768 STORED BLOOD

late war to establish the technique of oxygenadministration for flying at high altitudes, andhe also showed the value of oxygen for long flightsat lower heights (10,000-12,000 ft.) as a means oflessening fatigue. Group-Captain G. S. Marshall,who succeeded Flack as physiologist, working withthe Air Ministry’s scientific research staff at Farn-borough, has developed the present method of

supplying oxygen at high altitudes, using pressuresuits at heights above 35,000 ft. ; it was in one ofthese suits that the late Flight-Lieutenant M. J.Adams attained a height of 54,000 ft.-a recordonly recently broken by the Italian, Colonel Pezzi,when he reached 56,000 ft. last October. Nervousfactors concerned with flying and the mentalattitude for aviation were studied from 1917 to1920 by Henry Head, W. H. R. Rivers and

Squadron-Leader P. S. R.ippon, and as a resultcertain tests for nervous stability and additionalquestions of family and personal history have beenincorporated in the medical examination of candi-dates for flying. Group-Captain H. L. Burton,the consultant in neurology, has continued thiswork, especially in connexion with prognosiswhere there are significant temperamental defectsand excellencies, and Squadron-Leader G. 0.Williams, working with Prof. Bartlett, has

apparently succeeded in foretelling the flyingaptitude of candidates by means of sensorimotorcoordinating machines and a form-relation test,which may revolutionise medical examinations.The medical entrance examination for the R.A.F.

has been continually under review, and certainmodifications have been made from time to time.

Group-Captain H. A. Treadgold, when consultantin medicine, introduced the orthodiagram and

electrocardiogram into the examination ; he alsoestablished a relationship between body-build andfunctional efficiency and studied the significanceof blood-pressure. This work has been pursuedby his successor, Group-Captain A. F. Rook, who,in conjunction with Flight-Lieutenant Dawson,published an article on hypotension and flying inthis journal last December. Wing-CommanderE. D. D. Dickson, consultant in otolaryngology,has demonstrated the loss of auditory acuityresulting from continued exposure to present-dayaeroplane noise, and with Mr. A. W. G. Ewing,Ph.D., and Mr. T. S. Littler, Ph.D., of Manchester,has been investigating ways of protecting the earsof aircraft crews against excessive stimulation. In

ophthalmology, too, considerable progress has beenmade-first, by Group-Captain E. C. Clements,who instituted a training for heterophoria, to helpprevent bad landings due to this condition, andwho cooperated with the Air Ministry scientificstaff in improving bomb-sight and cockpit lighting ;and since 1934 by Wing-Commander P. C. Livingston,the present consultant in ophthalmology, who hasperfected the heterophoria training and has beenmainly responsible for the development of new

flying goggles and spectacles which counteract theeffects of glare from the sun and from night-landing flares.

ANNOTATIONS

STORED BLOOD

EXPERIENCE of stored blood for transfusion hasbeen limited in this country to small groups of

patients. In our present issue Dr. F. Duran Jorda,who was head of the blood-transfusion service of the

Spanish republican army, describes his conclusionsdrawn from experience with 9000 litres of bloodobtained from 20,000 withdrawals and the classifica-tion of 28,900 donors. His methods of withdrawaland storage appear complicated on paper, but medicalvisitors to his institute in Barcelona and those whohave had the privilege of talking to him in Londonare impressed by the simplicity of the method inaction. It is clearly a great advance on any systemthat has been advocated in this country. The greatadvantage, especially in time of war, is that largequantities of blood (25-30 litres per hour) can bewithdrawn and prepared for use in a short time understerile conditions. The apparatus is so devised thatadministration of the blood is very simple and canbe carried out single-handed by anyone capable ofdoing a venepuncture. The greatest danger withstored blood is haemolysis, which lessens the thera-peutic value of the blood and favours reactions aftertransfusion. The commonest cause of haemolysis is

shaking the blood in transit. Duran Jorda hasreduced movement of the blood to a minimum by hisspecial ampoule. This fact alone should attract closeattention to his technique. In time of war blood

may have to be transported for long distances, andany system that prevents it from being shaken is

clearly important. The blood is stored under two

atmospheres’ pressure of air ; this facilitates adminis-

tration and, Duran Jorda believes, establishes anautomatic bacteriological control. The oxygen presentprevents the growth of anaerobes, while if aerobes arepresent they grow at the expense of the oxygen, thusconverting the bright red oxyhaemoglobin into darkred reduced hsemoglobin. A glance at the flask, heclaims, is sufficient to show whether the blood issterile. He advocates the use only of group IV-0blood for emergency purposes, for it is impossible toobtain accurate grouping under war-time conditions.He mixes the blood from different donors, because inthis way the agglutinin titre is reduced and a morehomogeneous blood obtained. Some patients receivedtransfusions from as many as 96 donors withoutill effects. The work he describes is of biologicalinterest as well as of practical importance in bothpeace and war.

PSYCHIATRIC ASPECTS OF CRIME

THE official inquiry by Norwood East and Hubert 1into the treatment of crime produced much thatis of technical interest to psychiatrists in additionto the administrative proposals which are its chiefpractical outcome and which were commented onin our issue of March 11 (p. 583). During the lastfour years Dr. Hubert has investigated more than400 selected offenders and his conclusions as to theform, psychopathology, and therapeutic possibilitiesof their disorders are a valuable contribution toforensic psychiatry. A preliminary objection likelyto be made is that his material might have been unduly1. The Psychological Treatment of Crime. By W. Norwood

East and W. H. de B. Hubert. 1939. H.M. StationeryOffice.