Robert John Walsh 1917-1983
This memoir was originally published in Historical Records of Australian Science, vol.6, no.2, 1985.
With the death of Robert John Walsh on 20 July 1983, the medical profession lost one of its most distinguished and respected members. Of all his many achievements Walsh will be most widely remembered for his role in the establishment of the New South Wales Red Cross Blood Transfusion Service. From its beginnings in 1941 during World War II, when the transfusion of blood was not a common form of therapy, this service grew remarkably. Its outstanding success was due largely to Walsh's skilful administration. He was always proud, and rightly so, that it was founded and subsequently maintained on a basis whereby donors gave their blood without monetary reward. Walsh will also be remembered for his wise counsel in the planning and development of the new medical school at the University of New South Wales where he held the positions of Professor of Human Genetics from 1962 and of Dean of the Faculty of Medicine from 1973 until his retirement in 1982.
Walsh was born in Brisbane on 3 January 1917, but he spent almost his entire working career in Sydney. His forebears had migrated from Ireland about the middle of the l9th century and settled in Queensland where his parents, John James and Catherine Mary (née Ahern) Walsh were born and subsequently resided. John James Walsh matriculated from the Brisbane Grammar School and then proceeded to the University of Sydney (there was no university in Queensland at that time) where he graduated in Arts in 1899 with first-class honours in Greek. He then studied law and practised as a barrister in the Inns of Court in Brisbane from 1902 until his death in 1935. Around the turn of the century he played rugby for Queensland and later took a keen interest in community affairs. One of his many interests was a university in Queensland. He was honorary secretary of the University Congress for the establishment of the University of Queensland and a member of the first Senate of the University in 1911. Catherine Mary Walsh was a niece of the Hon. Andrew Thynne, a well-known Brisbane solicitor who was a member of the Legislative Assembly of Queensland for some 40 years, with ministerial rank, and also a member of the first Senate of the University of Queensland.
R.J. Walsh, or 'Bob' as he was known to his many friends, was the second of a family of seven children. He went to school at St. Laurence's Christian Brothers College in Brisbane. On matriculation he had to decide what course to follow at university. Although he had close family ties with the legal profession he had no inclination to follow the law. Rather, he was more interested in manual activities, so decided that he should enrol in either medicine or engineering. He also had family ties with the medical profession since his father's brother and his mother's brother both practised medicine in Queensland, and it was their encouragement that tipped the balance in favour of medicine. He enrolled in the University of Queensland in 1934, but since a medical school had not yet been established there, he proceeded to the University of Sydney in 1935 to continue his course. Here he resided at St John's College until he graduated with honours in December 1939. In 1940 he was a Junior Resident Medical Officer at Sydney Hospital and was appointed Senior Resident Medical Officer in 1941. His aim was to be a surgeon following in the footsteps of his uncle, Dr. Ahern, who was a leading surgeon in Brisbane. The outbreak of war in September 1939, however, was to have a considerable influence on his future career. In 1941, while still only 24, he became medical officer to the Red Cross Society, helping to recruit donors for the supply of blood in the event of possible air raids on Sydney. When later in that year he volunteered for military service, it was found that he suffered from hypertension that precluded active service abroad. Instead, he served at home in command of an army unit established for the preparation of blood serum for the armed forces. This was the beginning of a long and very distinguished period of service with the Army and the Red Cross.
New South Wales Red Cross Blood Transfusion Service, 1941-1966
During the early stages of World War II, preparations were being made for the treatment of severely injured civilian casualties, should air raids on Sydney eventuate. The value of transfused blood in the resuscitation of battle casualties had been demonstrated during World War I. The peace-time development of blood transfusion during the years that followed this conflict was, however, very slow. By the outbreak of World War II little progress had been made in methods of storing blood for subsequent use; consequently, the concept of blood banks was just emerging. In New South Wales individual hospitals had formed panels of blood donors on whom they could call when necessary, but transfusion of blood was a rare form of therapy. With regard to the blood components, plasma and serum, experiments had shown their efficacy in the treatment of burn shock, but such treatment had not been introduced widely for the resuscitation of patients.
The war was to change all this, very rapidly. At the outbreak of war a Blood Transfusion Sub-committee of the Medical Coordination Committee was formed to report on the establishment of a blood transfusion service in Sydney. This sub-committee recommended that the Department of Health should recruit donors to be called on to give blood in any emergency in New South Wales. Since only 400 donors were recruited in this way, the sub-committee revised its report late in 1940 and recommended that, as in other States, the Australian Red Cross Society should take over the recruiting in Sydney and that a medical officer should be appointed to assist. In February 1941 the Red Cross Society obtained premises in Bull's Chambers, Martin Place to enrol, examine and test volunteers who would be called upon when the need arose. Those premises began operating on 10 March 1941. (In 1942 better office space was obtained in Stanton House in Pitt Street.) In the meantime the Medical Co-ordination Committee had approached Walsh, requesting him to apply for three months' leave from Sydney Hospital to take over the medical officer's duties. Ten thousand donors were recruited in those three months and Walsh was asked to apply for another three months' leave to enable him to continue the work until June 1941.
It was at this time, however, that the New South Wales Blood Transfusion Service changed from a civilian to a mainly military role. The Director-General of Medical Services (DGMS) asked the newly-formed service to set up an organisation to provide serum for the troops in the Middle East, with the Red Cross providing donors and bleeding facilities, and the Army staff for the preparation of the serum. For this purpose the Army created the 2nd Australian Blood and Serum Preparation Unit. Walsh, who had just completed his second three months as the medical officer in charge of Blood Transfusion activities, had resigned from Sydney Hospital and had enlisted in the Army. Now, at the request of the DGMS, he was posted as the officer commanding the new unit. There he remained throughout the war as Major Walsh; he also acted as secretary to the Red Cross Blood Transfusion Committee.
Blood serum was first issued later in 1941 to the Armed Forces as far away as the Middle East and Malaya. The demand for serum for the troops greatly increased the work of the Red Cross Blood Transfusion Service. In June 1941, the Board of Sydney Hospital placed at the disposal of the Service one ward for the bleeding of donors and several rooms in the Kanematsu Memorial Institute of Pathology for the preparation of serum. After a considerable amount of initial trial and error, serum was prepared in large quantities. In February 1942, Sydney Hospital placed another ward at the disposal of the unit, and for many months more than 350 donors were bled each day. At this time 30,000 were on call for blood for the preparation of serum while a further 7,000 were held in reserve in the metropolitan area, Newcastle and Woollongong. Late in 1942, at the request of the Director of Pathology, Allied Land Headquarters, methods of whole blood storage were investigated. A technique for the aseptic collection of blood into the military-type Soluvac bottle was devised and an ice-box suitable for the transport of blood by air was designed and constructed. The first box of blood was dispatched to New Guinea in December 1942. From that time a continuous dispatch of blood was made to the forward battle areas, and from August 1943 blood was also supplied to civilian hospitals and private medical practitioners in the Sydney metropolitan area.
In addition to the supply of blood and serum to the Australian forces in the Pacific, blood was supplied to United States forces in the south-west Pacific during 1944 and early 1945. This was flown to New Guinea, the British Solomon Islands and the Philippines. On the arrival of the Royal Navy in the Pacific, serum was provided for all ships and shore establishments of the British Pacific Fleet. This placed a heavy strain on the Blood Transfusion Service since the use of suicide bombers by the Japanese caused many casualties, especially burns which required large quantities of serum. The end of the war in August 1945 brought to a close a period of almost five years of the closest cooperation between the Australian Army and the Red Cross Society. The No. 2 Australian Blood and Serum Preparation Unit that had provided the majority of the staff for the Transfusion Service was in due course disbanded.
The establishment and rapid development of the New South Wales Blood Transfusion Service would not have been so successful without Walsh's considerable organisational and administrative ability. He was assisted in his task by the National Blood Transfusion Service Committee, set up to coordinate the work of the army blood and serum preparation units that had been established in all States except Tasmania. Besides administration, Walsh had to contend with many technical and scientific problems. In tackling these, he and his colleagues had the cooperation of a technical sub-committee of the National Blood Transfusion Service Committee, whose duty it was to keep in touch with recent scientific advances overseas, especially in Britain and the United States. The investigations of the ad hoc technical problems marked the beginning of Walsh's research career.
One group of problems related to the donors. It was necessary to investigate the nature and causative factors of reactions in donors, the incidence of which was high in the young age group. Various haematological standards were determined and an analysis of the ABO blood groups was made in an Australian adult population to serve as a baseline. A method then had to be devised to determine the amount of blood that could be safely removed from donors on the assumptions that a donor should give an amount of blood not greater than one-tenth of his circulating blood volume and that his haemoglobin value should never fall below 82 per cent of the mean standard figures for males and females. Experiments showed that after the removal of 500 mL blood, the haemoglobin and haematocrit values and red cell count did not reach their lowest level until the fourth day after blood loss after which they gradually returned to their normal levels. It was also shown that repeated donations of this amount of blood could be made at intervals of three months without any effect on the final haemoglobin value.
A second group of problems concerned the quality of the blood or serum that was provided for the armed forces. The osmotic effect of various anticoagulant solutions was investigated to ensure a minimum change in red cell volume. The development of precipitates in liquid serum was studied, because users in the field could not distinguish turbidity due to precipitation from that due to bacterial contamination. It was shown that residual fibrinogen was more completely removed if the plasma was clotted immediately after collection and if merthiolate was not added until after clotting. It was further shown that the major factor in the development of the precipitate was the breakdown of the lipoglobulin complex, and that the removal of the lipoid complex with ether prevented this form of precipitate. A study of transfusion reactions found that the majority were due to pyrogens and that the Rh-factor and other agglutinogens were not often involved. Other investigations showed that the temperature at which blood was stored was important in preventing the formation of a sometimes toxic fibrinous buffy coat composed of degenerated platelets and leucocytes in a fibrinous matrix.
So successful was the New South Wales Red Cross Blood Transfusion Service during the war that at the end of hostilities it was decided that the service should continue during the peace that followed. On his release from the Army in 1946, Walsh, still only in his twenties, was invited to be the first Director of the New South Wales Red Cross Blood Transfusion Service. He held this position until his resignation in 1966.
With hostilities over, considerable changes had to be made in the Service. First, the accommodation at Sydney Hospital was no longer available. A move was made to the Sands Building in George Street for bleeding donors while the (old) Prince of Wales Hospital at Randwick was used for the preparation of serum. In relation to this time, Grace Parker writes:
In the early days in the John Sands Building, with space at a premium, our lunch time sessions with the coffee pot going on the old Valor stove ranged over many and divers subjects. Walsh had not yet acquired a formal, academic approach and all was grist to our mill.
The urge to make things carried over into his [Walsh's] professional life. He could not believe that any operation was beyond the capacity of at least someone on the staff. We had all been through the years of the depression and the war and were accustomed to making do. When a shortage of imported venepuncture needles threatened, he decided that the Blood Transfusion Service could make its own and ordered a quantity of steel tubing of the requisite gauge. It is true that he had one or two most accomplished needle cutters and sharpeners on hand and that the National Standards Laboratory had made him a beautiful little lapping [finishing] machine but attachment of the butt to the shaft in a manner such that sterility could be preserved was beyond his ingenuity. Fortunately the crisis passed.
In 1952, after eleven years in makeshift premises, the Red Cross purchased 1 York Street (originally the home of Dr. Dunmore Lang and then for over a century Petty's Hotel) where for the first time all the procedures concerned with blood collection, processing and distribution could be conducted under the one roof.
Secondly, the civilian pattern of blood and serum therapy changed from that which had pertained during the war. Whole blood transfusions soon became an essential part of the more sophisticated surgical procedures. Within a few years, by 1953, the amount of blood required greatly exceeded that needed during the war, but only about 4 per cent was used for the resuscitation of accident victims. The introduction in 1957-58 of artificial heart-lung machines for cardiac surgery at the Royal Prince Alfred Hospital and the establishment of the first artificial kidney machine in Australia, at Sydney Hospital, further increased the demand for freshly collected whole blood. This trend in the use of whole blood in civilian practice, in contradistinction to the use of serum during war-time, continued. In April 1961, 20 years after the establishment of the blood transfusion service, the millionth blood donation was made in Sydney.
In addition to whole blood and, to a much lesser extent, whole serum, the use of the various protein components of plasma also increased. The fractionation of the blood plasma proteins into their several components, pioneered by E.J. Cohn at Harvard University during the war, enabled several medical disorders to be treated, such as shock with pure albumin, haemophilia with anti-haemophilic factor or factor VIII, and tetanus with specific gamma globulin. These protein fractions were prepared by the Commonwealth Serum Laboratories in Melbourne from plasma supplied by the Red Cross Blood Transfusion Service.
The rapid scientific advances in post-war medical practice thus led to changes in the organisation of the Service, even though the primary function of blood collection from voluntary donors remained the same. For example, it became necessary to set up a blood group reference laboratory. Moreover, the Service came to act in a consultative capacity with hospitals and medical practitioners on all matters concerning transfusion of blood, serum or plasma protein components. The administrative load on the Director soon became too great. Toward the end of 1952, Professor H.K. Ward was appointed on his retirement from the chair of bacteriology at the University of Sydney as medical officer to assist Walsh. Ward had worked in close association with Walsh during the establishment of the blood transfusion service in the early years of the war. His knowledge of bacteriology and of sterility in the preparation of serum was invaluable. The Service continued to grow and in 1957 the Red Cross appointed Dr. G.T. Archer as Deputy Director.
Research at the New South Wales Red Cross Blood Transfusion Centre
In order to keep pace with scientific advances in blood transfusion therapy, the Red Cross realised that research was essential. When he assumed the position of director of the New South Wales Red Cross Blood Transfusion Service, Walsh had not had an opportunity for formal training in laboratory research. Nevertheless, as has already been seen, he was able to tackle several ad hoc problems during the war and solve them successfully. After the war the Red Cross granted him 18 months' leave of absence to study abroad in 1947 and 1948. He spent a year at the Harvard Medical School studying heme synthesis by immature erythrocytes in Professor C.A. Finch's laboratory. He then went to England where he worked in London and Oxford for six months.
On his return to Sydney he found the facilities in the Sands Building overcrowded and not very conducive to original research. With the move into the new quarters at 1 York Street in 1952, Walsh grasped the opportunity to establish a research section in the Service. Dr. Gordon Archer writes:
Ward encouraged Walsh in setting up a large research unit and he became a sounding board for Walsh's ideas. They spent many hours together in friendly debate, often over lunch with a visitor, and their advice was frequently sought by outsiders because the transfusion service was considered to be 'neutral territory', away from parochial hospital or institutional politics. There is no doubt that this period in Walsh's career was most enjoyable to him and from then on he became more and more interested in the academic and research scene in Australia. He had the ability to communicate his ideas on paper or in person with such clarity and enthusiasm that his audiences rapidly became admirers and supporters. His advice was sought by many, from heads of large research institutions to humble researchers trying to write a paper. He accepted all such challenges and the amount of paperwork that he took home at night began to increase. He acquired a portable dictaphone as soon as they became available so that he could record his ideas while travelling home in his car. The Chairman of the Blood Transfusion Committee at this time wondered whether Walsh's mind would ever switch off.
Being a very practical man, Walsh mainly tackled problems, the solutions of which would be of benefit to the donors giving blood or to the patients receiving it. His early research concerned the problems of that era in blood banking. He turned his attention primarily to iron metabolism. From an academic point of view his interest related to the role of iron in the formation of red blood cells. However, iron metabolism was to Walsh also of great immediate practical importance for the blood donors, who had to speed up the manufacture of red cells in order to make up the loss they incurred from their blood donation. In this regard Walsh wanted to persuade blood donors to take iron tablets after they had given their blood. He had to know the best way to give iron, the optimum amount to give and the best sort of iron compound to give. Another early interest in the problems of blood banking was the use of available antibodies for identification of blood groups, and in particular the study of unexpected agglutination results occurring either in vivo or in vitro in the course of work at the Blood Transfusion Centre. The pursuance of this work, which included the discovery of the first example of an anti-S serum, led naturally to an interest in population studies of blood group antigens. This became a fertile area for further research, and studies on Aboriginal and Pacific Islander populations followed. Australia and the Pacific have provided a rich area for many such studies because of the antiquity of the Aboriginal Australian population and, in contrast, the much more recent and highly dispersed nature of the Islander populations. Once Walsh had established a territorial prerogative in this area, it became relatively easy for him to study many populations, especially in New Guinea.
By 1954, two full-time research fellows funded by the National Health and Medical Research Council (NHMRC) had been appointed. At about the same time the Nuffield Foundation gave a grant jointly to the University of Sydney and the New South Wales Blood Transfusion Service to enable an expedition to be sent to the highland region of New Guinea for certain studies of the native population. Support was also received from the Colombo Plan to forge a close link with neighbouring Asian countries. At a time when research in Australia was beginning to gain momentum in the post-war resurgence, Walsh had built up a very active team with interests in a wide variety of problems relevant to the routine work of the Service. Lunch-time seminars held regularly at 1 York Street attracted many interested people from many medical disciplines in Sydney. This research activity was important to a man who had become the leading figure in the blood-banking field in Australia.
Studies in iron metabolism
The concentration of haemoglobin in the blood has long been used as a measure of the capacity of the blood to carry oxygen. In disease it is used as an index of the degree of anaemia when it is compared with the mean standard value in healthy subjects. The Blood Transfusion Service was in a unique position to study the haemoglobin values of various populations. One of the first groups investigated was that of healthy white Australians living at sea-level in New South Wales. Walsh and his colleagues found mean haemoglobin values of l5.71 g/100 mL for males and 13.89 g/100 mL for females. These values were to serve as standards for comparison with values obtained in other populations or in individuals with some haematological disorder. Walsh also showed that in healthy individuals under certain conditions the haemoglobin value might vary; for example, the value was found to be less when the ambient temperature was high, due probably to haemodilution during cutaneous vasodilatation, and in women with the onset of menstruation or in pregnancy when the plasma volume is increased. With regard to the accurate determination of the haemoglobin concentration in the blood in clinical practice, the Blood Transfusion Service provided a standard sample, issued free to pathology laboratories on a regular basis, for the calibration of instruments. This was one of the early attempts at quality control and did much to improve the accuracy of laboratory measurements.
Walsh next compared the haemoglobin values of several groups of New Guinea natives with the standard values for healthy Australians. Natives living in coastal regions of New Guinea had haemoglobin values which ranged from 71-87 per cent of Australian values in males and 80-87 per cent in females. Several factors such as malaria, hook-worm and poor nutrition were thought to account for these low levels. In contrast, the haemoglobin values of natives in the highlands of New Guinea were significantly higher than the standard values for healthy Australians at sea-level, being in the range of 104-111 per cent of these values for males and 106-113 per cent for females. In the highlands malaria and hookworm are less prevalent than in the coastal areas, but the altitude, 1500-2100 metres, was probably an important factor. The high haemoglobin values indicated that, as in other populations of the world living at high altitudes, the natives could respond to a lower level of oxygen in the air by manufacturing larger amounts of haemoglobin and red cells.
An important factor in the maintenance of the level of haemoglobin in the blood is an adequate supply of iron in the body. The study of iron metabolism is therefore relevant for an understanding of anaemias and of haemochromatosis, where there is an excessive storage of iron in the body. Walsh's studies concerned several aspects of iron metabolism in health and disease. He and his colleagues showed that iron was absorbed mainly from the upper third of the small intestine, and mainly in the ferrous form. The amount of iron absorbed depended on the level of the iron stores in the body when these were low relatively more iron was absorbed than when they were high. Iron absorption was also increased when there was a demand for erythropoiesis. With regard to iron therapy, when the dose was increased the percentage absorption was decreased. These findings were relevant to the fact that iron compounds taken orally are irritant to the gastro-intestinal tract, so that it is necessary to decide upon an optimum dose. Once absorbed into the body, iron is stored or metabolised, but excretion in the kidney is slow.
In addition to Walsh's own experiments in this field, much other fundamental research in iron metabolism was carried out by Imre Kaldor, Ilse Brading and others working in the Red Cross Blood Transfusion Centre. Walsh's practical interest in the work also concerned the treatment of haemochromatosis . The extent of iron overload in this disorder was able to be determined by a test using the chelating agent, Diethylene Triamine Penta-acetic Acid (DTPA), and the patients treated accordingly.
Regular venesection was shown to be the most effective method of treating the condition. If started early enough, before the organs had begun to be affected, the more severe symptoms could be avoided. As blood removal was the business of the Blood Transfusion Service, many patients were referred to the Service for management; this was the only sort of therapy to which the Service was committed.
Blood group studies
The determination of the various blood groups was a component of the routine work of the Transfusion Service. Problems arose that gave rise to research.
(i) The Rh-factor. One of these problems concerned the Rh-factor and its relation to haemolytic disease of the new-born, the aetiology of which was unknown at the outbreak of the war in 1939. An important discovery was reported in the United States by Landsteiner and Wiener in 1940. They noted that the red cells of a high percentage of human subjects, later shown to be 85 per cent, contained an antigen that was present in the red cells of the rhesus monkey. In the next year an important follow-up to this discovery was reported by Levine and his co-workers. They noted that in nearly all cases of haemolytic disease of the new-born, the father's red cells were Rh-positive and the mother's Rh-negative, and the mother's serum contained an Rh agglutinin. It was postulated that the Rh antigen passed from the foetus with Rh-positive blood across the placenta to the mother whose blood was Rh-negative; an Rh agglutinin produced in the maternal blood then entered the foetal circulation through the placenta to produce agglutination and haemolysis of the foetus's Rh-positive red cells.
At the time of these important blood group discoveries, Walsh, a medical graduate of only one year's standing, was just beginning to grapple with the problems of blood transfusion. Fortunately, his main concern was the supply of pooled serum for transfusion into casualties of battle in the Middle East, circumstances in which the Rh-factor would not be involved. When whole blood was later supplied to the battle areas of the Pacific, it was known that the Rh-factor would be of significance only if Rh-positive blood was transfused into men whose blood was Rh-negative and who had on a previous occasion been transfused with Rh-positive blood. With the supply of whole blood to the civilian population at home, however, Walsh came up against the problem of the role of the Rh-factor in the aetiology of haemolytic disease of the new-born. He felt that since this disease is a comparatively uncommon disorder of infants, the full sequence of events is not completed in all instances of Rh-positive foetus and Rh-negative mother. In a study of 107 cases of this disease he showed that the frequency and severity generally increased with increasing number of pregnancies. Following up this finding with a much larger study of 5694 pregnancies of Rh-negative women, he calculated that Rh-negative women married to Rh-positive men have 1 chance in 143 of being immunised during the first pregnancy, 1 in 14 during the second and third, 1 in 12 during the fourth, and 1 in 8 during the fifth. Moreover, the severity of the disease in the first affected child frequently set the pattern for subsequent children. He also showed that the effects of immunisation by a blood transfusion were similar to those when immunisation followed a pregnancy.
These studies indicated that although the association of an Rh-positive foetus and an Rh-negative mother meant that incompatibility existed, direct proof of iso-immunisation against the Rh-factor was obtained in only a minority of cases. Two questions were posed: (a) whether absence of evidence of iso-immunisation excluded the Rh-factor in the aetiology, and (b) whether the finding of iso-immunisation necessarily meant that the Rh-factor was involved.
In a further study it was shown that if an Rh-negative woman developed Rh agglutinins in her serum during the course of pregnancy, the foetus was Rh-positive and would suffer from haemolytic disease of the new-born. On the other hand, agglutinins detected in the early part of pregnancy were usually the result of previous immunisation and their presence was no indication of the Rh status of the foetus. It was also shown that whilst examinations for the detection of agglutinins were most important, titration of any agglutinins so found was of limited value as a prognostic aid.
One factor that could account in some cases for the variation in iso-immunisation of an Rh-negative mother with an Rh-positive foetus was the effect of incompatibility between the ABO groups of the father's red cells and the mother's serum. Walsh and his co-workers showed that their results were consistent with the hypothesis that rapid destruction of ABO-incompatible foetal red cells entering the maternal circulation prevented Rh immunisation. No evidence was obtained of immunological tolerance against Rh antigens being acquired by an Rh-negative woman whose mother had Rh-positive blood.
Other investigations concerned the method used in the Rh agglutination reaction, the effect of intramuscular injections of Rh-positive cells in women during the child-bearing age, the discovery of anti-S and demonstration of its association with the MN system, and the detection of various rare blood groups such as A3 and the Rh allelomorph cv.
In other studies Walsh found that in the transfusion of several thousand litres of blood, the Rh-factor was an infrequent cause of transfusion reactions. Such reactions due to the Rh-factor were found only in women with Rh-negative blood who had been immunised by pregnancy, and in patients with Rh-negative blood who had been immunised by previous transfusions of Rh-positive blood. In a study of cases of repeated miscarriages, it was shown that Rh incompatibility was not a major aetiological factor, but that it could not be excluded in individual cases.
(ii) Blood group patterns and disease. Although suggestions had been made that genetic factors in man might determine the susceptibility or resistance to disease, little proof of this concept had been produced. Aird and his colleagues in the United Kingdom had in 1953 demonstrated an association between carcinoma of the stomach and blood group A and similarly, in 1954, an association between chronic duodenal ulcer and blood group O. Walsh believed that strong support for a genetic factor would be obtained if it could be shown that the blood group distribution of a series of patients with an active disease differed from the distribution found in the random population. He studied patients with acquired haemolytic anaemia and found a higher proportion in blood group O than in a normal population. In other diseases studied, however, rheumatic fever, pulmonary tuberculosis, carcinoma of various organs other than the stomach and haemochromatosis, he found no difference in the distribution of ABO, MNS and Rh blood groups from that in a normal population. Walsh maintained that whereas a strong association had been established between some diseases and various blood groups, the significance of such associations was not at present understood. He felt, however, that one day these findings might be of considerable importance.
(iii) Blood group gene frequencies of New Guinea natives and other populations. Walsh's broader research interest in blood groups concerned the study of gene frequencies in the natives of New Guinea and in neighbouring Asian and Oceanic peoples. He wanted to explain why there were differences in the gene frequencies of peoples in these different regions. His studies focussed on the possible origins and migrations of these populations, and on the theory of random genetic drift in populations that had remained for a long time in a relatively isolated state. Although New Guinea is an island with only two to three million people, the population is far from homogeneous. On the contrary, it is divided into some 400 language groups and the people display relatively great cultural diversity. In the highlands, especially, the rugged terrain with deep gorges and ravines makes travel difficult. In such terrain, even marriage between neighbouring tribes diminishes rapidly with increasing distance. Many highland groups have therefore lived in primitive isolation for centuries.
After World War II, human biologists were quick to realise that the peoples of New Guinea were one of the few remaining primitive populations in the world ideal for the study of factors influencing human variation. Walsh was one of the first such researchers to enter this area. He was in a unique position to study blood group gene frequencies and other problems of population dynamics in this primitive population. As early as 1951 he published a paper on the ABO, MNS and Rh blood group systems of 178 Australian Aborigines and 141 New Guinea natives. In his early studies he identified the overall blood group pattern of the peoples of New Guinea, who are Melanesians with high frequencies of B, N and R1, and at the same time he showed that the natives from different regions were not a homogeneous group.
In collaboration with numerous colleagues, especially with Olga Kooptzoff, Walsh followed up these early studies with extensive investigations, over a period of many years, into the blood group patterns of the inhabitants of the different regions and language groups of Papua New Guinea, both in the relatively rugged highlands and in the coastal regions where contact with the outside world is less difficult.
He also studied the blood group frequencies of several neighbouring populations in Asia and in Oceania such as the indigenous peoples of the Philippines, Australia, Korea, Fiji, British Solomon Islands, Bougainville, New Caledonia and the Tongan Islands, to ascertain whether ethnic links might exist with these peoples.
In these studies Walsh hoped to find gradients of gene frequencies that might indicate routes along which migrations occurred. Few clear-cut gradients were, however, found although differences were observed in different regions, even in neighbouring groups. In the western highlands, for example, not only was there a lower frequency of the M gene and a higher frequency of the S gene compared with the frequencies in indigenous natives of the coastal regions, but there was also evidence of a gradient of the S gene from Wabag in the west to Goroka in the east. In the coastal regions, too, the frequencies of the B and M genes showed gradients from west to east with that of B falling and of M rising. On the basis of the S gene gradient in the highlands, Walsh postulated that there could have been an infiltration of a group of people along the highland ridge into an earlier population. The invading and resident peoples would have been similar in their blood group patterns, except that one must have had a higher frequency of S than the other. When gene frequencies of the 18 sub-areas of the Wabag region were plotted, however, no clear-cut evidence of possible paths of travel could be seen. Walsh thought that differences within the Wabag area itself in the distribution of the S and Rh blood group phenotypes could result from uneven mixture of successive waves of immigrants from the same population or to random genetic drift.
An hypothesis was developed which suggested that the early inhabitants of New Guinea, who possessed the S gene but little or no M gene, had moved to the highlands where they had found better living conditions. Later arrivals who possessed little or no S gene but a moderate frequency of the M gene had impinged on and occupied the coastal regions, submerging the earlier residents. Some of these later arrivals had then spread to the highlands, probably along the waterways, but the intensity in the highlands would not have been so great as on the coast. The findings also suggested that there must have been differences in the frequencies of the A, R1 and R2 genes in view of the differences now present in the frequencies of these genes in the coastal and highland natives. Studies of the blood group gene frequencies of neighbouring Asian and Oceanic populations, populations that might have migrated to New Guinea, showed that these differed markedly from the overall pattern observed in New Guinea. It was not possible to designate any combination of existing ethnic groups that, on hybridisation, would have produced the existing blood group pattern. It seems that the New Guinea highland natives are probably no 'purer' than any other population, and that they have almost certainly received many immigrations and experienced many wars and other vicissitudes during several centuries.
(iv) Other fields of research. Mention has already been made of research in iron metabolism by Kaldor and others. Research was also undertaken in other fields by Walsh's colleagues. P.S. Venkatachalam, working with a grant under the Colombo Plan, studied nutrition and especially the incidence of Kwashiorkor in children in New Guinea. G.E. Archer, on his appointment as Deputy Director in 1957, brought a new field of research, the study of eosinophils and mast cells and their role in certain allergies such as asthma.
The University of New South Wales, 1962-82
By the early 1960s, the New South Wales Red Cross Blood Transfusion Service had gained a high reputation both in Australia and overseas. Walsh was now ready to accept a new challenge that came from the newly established medical school at the University of New South Wales. Following a recommendation in the Report of the Committee on Australian Universities (the Murray Report) of 1957, authority to conduct courses in medicine was given to the university by the University of New South Wales Act of 1958. A faculty of medicine was constituted in 1960 and in 1961 students were enrolled for the first year of a six-year course. In 1962 Walsh was appointed Visiting Professor of Human Genetics, a position that involved him from 1963 in a teaching commitment mainly directed to a short course of human genetics in the third year. Probably of equal importance to the university, however, was his wise counsel as a member of faculty and of several of its committees in the planning of the medical school in its early stages. His considerable experience and knowledge of matters relating to the general medical scene in Sydney were of great value. He was a Fellow of the Royal Australian College of Physicians and of the Royal College of Pathologists of Australia. On the basis of his medical research Walsh had been elected to the Fellowship of the Australian Academy of Science in 1959, and in the same year he became a member of the Research Advisory Committee of the NHMRC. He was therefore well suited for the position of chairman of the university's Medical Research Advisory Committee.
Walsh's activities in the university were all part-time but very challenging and time-consuming. He of course still retained his major interest as Director of the Red Cross Blood Transfusion Service. His base remained at 1 York Street and it was here that he continued his research into the blood group gene frequencies of various groups of New Guinea natives. These studies confirmed that even in neighbouring villages in New Guinea there existed a heterogeneity that could best be attributed to random rather than directional factors. Meanwhile Human Genetics in the university grew but slowly. An associate lecturer was appointed in 1964, but as there were no laboratories available at the university, research was still carried on at 1 York Street.
In the 1960s, activities outside the blood bank and the university also began to take up more and more of Walsh's time as his administrative ability and wide biological interests were fully recognised. Besides becoming a member of the NHMRC research advisory committee in 1959, he became a member of the Council of the Australian Academy of Science in 1963, of the Australian Research Grants Comrnittee in 1965 and of the National Radiation Advisory Committee in 1966. In addition he was one of a small group to found the Haematology Society of Australia. By 1966 he had also undertaken two very time-demanding activities as joint Secretary-General of the XIth Congress of the International Society of Haematology held in Sydney that year, and Secretary (Biological Sciences) of the Australian Academy of Science. With all these commitments he frequently had several meetings in different places at the same time and had to decide which he would attend. His responsibilities at the blood bank were clearly his first priority. The pressures on him from his other activities increased to such an extent that toward the end of 1966 he made the important decision to resign as Director of the Red Cross Blood Transfusion Service in order to accept a full-time position as Professor of Human Genetics and Head of the School of Human Genetics in the Faculty of Medicine at the University of New South Wales.
The move to the university in 1967 was, for the small group involved in it, a happy event. It signalled the setting up of a true university department to be called the School of Human Genetics, with adequate space and time for the various activities that had developed. The teaching commitment could at last be attended to in the manner which students might rightfully expect of staff, and with greatly enhanced convenience since the students' laboratories were now next door to the staff offices.
For Walsh the move may have appeared a mixed blessing. His whole professional life for the previous 25 years had developed around a single central core at the Blood Transfusion Centre and at the time of his departure from 1 York Street there was a very large staff and thriving activity which, when suddenly withdrawn, could leave a large psychological hiatus. In particular, many of the staff of the blood bank had participated in processing material brought back from New Guinea, and the sudden loss of this manpower resource was going to require a great deal of adapting on his part if the same tempo of research were to continue. The generosity of the university in providing research equipment in the newly-developing 'on campus' department helped to bridge the gap between the old activities and the new. The added space available also led to the slow acquisition of more staff. By the end of the 1960s, the teaching load had increased by the addition of a course in medical statistics. To cope with this the staff increased to three senior lecturers, in addition to four or five support and research staff.
In these early years of the School of Human Genetics, Walsh had to determine in his own mind, either consciously or subconsciously, whether he would throw most of his considerable energies into building up within the university a school with an international reputation, or use his energies mainly to develop his broader interests in the field of administration. Events soon showed that the latter course was the one he preferred.
The opportunity as Secretary (Biological Sciences) of the Australian Academy of Science from 1966 to 1970 to become involved in broader fields of biology proved attractive to Walsh. It was while holding this position that he became deeply involved in the organisation of a world-wide biological project, the International Biological Programme (IBP), which continued for several years. More than 40 nations participated in the IBP, which was sponsored by the International Council of Scientific Unions (ICSU). The aim of the program was to study over several years the 'biological basis of productivity and human welfare'. Australia, with the Academy of Science as its official agency, participated in several of the program's seven sections. Walsh was mainly concerned with the Human Adaptability (HA) section, which dealt with all aspects of man and his adaptation to the varying environments in which he lives. One of the significant Australian HA projects was a multi-disciplinary study in New Guinea that was felt to be of particular importance because of the rapidly changing socioeconomic conditions in the areas concerned.
This New Guinea project consisted of a study of two populations, one at sea-level and the other at an altitude of 1500 metres or more. It was in effect a collaborative undertaking involving the United Kingdom HA Committee, the Australian HA Committee, the Institute of Human Biology of Papua New Guinea, the Department of Public Health of Papua New Guinea, and various institutions and laboratories in Australia, the United Kingdom and Papua New Guinea. As chairman of the Australian HA Committee and a member of the National Council of IBP, Walsh was in a unique position to play a leading role in the organisation of the New Guinea project. Although his term of four years as Secretary (Biological Sciences) of the Academy of Science ended in April 1970, his considerable involvement in the IBP, at both a national and an international level continued to occupy much of his time.
Meanwhile, he had also become more deeply involved in administrative matters in the University of New South Wales and in several other organisations. In 1969 he became a member of the University Council and in 1970 he accepted the demanding position of Chairman of the Professional Board. In 1970 he also became involved in several Australian Government committees. He was chairman of the Advisory Committee on the Environment and a member of the Immigration Planning Council, the Population Inquiry, the Cities Commission Advisory Committee and the Interim Council of the Australian Institute of Marine Science. Walsh also accepted the chairmanship of a joint Commonwealth-Queensland Committee of Inquiry into the Crown-of-Thorns Starfish. This committee was asked to review the present knowledge of the crown-of-thorns starfish, to determine whether the starfish constituted a threat to the Great Barrier Reef, and, if necessary, to determine what control measures should be undertaken. After intensive investigations occupying much of his time in 1970, Walsh submitted a report on behalf of the committee on 25 March 1971.
In addition to these university and government commitments, Walsh was involved in a wide variety of other organisations. He was chairman of the Great Barrier Reef Study Group and a member of the Science and Industry Forum of the Australian Academyof Science; President of Section 15 of the 42nd ANZAAS Congress and a member of the Council of ANZAAS; President of the Australian Academy of Forensic Sciences; a member of the scientific sub-committee of Apex Trust for Autism, the Queen Elizabeth Fellowships Committee, and the medical and scientific committee of the World Federation of Haemophilia; President of the Sydney Hospitallers Association; a member of the Pathology Sub-committee of Sydney Hospital (responsible for advising the Board of the hospital on matters pertaining to the Kanematsu Institute) and of the International Society of Haematology; President of the Cystic Fibrosis Association of New South Wales; and a member of the Medical Research Advisory Committee of New Guinea and the Council of the Institute of Human Biology of Papua New Guinea.
Walsh's administrative responsibilities within and without the university therefore grew in intensity from the time he relinquished the Directorship of the New South Wales Red Cross Blood Transfusion Service at the end of 1966 through to the early 1970s. Some of his colleagues regarded him as a 'workaholic' and a compulsive acceptor of responsibilities. These administrative responsibilities did not leave him a lot of time to develop his own creativity nor to provide the same leadership in research, necessary to build up in the university a School of Human Genetics of international repute, as he had shown in the development of the Blood Transfusion Centre.
After the establishment of his School, Walsh's own research in human genetics was in diverse areas that were not explored in great depth. The most important activity came about as a result of his close contact with Aborigines and Islanders. This was his work on skin pigmentation. Using a portable reflectance spectrophotometer, Walsh made large numbers of observations on skin reflectance in diverse population groups. Other studies were on hand-clasping, which was shown not to be inherited in any way, and ear-lobe shape, which has a complex genetic causation. At about this time also, some observations on twinning, in particular an excess of dizygous twinning in one area of New Guinea, were recorded. Amidst all his activities, Walsh still found time to counsel on their scientific research projects many people who sought him out for this purpose, so that his contribution spread widely through the research of the general scientific community.
At a more routine level, Walsh had actively promoted the establishment of cytogenetic studies, first at the Blood Transfusion Centre and then at the Prince of Wales Hospital. He was also a driving force in recognising the importance of the new work on HLA typing when it first entered the practical arena in the field of transplantation. The high quality of work at the Blood Transfusion Centre to this day must be attributed to the vigorous adoption of the new ideas. Some of his colleagues at the university hoped that cytogenetics would become an active component of the School of Human Genetics, so identifying the school in the minds of medical practitioners. Walsh, however, felt that cytogenetics was a servicing technique that could function better in the Prince of Wales Hospital than in the School of Human Genetics.
In March 1973 Walsh accepted the position of Dean of the Faculty of Medicine in the university, a full-time position that he held until his retirement in January 1982. The School of Human Genetics was replaced by a School of Community Medicine. Until 1976, when a professor of community medicine was appointed, Walsh acted as Head of the new School. Although the staff of the former School of Human Genetics was absorbed into the School of Community Medicine, the incentive for research in human genetics faded. The demise of the school he had created must have been a disappointment for Walsh as it was for the rest of the staff but he had bigger and broader issues with which to contend when he became dean of the faculty.
As dean, Walsh was immediately involved in a major change in the medical course. Until 1974 the medical course had extended over six years, but in 1974 an entirely reorganised course extending over five years was introduced. This reorganised course was developed in response to a world-wide pattern of change in medical education. The changes included integration of all parts of the course and detailed specification of course objectives. Clinical experience began in the first year of the new medical course with the object of indicating the relevance of all parts of the educational program. The course in Medical Statistics and Human Genetics given by the staff of the School of Human Genetics in the third year of the old six-year course was phased out. With regard to faculty matters in general, Walsh, as dean, could be tough when dealing with some students but extraordinarily kind to others. As far as the staff were concerned, he felt strongly that research should play a major role in their duties.
Some of his clinical colleagues thought that he failed to appreciate the problems of clinical academics because of his lack of clinical experience. They felt that he never accepted that clinical responsibilities and teaching were as important as research to clinical academics.
Although the office of Dean of the Faculty of Medicine included in its duties membership of numerous university and teaching hospital committees, Walsh continued to accept outside responsibilities. In 1972 he had become Deputy Chairman of the National Blood Transfusion Service Committee. On the disbandment of the National Radiation Advisory Committee (of which he was a member) in 1973, he was appointed Chairman of the Australian Ionising Radiation Advisory Council that replaced it. He also accepted membership of several other bodies such as the Uranium Advisory Council, the Clive and Vera Ramaciotti Foundation, the Jenny Leukaemia Trust, the Board of the Benevolent Society of New South Wales, the Council of the Australian Club of Rome, the Australian Cancer Society, various committees of the New South Wales State Cancer Council, the research advisory committee of Foundation 41, the Australian Postgraduate Federation in Medicine, the Society for the Study of Human Biology, the Australian Population and Immigration Council, the Council of Macquarie University and the editorial boards of several scientific journals. He was a serving Brother of the Order of St. John and an honorary life member of the Red Cross Society, the Australian Blood Transfusion Society, the Haematology Society of Australia, the German Haematology Society, the German Society for Blood Transfusion and the Australian Society of Anaesthetists. While Walsh undoubtedly enjoyed his many administrative activities during the nine years that he was dean, he must have regretted that this left him no time for those manual activities which, as a young man, he had hoped a career in medicine would provide.
Walsh retired in January 1982 at the age of 65. Although he rarely mentioned it, his close friends were aware that throughout his entire career he had had to give himself daily injections to combat hypertension. At one stage in 1953 he suffered a severe episode of this disorder leading to retinopathy and nephritis, and he had to be hospitalised. The prognosis was very grave, but Walsh soon bounced back to apparent health, much to the surprise and even bewilderment of his medical colleagues. Many thought that on retirement he would 'call it a day' and relax, especially since he was now affected by an even more serious affliction than his hypertension, an affliction which required unpleasant treatment for its control. But this was not to be. In 1982 he accepted two major government commitments that were to keep him busy until his death.
The first of these concerned the Australian Institute of Aboriginal Studies. This Institute had its beginnings in 1959 when the then minister responsible for Aboriginal affairs prepared a document entitled 'An Australian Institute for Aboriginal Studies'. This argued for a comprehensive and coordinated effort by the Australian Government to record for posterity what remained of the culture of the Australian Aborigines. In 1982 Walsh was asked by the Commonwealth Government to examine and report on the activities of the Institute in relation to its statutory function of promoting Aboriginal Studies and to make recommendations about the future conduct of the Institute's activities. His report on these matters was presented to the minister concerned in September 1982.
The second commitment concerned the investigations being carried out on health problems of veterans of the Vietnam War. In 1980 the Commonwealth Government sought to investigate whether health problems among these veterans might arise as a result of contact with the herbicide, Agent Orange. The Commonwealth Institute of Health was commissioned to conduct a series of scientific studies into the health of the veterans and their families. A special unit known as the Australian Veterans Herbicide Studies Unit was set up within the Institute to conduct the investigations with Professor Lindsay Davidson as Director of Scientific Studies. Following Davidson's departure from Australia, Walsh was appointed to take his place early in 1982. He became involved in two studies that were being carried out, a birth defects study and a mortality study. The report of the birth defects study was published in 1983, but that of the mortality study was not published until 1984, after Walsh's death.
Walsh died 'in harness ' so to speak, even though he was in official retirement. Up to his death on 20 July 1983, his mind remained as inquiring as it had been throughout his working career. He got great satisfaction from delving into all sorts of problems as a member of a committee, or, more especially, as chairman of a committee. In committee he was blunt, outspoken, accustomed to getting his own way and reluctant to change his point of view. He did not suffer fools gladly and said so. As chairman, he had great skill in summing up with considerable clarity the most diffuse discussion.
Walsh also enjoyed social occasions in the company of his friends. For example, he got much pleasure over a number of years as chairman of the dining club of the Fellows of the Academy residing in New South Wales. He was a bon viveur with a penchant for Scotch whisky and good red wine, and a good dinner guest to have in the home. Throughout his career he was always supported, both in his medical and his social spheres of activity, by his wife Helen. In 1944 Bob had married Helen Tooth. They both had graduated in medicine with honours in December 1939 and both had been appointed junior resident medical officers at Sydney Hospital in 1940. While Bob became involved with the Blood Transfusion Service, Helen remained at Sydney Hospital where she became acting medical superintendent in 1943. She subsequently practised her profession as a pediatrician. Bob and Helen had four children, one daughter and three sons whom they always included on social occasions with their friends in the family home in Epping.
During his active career Bob Walsh achieved much in the fields of medicine, science and community service. For his achievements he was awarded the O.B.E. in 1970, A.O. in 1976, the James Cook Medal of the Royal Society of New South Wales in 1980 and A.C. in 1982. However, his greatest achievement, the New South Wales Red Cross Blood Transfusion Service, will remain for all time as a memorial to the man who did so much to create it.
In writing this biographical memoir, I should like to acknowledge the assistance of Dr. Helen Walsh, Margaret Walsh, Clare Walsh, Dr. Gordon Archer, Grace Parker, Olga Archer, Professor W.R. Pitney, Dr. E.M. Nicholls and Dr. L.Y.C. Lai.