkins on the bladder function in low spinal injury ; Feb. 2nd, Mr. E. G. Muir on carcinoma of the prostate ; Feb. 5th, Mr. A. A. Davis on the presacral nerve-its anatomy, physiology, pathology, and surgery; Feb. 7th, Mr. J. M. Yoffey on the study of lymphoid tissue ; Feb. 9th, Mr. C. P. G. Wakeley on the surgery of the pineal gland ; Feb. 19th, Mr. Denis Browne on talipes equinovarus ; Feb. 21st, Mr. C. Bowdler Henry on aberrant third molars and their menace ; and on Feb. 23rd, Sir Thomas Dunhill on diaphragmatic hernia (non-traumatic). All the lectures will be given at the College at 5 r.mt. On Tuesday, Feb. 13th, at 4 P.M., Sir Cuthbert Wallace will deliver the Hunterian oration.
on
Jan.
Leverhulme Research Fellowships Elections to these fellowships will be made in 1934. They are intended for the assistance of experienced workers who are prevented by pressure of routine duties from undertaking investigations in any subject. Fellows will usually be required to work in connexion with some recognised centre of research. Applications should reach Dr. L. Haden Guest, the secretary, at Union House, St. Martin’s -le -Grand London, E.C. 1, not later than March 1st.