The use of blood has greatly increased during the past 25 years. One of the most important advances during this period is related to the development of methods of isolating, concentrating and storing the individual components of blood for specific clinical requirements. Along with this, new problems in science and technology, blood-donor organisation and medical care and the recruitment and training of staff have emerged. The opinion is advanced, that in the future, the efficiency of blood transfusion lies in its establishment as a separate discipline.

Estuarine development was contemporaneous with the onset of glaciation. In the Tay estuary fluvial erosion dominated the downcutting, with minor glacial modification; in the Forth estuary glacial scouring dominated the erosion of rockhead.

Extensive subsurface exploration in connection with road improvement and foundations for bridge building and electricity pylon construction have yielded information on the fill of the Tay and Earn valleys. In addition to geophysical investigations the surveys include boreholes along a 20 km long section from Kinfauns to Longforgan, revealing deposition of lodgement tills followed by Arctic Clays, believed to have been deposited partly from floating ice. Above it are coarse sands and gravels, perhaps outwash deposits. Both were deeply dissected during a fall of sea level associated with a channel cut to − 37 m O.D. at Dundee.

Erosion and marine planation during lowered sea levels produced laterally extensive buried gravels.

A rise of sea level led to burial of the eroded surface by early estuarine sediments which become finer upwards and terminate in peats, dated at 8500 b.p. Further erosion was followed by a second phase of estuarine sedimentation. This produced the carse deposuts whose terminal peats accumulated at 5500 b.p.

The modern estuarial deposits partly bury those of the two preceding estuaries, which exert a major control on the migrations and depth of the modern channels.

One unit of donor blood may be used to treat several patients. Each recipient is given the appropriate blood component. Proper component therapy is more effective and less hazardous than whole blood transfusion. In addition, valuable human blood is conserved.

Transfusion services require facilities to process fresh blood and separate otherwise labile components such as cryoglobulin precipitate and platelet concentrates. The production of large amounts of these components and of fractions such as plasma protein solution is facilitated by the clinical use of concentrated red cells rather than whole blood. Recurrent shortages of fresh donor blood are inevitable. Components which can be preserved for long periods should be stockpiled.

Plasmapheresis, plateletpheresis and leukapheresis allow the frequent collection of selected components from individual donors. Some of these donors may be hyperimmunised by the injection of an appropriate immunogen, and a specific immunoglobulin IgG can be prepared from the donated plasma. Hazards such as wrong identification and protein depletion must be avoided by individual attention to plasmapheresis donors.

Automation and modern transportation may increase the availability of blood. The importance of the blood donor to the health service and to the community should be fully recognised.

The present poor understanding of the fundamental mechanisms of estuarine water movement necessitates an empirical or semi-empirical approach to the circulation problem.

The Tay estuary may be considered as a system for which the inputs consist of phenomena of marine and fluvial origin, and the output is the resultant fluid motion. The definition of the boundaries of the system and of the inputs is explained. The functional dependence of fluid motion is examined with respect to the existing knowledge of estuarine circulation and the economic and technological difficulties associated with prototype estuarine investigations. The results of these studies formed the basis for planning a field study of the Tay estuary.

Data collected during the year 1969-70 has permitted the formulation of empirical relationships between parametric forms of the input and output variables. Thus, to a first approximation, the parameters of estuarine water motion can be predicted for particular antecedent input conditions.

‘Selective transfusion of appropriate blood components is preferable to the routine use of whole blood.’ (American Association of Blood Banks. Physicians' Handbook of Blood Component Therapy, 1969).

The rational use of donor blood in the environment of modern blood transfusion revolves around a series of developments in the field of component therapy. The fractionation of plasma, i.e. the separation of plasma into a series of subdivisions each containing one or other of the constituent proteins in varying degrees of purity and concentration, was one of the first of these developments to become established.

Early fractionation of plasma was applied in various ways to the purification of animal antisera; initially to antipneumococcal serum for therapeutic use. These sera frequently provoked reactions in patients until Sabin showed that absorption with Fullers earth could abolish these side-effects by removing complexed molecules.

Even a superficial attempt to record the earlier studies on the Firth of Forth brings out the importance of the Royal Society of Edinburgh in supporting research on the underlying principles of estuarine water conditions.

My bibliography starts with the Transactions of that society for 1816, though it is not until 1884, with the studies of H. R. Mill, that we come to work which is really useful to our present purpose. Mill worked from a floating laboratory at Granton Sea Quarry. He carried out twice-daily observations at the Quarry, and systematic observations over a long period at 12 stations in mid-Firth, from Alloa to the Isle of May, and also at several points on the south coast. He reports on variations (largely seasonal) in temperature and on density as an index of salinity, and on the alkalinity of the water. These latter, of course, vary largely with the river inflow, which has a rather imprecise correlation with season.

The Forth Estuary is divided into two parts, the narrow part to the west of Queensferry which is wholly within the area of the Forth River Purification Board and in which there is a substantial tidal variation in salinity, and the broader part to the east of Queensferry which is divided between the Forth and Lothians Boards and is virtually open sea.

There is no record of extensive biological appraisal of the narrow part of the Forth and the quality is assessed largely by general physical and chemical observations. The quality is largely determined by discharge of degradable organic matter in the form of sewage, sewage effluents and trade effluents, the bacterial oxidation of which deoxygenates the water, more or less, according to the combination of fresh water flow, meteorological conditions and the monthly tide cycle. The condition may be aggravated by thermal waste discharge.

In the broader part of the estuary on the north shore, pollution problems are limited to the littoral zone. In a number of places there is local beach pollution from sewage solids but mining pollution in the form of washery slurry pit redd and ferruginous pit waters has extensively affected conditions over a six mile stretch of shore.

In 1967 when Tullis opened a discussion on ‘Methods and standards of blood transfusion’ he said that the discovery of citrate, which made it possible to store blood for a few days before transfusion, was perhaps the worst step that ever took place, because it made it possible for clinicians to abuse blood. Now they could collect it in a bottle, put it in a refrigerator for a few days and fully inactivate many labile components such as platelets, anti-haemophilic globulin, leucocytes and lipoproteins [1].

When blood is stored prior to transfusion there is a deterioration in the viability of the red cell in addition to other components. This has been assessed mainly on the post-transfusion survival, but in recent years more interest has been shown in the oxygen-carrying capacity.

The introduction indicates the legal position relative to the control of discharges to the Forth estuary. Details are given of the volumes of the known sources of pollution, in 1958; chemical, bacteriological and biological data then follow relative to a survey carried out in August and September of that year. The conclusions, drawn from the 1958 Survey, emphasised the gross pollution existing at that time, and suggested methods whereby the pollution might be reduced. Section 4 of the paper discusses the results of chemical, biological, bacteriological and hydrographical surveys carried out since 1962. The results stress the deterioration in conditions in the estuary compared with the earlier survey, and in particular, the lower dissolved oxygen concentration in inshore waters and the increase in the Coliform and Escherichia coli counts in certain areas. Isolation of Salmonella species implies the possible health hazards existing at the present time. Work so far carried out in respect of the determination of heavy metal concentrations in core samples taken in the intertidal zone along the shore has indicated relatively high concentrations of certain metals and their effect on the ecology of the estuary has yet to be fully assessed. Float tests made over a period emphasise the tendency for the sewage discharges to be confined to inshore waters, resulting in the gross pollution of certain beaches. Present information stresses the need for the continuance of the monitoring programme.

If the organisers of this Symposium had invited our colleagues in the pharmaceutical industry to outline their concepts of efficiency, it is probable that two quite separate areas of endeavour would have emerged. In the first place, emphasis would have been made of efficiency in terms of technology, use of manpower and the production of profitable and useful by-products. In the second place, as the result of clinical trials, the persuasive Clinical Advisors would define the type of patient likely to benefit from their preparations, the correct dosage and the possibility of untoward effects. It is these broad aspects of effectiveness and safety which I wish to discuss in relation to blood transfusion, set against the fundamental question: what we are doing with our raw material at the present time and what awaits us in the future?

The most valuable species are Nephrops, salmon, haddock, lobster and sprat. Demersal fish, haddock, whiting, cod, plaice and lemon sole, are mainly taken by seine-netters and light trawlers from 40 to 70 ft overall length. Landings of cod and lemon sole have declined, as has fishing effort. The estuarine environment is especially important for plaice and cod, which spend their early life in coastal waters. Pelagic fish, herring, sprat and mackerel, are unimportant but occasionally pair-trawling for sprats occupies up to 75 boats. Nephrops trawlers, from 40 to 55 ft, fish mainly west of May Island. The Nephrops stocks are heavily exploited. Creel fishing for lobster and crab supports 85 boats. The lobster stocks are intensively fished and landings have decreased. Periwinkles and mussels are gathered but shrimps, though present, are not exploited. Landings of salmon and sea trout, mainly by net and coble from the estuaries, are important chiefly in the Tay. The fisheries have changed dramatically in the past century. Those for herring, oysters and queens have ceased whilst new fisheries have developed for Nephrops and sprat.

When one has spent—or mis-spent—substantial fractions of many years in gathering materials for a study and has eventually seen the results published in book form one is strongly conscious of a need to forget; at the very least there is a wish not to live in repetitious ways. An ancient Arab proverb, possibly relevant here, runs something like this: the word you have spoken is your master; the word you have not spoken is your slave. And so it is with my book The Gift Relationship which I sub-titled From Human Blood to Social Policy.

(1) Factor VIII preparations in the treatment of haemophilia and von Willebrand's syndrome. It should be appreciated that despite the recognition of many genetically determined coagulation defects, haemophilia is the only relatively common hereditary coagulation defect. The incidence is of the order of 1 per 20 000 of the population. Although relatively rare, the severe haemophiliac has so many problems that relevant therapeutic issues impinge more frequently on the physician than the incidence rate would indicate. These preparations also have a role in the rarer disorder of von Willebrand's syndrome, which is a genetically determined haemorrhagic state characterised by a prolonged bleeding time and often by a deficiency of factor VIII.

Plasma is used in the treatment of these conditions either as whole plasma or as one of its fractions —a simple prepared fraction called cryoprecipitate or as a lyophil dried preparation made by much more sophisticated and expensive techniques.

(2) Consideration must also be given to factor IX in the treatment of haemophilia B or Christmas disease.

In some ways this is easier to treat while in others it is more difficult. It is easier in the sense that factor IX is much less labile than factor VIII, but cryoprecipitate does not contain therapeutic amounts of factor IX and there is no equivalent simple fractionation procedure for factor IX. The ‘purified’ fractions are prepared by relatively more sophisticated and expensive techniques.

(3) In the management of vitamin K deficiency, oral anticoagulant therapy or liver disease then purified preparations of factors II, VII, IX and X may be required.

(4) In the defibrination syndrome fibrinogen may be needed.

Although no particular studies have been made of pollutants in fish of the Forth and Tay estuaries, samples from these areas have been examined together with similar samples from other Scottish coastal waters, as part of a national survey of marine pollution. The contaminants investigated so far have been organochlorine compounds, including pesticide residues and polychlorinated biphenyls, mercury (including organic mercury), lead, cadmium, copper and zinc. Pelagic and demersal fish, molluscs and Crustacea have been sampled, although not all contaminants have been determined in all species.

Few samples have been obtained from the upper sections of the two estuaries, but in comparison with residue levels found in other Scottish waters the species in the two areas contained concentrations little different from those considered to be normal. The selection of species and tissues for analysis, and the problems of interpretation of the analytical data, in terms of locating the sources of pollution and assessing the effects of the pollutants on fish, are discussed. More detailed surveys would be required to identify any localised areas of high contamination.

Although active immunisation against infection tends to diminish the usefulness of immunoglobulin a return to passive immunisation may well occur because of the public apathy regarding childhood immunisation schedules, the development of antibiotic resistance and the expanding proportion of patients who are infection prone because of immunosuppression. An assessment of the usefulness and likely demand for immunoglobulin is urgently needed. It does not transmit infection and it is generally free of side-effects when a single dose is injected. Human normal immunoglobulin prevents infectious hepatitis (virus A) and measles and is valuable for hypogammaglobulinaemic patients. Limited supplies of human specific immunoglobulins are available and effective in preventing Rhesushaemolytic disease, in treating the complications of smallpox vaccination, and for tetanus prophylaxis. Hyperimmune material may also become available for the prevention of serum hepatitis (virus B), chickenpox and the rubella syndrome. Problems of administration and supply could prove difficult to overcome. The principles involved in preventing Rhesus-haemolytic disease with immunoglobulin could possibly be applied in the management of auto-immune disease at some future date.

Two aspects of the relationship between macroalgae and their environment are considered.

Firstly, the serious deterioration of algal populations in the Joppa area is examined, comparing recent studies with those of G. W. Traill, an active phycologist working on the marine algae of the Firth of Forth in the nineteenth century.

The second aspect of the paper is an assessment of the contribution by macroalgae to estuarine ecosystems. The path of photosynthetically fixed carbon through the growing macroalga, and the various ways it enters the water receive particular attention.

The river Tay receives water from an area covering over 2500 square miles of Scotland and has a discharge which is greater than that of the Severn and the Thames combined. It is, in addition, the least polluted of our major British rivers today. It thus provides a composite sample of the waters draining through much of east central Scotland, it provides a baseline for studies on other major British rivers, and with the impending upsurge in industrial activity along the Scottish east coast with the discovery of oil and gas in the North Sea, the importance of having a baseline against which future environmental changes can be measured is now a matter of urgency.

Plasma fractionation has provided a number of materials which may be used to treat conditions in which whole blood would be of little or no value. It was in 1944 that Cohn and his co-workers published a series of papers on plasma fractionation (Cohn et al. 1944) and in the same year Janeway and his colleagues first suggested the use of albumin in hypoproteinaemic states (Janeway et al. 1944). Since then many accounts of the treatment of generalised oedema have mentioned the employment of salt-poor albumin as an adjunct to therapy (Chamberlain et al. 1966; Garnet and Webber 1967; Silverberg and Kjellstrand 1968; Snashall 1971), but no attempt has been made recently to evaluate the place of albumin in such patients.

The Blood Transfusion Service has an important role to play in organ transplantation in finding and classifying typing reagents for histocompatibility testing. The development of banks of frozen blood is of importance in reducing the incidence of sensitisation to HLA antigens and the hazard of posttransfusion hepatitis.