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A colleague writes:" Chubb’s responsibilities at Westminster, Golden Square,

and Roehampton Hospitals left him little time for writing or forattending meetings of medical societies, and during his middlefifties he withdrew, and rarely attended any gathering of hiscolleagues. This was a great loss for he had an extremely clearmind, a caustic wit, and, probably because of his early trainingin the zoology school, an ability to deflate the ebullient speakerwhose ideas or new methods of treatment had not been suffi-

ciently checked or controlled. Chubb did, however, make onememorable final contribution shortly after 1945, when he read apaper to the Section of Otology of the Royal Society of Medicineon the effects of disease and of injury of the ear as he had seen itduring his work with the Ministry of Pensions. This was suchan example of lucid thinking and exposition that the almostuniversal comment was-why haven’t we had this man oftener."

In 1917 Mr. Chubb married Phyllis Barker, who sur-vives him with two sons and two daughters. After heretired from active practice, he lived for many years inWimbledon, and later moved to Shoreham-by-Sea.

RAYMOND JOHN CLAUSEN,

M.C., M.B. Lond., F.F.A. R.C.S., D.A.

Dr. R. J. Clausen, consulting anaesthetist to CharingCross Hospital, died on July 29 at the age of 76.A son of the famous painter in the Victorian era, he did his

medical training at the Westminster Hospital. After graduatingM.B. in 1913 he held the post of house-physician at theWestminster Hospital. At the outbreak of the 1914-18 warhe joined the R.A.M.C., and he served with distinction

throughout the war, being awarded the Military Cross. Hehad already decided to specialise in anaesthesia and, after

holding the post of resident anaesthetist at St. Bartholomew’sHospital, he obtained consultant appoiritments to St. Paul’s

Hospital, the Chelsea Hospital for Women, and, in 1927,Charing Cross Hospital. At the beginning of the 1939-45 warhe again joined the R.A.M.C. and worked as an anxstheticspecialist in several hospitals. In 1945 he became surgeon-anaesthetist to Charing Cross Hospital, and he retired from thestaff in 1955.

Clausen was a founder member of the Association ofAnaesthetists of Great Britain and Ireland, and a past secretaryand past president of the Anaesthetic Section of the RoyalSociety of Medicine; and his was one of the original list ofnames submitted to the council of the Royal College of

Surgeons for the first election to the fellowship of the Facultyof Anaesthetists in 1948.

H. K. A., to whom we owe this biography, writes:" Joe Clausen was the most charming of colleagues, the

gruff voice and sometimes abrupt manner hiding a heart ofgold and a keen sense of humour. He had an inventive turnof mind, and his ring and harness will ensure that his nameis known to all anaesthetists for many years to come. He wasan excellent clinical teacher and was greatly missed at his

hospitals after his retirement. He and Mrs.- Clausen attendedthe medical staff dinner given to Lord Inman on his retirementfrom the chairmanship of the Board of Governors of CharingCross hospital only four months ago, when he was in goodheart and apparently good health."

SARAH HIGGINSON BOWDITCHM.D. Johns Hopkins, M.P.H. Harvard

Dr. Sarah H. Bowditch, chief of the department ofhealth data of the division of preventive medicine, in theWalter Reed Army Institute of Research, died at BlueHill, Maine, on July 21, at the age of 61.

Dr. Bowditch was born in Milton, Massachusetts, and waseducated at Milton Academy, St. Timothy’s School, SimmonsCollege, Johns Hopkins University, and Johns Hopkins Schoolof Medicine. She received her M.D. in 1935, and an M.P.H.from the Harvard School of Public Health in 1948. During

the 1939-45 war, she served for a year as a medical officer inour British Emergency Medical Service, and from 1942 in theMedical Corps, Army of the United States. For her work d;

an assistant military attache at the American Embassy inLondon, she was awarded the Bronze Star. In 1948 she wa;appointed to the Massachusetts State Department of Pubh;Health, and after a brief period at Johns Hopkins HospitaBaltimore, took up civilian employment with the Departmea,of the Army in Washington. In 1957-59 she served as assistan:chief of the health and welfare division, United States OverseaMission to Haiti. The Haitian Government’s wish to decorat,her was prevented by American regulations. She eventua1l;retired from the United States Army Reserve with the rank oflieut.-colonel.

J. S. F. N. and D. S. R. write:" Sally Bowditch’s friends in this country will be sad to hea;

of her untimely death. In addition to her professional workhere during the 1939-45 war, many will recollect with gratitudeher imaginative insight into our problems, not excluding theminor but very irritating ones. A visit from her would befollowed perhaps by the arrival of a messenger with a batch ofmuch-needed pipettes; on occasion she would appear with heruniform pockets stuffed with all-glass syringes or some othersmall articles of equipment in short supply. During this periodshe developed a lively interest in our medical and social services,of which she in principle approved, and in her all too infrequentvisits to Europe after the war made apoint of keeping herseifup to date with the problems of developing comprehensivemedical services. Some of us were also privileged to get hersuccinct and clear-sighted views on American policies invarious parts of the world, on which she was most informative

" Her devotion to public work was matched by the deepgenerosity of her private life, her loyalty to all that she accepted,and unswerving courage during recent years of illness. Thoughher work demanded a peripatetic career, she always retained alove for her childhood summer home on the coast of Maine.There, together with her brother and sister, she gave the bulkof her family landholding on Isle au Haut to form a put ofAcadia National Park."

Medicine and the Law

Failure of a Heart-lung MachineAN inquest was held in Manchester last month into the

death of a 12-year-old girl who in 1962 underwent open-heartsurgery. Her mother was warned that further heart surgerymight become necessary, and a mitral-valve replacement wascarried out on June 29 at Baguley Hospital, Manchester. Thechild died 13 days later.At the inquest, Dr. G. B. Manning, a Home Office patho-

logist, said that her death was caused by bronchopneumowand coma due to anoxia. Dr. C. B. Franklin, consultan:anaesthetist, describing the failure of a heart-lung machinejust after the start of the operation, said that partial perfusicwas begun at 11.40 A.M. and was increased to total-bodperfusion with heart-lung bypass. At approximately 11.45 A.Mbefore there had been time to stabilise the perfusion, arteriovenous tube tore apart in the roller-pump casing. Themachine was restarted within about a quarter of an hour, andperfusion continued uneventfully until 2.8 P.M. At the eD4of the operation the patient’s circulatory and respiratorysystems were functioning, but she did not recover consciousawareness. Describing the action of the machine, DrFranklin said that if the internal surface of the drum was wetor moisture was introduced, the rotation of the roller arm

tended to make the tube slide backwards and forwards,spraying a small amount of water into the drum while it ’’revolving he had produced an effect similar to that which ’’

thought must have occurred at the operation. Since this ·"

he had been informed of a rather similar incident in a Scot’-’-.hospital during 1965; but he believed that the inquiries thenmade did not suggest any positive cause of the disaster.

349

Mr. D. Summerfield, the city coroner, recording a verdictof accidental death, said that he was surprised that no noticeof the Scottish incident seemed to have been circulated toother hospitals which might be using this machine. He

added: " I should have thought that the first time anythingsees wrong it would have set off a tocsin throughout thehospital system of this country if not the whole world. Anynew peril in this or any other machine should be made knownas widely as possible."

Parliament

Doctors and the Prices and Incomes BillON Aug. 1 Mr. HAROLD WILSON, the Prime Minister, met

representatives of the British Medical Association in his roomat the House of Commons to explain the effects of theincomes standstill on the recent award to the medical pro-fession. The meeting lasted an hour and a quarter, and Mr.KENNETH ROBINSON, the Minister of Health, was present.

Mr. BERNARD BRAINE has tabled a question asking theMinister of Health what representations he has received fromdoctors about the expenditure commitments entered into afterthe recent remuneration agreement, and what he proposes todo to enable doctors to honour those agreements. Mr.ROBINSON is expected to answer the question on Monday,which is the usual parliamentary day for questions about hisMinistry.

Standing Advisory Committee on Drug AddictionLord BMN is to be chairman of the Standing Advisory

Committee on Drug Addiction, which the Minister of Health issetting up. It will have the following terms of reference:"To keep under review the misuse of narcotics and other drugs

which are likely to produce dependence and to advise on remedialmeasures that might be taken or on any other related matters whichthe Ministers may refer to it."

QUESTION TIME

Emigration of DoctorsMr. JOHN TILNEY asked the Minister of Health for the total

number of medical practitioners in practice in England andWales at the latest available date and the corresponding figurefor Jan. 31, 1965.-Mr. KENNETH ROBINSON replied : The

- number providing full general medical services was 19,957 at: April 1 of this year and 20,207 at Jan. 1, 1965.: Mr. TILNEY: Does the fall in the numbers worry the

, Minister? Does he not fear there may be an increase in

emigration of doctors due to the freeze on pay ?-Mr.! ROBINSON: Of course, any fall in the number of general! practitioners is a worrying thing. I think we should get this- fall in perspective. It was 250 doctors, 11/4% of the total.I hope very much nothing that has been announced by the, Government will affect the emigration figures in the way the,

hon. member fears.. Mr. BERNARD BRAINE: Would the Minister not agree these

figures are very serious indeed ? They indicate an increasing! number of persons per doctor in the service. Can he indicate- -all questions of pay and remuneration aside-what special

aeps he is taking to try and increase the total number ofdoctors coming into the service ? What is he doing about.omen doctors ?-Mr. ROBINSON : The solution is to get doctors. I am glad to tell the House that the output newly qualified British doctors from medical schools lastyear was 1618, compared with 1511 in 1964. We anticipatethe output will increase each year hereafter.

Weekly Charge on Hospital Patients?Mr. D. J. WINNICK asked the Minister of Health if he would

givee an assurance that hospital patients would not be required° pay a weekly charge while in hospital.-Mr. KENNETHROBINSON replied: I have no plans to introduce the legislation- .h1ch would be necessary to impose such a charge.

Notes and News

PENSIONS AND BENEFITS

ABOUT 13 million National Insurance benefits and allow-ances, including 6 million retirement pensions, are now beingpaid each week.l The total cost of all payments during 1965was over E2000 million, of which more than S200 million wenton sickness benefits, over £30 million on maternity benefits,and E45 million on unemployment benefits. Retirement

pensions cost over E1015 million, and widows’ benefits E108million. Industrial injuries accounted for £27½ million

(957,000 claims were made during the year), disablement benefitfor E42 million, and industrial death benefit for £5½ million(24,300 widows were receiving benefit at the beginning of1965). The new earnings-related supplements to these benefitsand the additional contributions will be payable at the begin-ning of October this year.

ARS SPHYGMICA

A FASCINATING display of books about the pulse is on showat the library of the Royal College of Physicians of London,London N.W.1, until November 30. More than half the itemshave been lent by Dr. Evan Bedford.The Smith and Ebers papyri suggest that Egyptian physi-

cians were feeling the pulse about 1700 B.C. and throughGalen, who wrote at least 18 books on the subject, we know theviews of Praxagoras (340 B.C.) and his followers in the Alex-andrian school. And so down through the centuries, withbedside observation mixed with fantastic interpretation, thesignificance of the pulse has been gradually unravelled. Manya doctor who has wonderingly felt a pulse will be grateful forthis exposition of the changes of fashion in the physician’sapproach in so many different countries. Various notationswere used, diagrammatic or even musical, until theinvention of a clinical sphygmograph in the 19th century.From the most ancient times the pulse has been likened to thecharacteristic movements of different animals (e.g., insects,goats, and serpents). Nor was it simply a matter of taking thepatient’s wrist. The Hindu doctor must take a man’s righthand and a woman’s left (although, as the catalogue points out,eunuchs must have necessitated discretion). The Chinese

physician, at sunrise, was supposed to detect twelve distinctpulses with three fingers of each hand, thus obtaining informa-tion about a dozen different organs.A visit to this exhibition is obviously essential for any

aspiring sphygmologist and, who knows, when questions areasked on the history of this vital clinical technique, the candi-date who can quote Alfanus, Archbishop of Salerno, or

Theophilus Protospatharius may even hoodwink the examiners.

APPROVED NAMES FOR DRUGS

THE British Pharmacopoeia Commission has issued the

following new supplementary list of approved names:Approved name Other names

Acetorphine .... 5-Acetoxy-1,2,3,3a,8,9-hexahydro-2&agr;-[1(R)-hydroxy-l-methylbutyl]-3-methoxy-12-methyl-3,9a-etheno-9,9b-iminoethanophen-anthrofuran

O3-Acetyl-7,8-dihydro-7&agr;-[1(R)-hydroxy-1-methylbutyl]-O6-methyl-6,14-endoetheno-morphine

3-O-Acetyl-7&agr;-[1(R)-hydroxy-1-methylbutyl]-6,14-endoethenotetrahydro-oripavine

3-0-Acetyl-19-propylorvinolM.183 is the hydrochloride

(Narcotic analgesic) -

Alcuronium chloride .. Diallyldinortoxiferin dichlorideAlloferin(Muscle relaxant)

1. Ministry of Pensions and National Insurance report for 1965. H.M.Stationery Office. Cmnd. 3046. 12s. 6d.