PNGAA LibraryOld men forget: Peter Booth |
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Dr Peter Booth arrived in Port Moresby in October 1962 to take up the position of the first Director of the Red Cross Blood Transfusion Service in the Territory of Papua New Guinea. When he arrived, the Blood Transfusion Service consisted of two nursing sisters in Port Moresby and one in each of Lae and Rabaul, with a few ancilliary staff. By the time he left, shortly before Independence, there was a fully operational Blood Bank in all the major centres. Peter Booth was a serologist. His wife, Kitty, was a heamatologist. Between them, they knew everything about blood that was known. While he was building the Blood Transfusion Service, she was a specialist pathologist at Port Moresby Hospital. A formidable pair, especially as Kitty had a hairstyle like that of Elizabeth II and a regal manner that concealed a shy person. After some years in Christchurch, running the Blood Transfusion Service there, they returned to Port Moresby, where they shared a Visting Professorship at the University of Papua New Guinea. Then as a prelude to retirement, they went to Nepal where he spent two years helping the Nepali Government to set up a Blood Transfusion Service. In April 1989, well into his retirement, Peter Booth was invited to deliver the inaugural Ruth Sanger Memorial Ovation at the Conference of the Australasian Society for Blood Transfusion, to be held in Christchurch in October 1990. Although not in good health, he accepted this invitation and, with assistance from his daughter Suzie, completed the manuscript shortly before his death in February 1990. It was his 100th paper and, renamed the Peter Booth Memorial Ovation, was read at Christchurch by his son Nick. Hello playmates. This is Peter Booth, your friendly orator, speaking. I'm getting off my chest this oration for our Society, and have called it Old Men Forget. Not very subtle, but Shakespeare was joking, of course, as you are bound to find out. Anything designed for an audience—whether book, play, symphony, or oration, for example—should engage the attention straightaway. Writing a century ago (ten years before ABO blood groups were discovered) Daisy Ashford, aged nine, knew this instinctively when she began her slim masterwork, The Young Writers, by telling us that Mr Salteena was an elderly man of forty-two, was fond of asking people to stay with him, and had quite a young girl staying with him, of seventeen, named Ethel Men. Etched forever in the mind. Quite a different sort of girl, Henrietta Wilson, born two hundred years ago to lead a rather steamy life, opened her Memoirs, appropriately enough, with a bang, thus: "I shall not say why or how I became, at the age of fifteen, the mistress of the Earl of Craven." One could speculate, of course, but instead, if you are sitting comfortably, I could start by saying why and how I became, as an elderly man of long gone forty-two, your Orator today. When, in April 1989, I accepted this honour, it was with some trepidation. Of course it was a privilege, and I felt bound to comply under the Noblesse Oblige section of the Old Pals Act, having first met Ruth Sanger some forty years ago, and Judith Hay, who was doing the asking, just a little more recently. It was heartening that there seemed to be some optimists about who expected me to survive another eighteen months, and with intact marbles. Concerning these, you can form your own judgement. Dotage or just anecdotage, that is the question. The problem was, what to say? Not difficult, and always a pleasure, to pay homage to Ruth and we'll come to that later. But what else? I can hardly hope to stun you with the blunt edge of modern up-market transfusion medicine. From this I have been happily insulated for some years now, being no longer on the game but living quietly. Of course, one man's quiet is another's riot, and I have a tale to illustrate this. First, though, let me reassure you that there will be a bit of substance to this dissertation, after the foreplay. On the rather frayed record of a lifetime spent in blood transfusion, I propose to string a few pearls—tarnished, I daresay, and not uniformly edifying—but which should give some idea of the continuity and progress of a subject which at least in some of its aspects must interest all of us here present. The historical references may combat the pervasive and pernicious belief that nothing much could have happened on this planet before one's own lifetime. Unlikely though it seems, there was life even before Landsteiner, so I'll touch on the growth of knowledge. But in a minute. In a minute! First, about Edmund Kean, the great actor. He had a long nose, considered by some to be a sign of vinlity. Certainly Kean’s activities lent colour to this belief, and in 1825 he was embroiled in a frightful scandal concerning the wife of an alderman. The Times denounced him, thunderously, as a profligate mummer, and the Manager of Drury Lane Theatre asked to see him at his lodgings, to persuade him not to appear. He found the actor sitting up in bed, drinking brandy and water and smoking a cigar, being soothed by a broom girl dressed in picturesque attire, and watching a strolling acrobat tumbling over the furniture. Kean pooh-poohed the managers fears, adding “see how quietly I am living here”. This sort of lifestyle is, I daresay, still commonplace, especially at festival time in the cities of the plain such as Adelaide and Christchurch, but as far as I know is alien to rural New Zealand, possibly due to a shortage of broom girls, with or without picturesque attire. Plenty of strolling acrobats, however; now called politicians. So much for the quiet life. Now about knowledge. Some three hundred years ago Sir Thomas Browne, who was a physician as well as a writer, felt that “what song the sirens sang, and what name Achilles assumed when he hid himself among women, though puzzling questions, were not beyond all conjecture”. Less than twenty years ago I asked candidates in a New Zealand technologists’ exam to compare and contrast the discovery of the ABO and Rhesus blood group systems. An absolute sitter I thought, so I was astounded that for some it proved a puzzling question, giving rise not only to amazing conjectures, but also to protests to the referees that it was not in the syllabus. These were disallowed; presumably the referees felt, as I did, that the origins of blood transfusion—the scientific variety, not Popes and choir boys, lunatics and lamb’s blood—should not be allowed to lapse into obscurity so soon. One exam candidate who did have some idea of the facts also had a touch of the Ashford-Wilsons, and began her answer with a gripping account of how Landsteiner always took morning and afternoon tea with his colleagues at the University of Vienna. In the Library, if you please. One could almost smell the old leather and hot chocolate. She went on to say that it was on one of these occasions that Landsteiner was hit with his Great Idea. For a moment I thought she would have him leap to his feet, shouting “Eureka!” (in German) and scattering the Sachertorte and Wiener Strudel like piffle before the wind, but the account suddenly became pedestrian. Pity really, though it seems highly unlikely that the idea of human blood groups came over Landsteiner like a hot flush. More a slow, cold fermentative process, such as is needed to produce first-class wine. There is evidence from the great man himself that he did not regard his discovery as a Great Idea, for the first mention was in a footnote to his 1900 paper entitled Concerning Knowledge of the anti-fermentative, lytic and agglutinating effects of blood sera and of lymph. Here is an unusual representation of Landsteiner, on a medal struck to commemorate the Silver Jobilee of the Japan Society of Blood Transfusion. His big brother is Hiroshige Shiota, a Japanese pioneer. This memento was produced for the Silver Jubilee of the Japan Society of Blood Transfusion in 1977. I hope that the Council of our Society is proposing some original mark of our Silver Jubilee next year rather than a plastic kangaroo. Landsteiner, born 1868, was quite a young boy of seven when incompatibility between bloods of different species of animals was reported and no doubt he learned all about this. The animal work itself followed after knowledge of bacterial agglutination by immune antisera had been acquired. We are getting back now to Pasteur, born 1822, and then Jenner, born 1749, and vaccination; but that was before my time. The point I wish to make is that these discoveries were incremental, not saltatory. (Saltation describes the mode of progress of frogs, kangaroos, certain birds, and also electrical impulses along the neurones of those who possess any.) That knowledge gives an appearance of progressing by leaps and bounds is largely illusory. As Hippocrates stated in his first aphorism: Life is short, Art is long. Thus it is hard for us to see events separated in time by perhaps a quarter of a century as being connected or even consecutive, but bear in mind that the mode of ABO inheritance took twenty-four years to establish. Popular belief in the myths of sudden break-throughs, miraculous discoveries, and astounding revelations is fostered by those agencies of misinformation and self-advertisement known collectively as the Tedia. Look at this, the front page of the world’s most smoked newspaper, the New Guinea Post-Courier. This edition features lmpuru Samu, the original New Guinea Gerbich negative who started everything off. But it is apparent that the tremendous progress made in blood transfusion matters over the last half century, and, as previously mentioned, even the discovery of the ABO groups, did not arrive out of thin air, any more than did Archimedes’ discovery of the way to relate mass to volume—i.e. specific gravity. According to legend, that finding came out of bath water rather than thin air, and was literally saltatory, as Archimedes leapt from the bath and streaked off starkers, shouting “Got it!” In Greek, of course. But the reason the finding came at all is that it was being sought. King Hiero II of Syracuse had put the hard word on, as he wanted to find out if his 250 BC model gold crown had been adulterated with silver. We are not told why he suspected the goldsmith. Eyes too close together, perhaps? Two left feet or nose too long? Would you buy a second-hand gold crown from Richard Nixon? Perhaps you would from Schnozzle Durante who was a discoverer in his own right. Some of you may recall that he was the guy who found the lost chord. It might be appropriate to end this section with a few words from Sir Isaac Newton, a modest man who was good at discoveries. Shortly before his death in 1727 he said that to himself he seemed like a boy playing on the sea-shore, diverting himself in now and then finding a smoother pebble or a prettier shell than usual, while the great ocean of truth lay all undiscovered before him. That ocean is, I feel, not very likely to be disturbed by anything I may say, but we could try turning over some of the flotsam and jetsam deriving from the last fifty years of blood transfusion. My own initiation took place in 1938, when ABO groups were tested as part of a practical at Cambridge. I was most disappointed to find I was group O, my slide lacking any of these interesting agglutinates. So I gave it all away until April 1944, when the British Army decided to groom me for stardom by sending me on a short course at their blood supply depot in Bristol. On the strength of this, I was, a year later and in India, winkled out of a 1200 bed general hospital in Bangabre (which had neither beds nor patients, nor indeed any building), and posted to the Base Transfusion Unit in Poona. The dastardly idea was that I should take a Field Transfusion Unit up the jungle. (An FTU consisted of a medical officer, a sergeant, a driver, a jeep, and a two-tonner with rather more equipment than could conveniently be stored. Its task was to provide blood to Forward Surgical Units.) Anyway, as I arrived in Poona with hepatitis A, I went up the Himalayas on sick leave instead of up the jungle and, by the time I got back, the war was more or less over. In 1976 at the Fifth International Congress on Immunology, Ruth Sanger gave the Ernest Witebsky Memorial Lecture, entitled Blood Groups in Human Genetics. In it she happened to mention “amateurs, like myself, drawn into blood groups by the transfusion services of World War II”. While Ruth fell, and I was pushed, I’m sure neither of us suspected that a life-long commitment to blood groups had begun. Nor were we the only ones. Already in Poona in 1945 was George Bird, who twenty years later was to quit India to become the scourge of Birmingham. Geoffrey Tovey was striving with those new-fangled Rh antisera and 20% albumin, but he soon left to begin a life sentence at Bristol BTS. In India too was Jack O’Riordan, the leprechaun of Dublin. We four met by chance in 1969 as we boarded the plane at Heathrow en route to the ISBT Moscow meeting. There was a good deal of boisterous auld lang syne, causing the Aeroflot wardress to take a dim view. Her first reaction was to try separating the men from the women (our wives) to ensure there would be no zizi-pompom or hanky-panky in the aisles. We resisted this move, so she slammed down our lunch trays in a marked manner. All a bit farcical as the only other passengers seemed to be a couple of commissars in the caviar and samovar section up front. Back at the ranch—Poona, 1945—we found Rh grouping to be less troublesome than expected, and soon were testing antenatal patients from the Presbyterian Mission Hospital clinic in Poona City. This hospital selected itself because it was fairly small, suiting our limited resources, because it was free from bribery and corruption, and because the two valiant Scottish ladies in charge had a robust attitude to blood transfusion. Their rule was: Hb less than 2g/dL, needs transfusion; between 2 and 4g, may need transfusion; greater than 4g, potential blood donor. Or so they said. We found few D negative Indians—about 1 in 25, I think—but early in 1946 it fell to my lot to transfuse a miserable little blighter, weighing all of 5 lb, with severe HDN. I drew the short straw as by then all my seniors had gone back to UK. Note that in those days the buck passed upwards. Nowadays the end result of buck passing often seems to be that the cabin boy kicks the ship’s cat overboard. Quite by chance, everything went according to plan, and the infant did well. He eventually perhaps did rather too well, as I most unexpectedly heard, about fourteen years later, when an Indian nurse on a Florence Nightingale Scholarship visited the North London Blood Transfusion Centre as part of her junketings. Before I even had time to pour the ceremonial cuppa char, she began to parade her credentials, telling us she had trained at the first hospital in India to perform antenatal testing and to treat HDN. I was strangely interested, of course, and even more so when she developed a touch of the Ashford-Wilsons and told me—word for word as she had heard it as a student midwife, I suppose—how the gallant British officers came by night and pumped this tiny scrap of Indian humanity full of good blood. (It was certainly by night, and the lighting was appalling, but I deny the charge of pumping.) Recovering from the shock, I asked if she knew what became of the infant. “Of course,” she said, “all the nurses are knowing that naughty boy.” It transpired that he was exhibited annually to the student midwives, and I suspect that his position as India’s premier erythroblastatic had given him some ideas “au-dessus de sa gare” as Terence Rattigan said in French Without Tears. One would like to know if, as an elderly man of some forty-two, he is still being exhibited and trying in vain to exercise the droit de seigneur. In the end I told this nurse that the gallant transfusionist was myself, and she looked pretty horrified. No doubt in her mind’s eye she had envisaged a minor Hindu Deity descending in a chariot of fire, or a least a sunburnt Chariton Heston, and I did not meet these specifications. As I said, reagents were scarce in India, and to eke them out we used measured volumes rather than drops, and managed 100-200 tests per ml, in precipitation tubes, capped, two hour incubation. This was indeed the method most used for the next twenty years or so. The measured volume was the last 5 mm of a fairly fine-drawn Pasteur pipette, marked with a speck of grease pencil. I was this method under quite different circumstances at the old hospital in Lae in 1963. (The grease pencil, not the serology.) This picture is in fact the old hospital at Saiho, 18 miles and 18 rivers from Popondetta, but it is just the same. Bush materials, flat swampy ground, a tropical paradise, and absolutely lethal. Infested by mosquitoes all full of talciparum malaria—luckily not chloroquin-resistant in my day. The lab was much the size of an average garden shed, and when it contained two burly Melanesians—Edward the technician and his mate—and myself, it seemed like Wembley Stadium on Cup Final Day. I was peering about, longing to see what marvels of science the Director of Public Health might, in his wisdom, have provided, and had identified a battery operated EEL colorimeter and a hand-powered centrifuge, when Edward suddenly seized a colorimeter tube, held it up to the light, and drew across it a flamboyant grease pencil mark. He looked at me defiantly, so I asked "Wha's that?” He replied “4 ml”—but I only laughed and he looked disappointed. I knew he was leading up to the usual complaint about shortage of pipettes, which was nothing to do with me but much to do with the adoption by many PNG labs of a “no wash” technique, which involved using a fresh pipette for each test, then leaving it on the bench to dry. In consequence, many pipettes found their inferior orifices were blocked by the Sands of the Nile. So instead of laughing maybe I should have smiled an inscrutable smile—like the Sphinx. Edward liked these ploys. An Australian nursing sister had riled him by too frequently presenting her walking wounded for path tests just as he was going to lunch. So one day he was ready for her. Hb and blood group were requested. Edward pulled down the patient’s left lower eye-lid and carefully inspected the mucous membranes. “10g, Sister.” “But what about the blood group?” Edward pulled down the patient’s right lower eye-lid. “Group O, Sister.” And so to lunch. Some years later Edward found he had disadvantaged himself by avoiding the Nelson touch system whereby we got the old war-horses over the jumps and through the hoops when a three-year Certificate course for lab technicians was introduced, largely by dint of my wife’s efforts. So he applied to take our exam, but with Certificates come Regulations, and Evidence of Secondary Education was needed. No-one doubted that Edward had spent the best years of his life at high school, mostly playing the guitar, but my wife had to write an enquiry. Thereafter some time elapsed, but eventually the school replied. It was most unfortunate, they wrote, but investigations had revealed that all records of Edward’s scholastic attainments had been eaten by cockroaches. So his bathing suit never got wet, and we note you must watch out for your testimonials in the tropics. This story has, I’m glad to say, quite a happy ending, for even the Public Health Department felt that Edward had been a bit hard done by, what with the Regulations and the cockroaches. So eventually he was posted to his home province, which was about as far as one can get from HQ, and given a lab to run with a small responsibility allowance. This was really quite generous, for in addition to transporting Edward and all his worldly goods and possessions, the Department also had to transport his wife and his twelve or thirteen children. He was not just a guitar player. Reverting to Saiho old hospital, I had another picture to show you, but have mislaid it. It showed preparation of the patients’ lunch: slices of bread being fried in pig grease on top of old 40 gallon drums. It smelt delicious, and I was even more envious after lunch with the Saiho Medical Officer. He was a single man, with mind well elevated above the humdrum, so he failed to notice that his house-keeping was being deplorably neglected by a handful of slovenly Papuan house-boys, who served up an abominable lunch. However, an even worse meal from PNG is on record. It was served in 1888 at Government House, Port Moresby, to the Resident Deputy Commissioner, Hugh Hastings Romilly, who was living alone there, awaiting the arrival of the first Administrator, William MacGregor. When Romilly came to breakfast on his first day, he was confronted by a table covered with a dirty old blanket on which was arranged a bizarre meal.
That report came from a Canon, so should be authentic. I refer to lan Stuart, Canon of Dogura Cathedral, Papua. Moving on to a more salubrious occasion, this photo was taken in early 1952 at one of the Inauguration Ceremonies for the new North London Blood Transfusion Centre, at Edgware, by Tom Davies, who is doubtless well-known to many of us. Some thirty years later he succeeded Tom Cleghorn as Director at North London. The then Director, Jimmy James, is seen propping up his hat stand (or vice versa) at the near right, and may well have been exercising severe quality control on the Dry Martinis he favoured. Next along is Rob Race, then Bill Maycock, with the pipe he had probably forbidden himself at his Blood Products Unit at Elstree, where fractionation was by an ether method. This had originally been worked out by Margaret Mackay (ex-Adelaide, I think) and her colleague Bushby, as a lab exercise. She told me that large-scale production had not been envisaged. Ruth Sanger stands next to Maycock, and then front left we can observe the lawyer-husband of the Centre’s SRN illicitly clasping Hal Crawford, a Canadian then working with Pat Mollison and Marie Cutbush at Hammersmith. On the right, Arthur Mourant lays his hands on both Margaret Mackay, already mentioned, and Gertie Plaut. I expect you know something of Arthur, through his monumental tome The Distribution of the Human Blood Groups, his early (1945-46) serology (e.g. anti-e, -Lea, -k, and the Coombs Test), and his late first marriage when he was quite a young boy of gone seventy. Plautie may not be so well known to you, but she was to me, as I worked beside her for fifteen years. She was in charge of the lab at North London. She qualified from Heidelberg in 1933, and had to flee Hitler. One of her teachers had been Hirschfeld. Inevitably I absorbed much concerning lab work and attention to detail from Plautie. She so impressed my son, when he was about three, that he believed “Plaut” was the generic term for all those who wore white coats; Plautie being the feminine form, I suppose, or perhaps an endearment. I am glad to report that my son is alive and well, though living in Sydney. Quietly, of course, as befits an elderly man of gone forty-two. Lastly, the debonair boulevardier in the middle is not lucky Alphonse. Not at all. It is I, your orator. Just now, I mentioned attention to detail, which I recommend. It paid off on each of the two occasions when I was present at a Transfusion Centre opening. The first was Edgware, 1952. The Minister of Health, lain Macleod, was coming, so beforehand Jimmy and myself wandered around to see that all was in order. It was, until we reached the wash-up department. There, against gleaming tiles stood an enormous drying cabinet, the size of a double wardrobe, and painted that dull dark green beloved of in Whitehall. Certainly it caught the eye, so we thought we should see what lay within, expecting of course the usual masses of rubber tubing, drip chambers, glass tubes, metal fitters, rubber bungs, pilot bottles, etc., that were always being washed and recycled. Imagine our consternation when it proved to be empty, save that bang in the middle stood the largest pudding any of us had ever clapped eyes upon. Talk about a bun in the oven! It was heaving and hissing and quaking, rather like the bubbling mud at a Thermal Resort, but with a more appetising smell. Jimmy sprang back a pace, adopting a pugilistic defensive stance and poking out his left at the apparition. At this there was an anguished squeal from the rear, and thrusting through the throng came a vigourous and impertinent bottle-washer, crying out “It’s my bread pudding, Dr James. It’s my bread pudding”—as if Jimmy was about to scoff the lot . And seizing the pudding in her gloved hands, she rushed off with it we knew not where, leaving us gaping. In that tale, something was present that should have been absent. East of Suez, matters are ordered differently, so when thirty years later a new Blood Transfusion Centre was inaugurated in Kathmandu, something that should have been present was found to be absent. This new Centre, its equipment, and staff training, were funded by the Australian Government as a Development Aid Project, with Red Cross in Nepal and Australia as agents. This new building was to replace an extremely low caste dungeon owned previously by the BTS. Nepal Red Cross most fervently wished that the Queen of Nepal would smile upon them, but Queens don’t bat on sticky wickets, and she kept them waiting for four years before deciding that the BTS was a going concern and deigning to open the place. So meanwhile HRH Princess Princep Shah, Chairman of Nepal Red Cross and aunt by marriage of the King, was to hold an Inauguration. Mindful of the bread pudding, Kitty (my wife) and myself did a sweep through the building on the big day. Nothing was found on the ground floor, except the smell of drains associated as usual with Eastern type countries. Upstairs was a high caste western loo, suitable for substantial Royals, and Kitty took a look. The pan left something to be desired, so she pressed the button. Imagine her surprise when no water appeared in the bowl, but a veritable Niagara cascaded down onto the floor. The pipe connecting cistern with bowl was absent. A cringing minion conveyed the sad tidings to Dr Giri, Secretary of the Red Cross, who was hovering about the place and he nearly had a seizure, for he foresaw in a flash, with dreadful clarity, the horrid consequences that might be visited upon him by a grumpy Princess with feudal leanings and wet feet. Luckily, the plumber was found, almost at once, asleep on the premises and readily persuaded that it would be in his best interests to get the pipe fixed in place, and that right speedily. This he did, and we all breathed more easily. Of course, the Princess had everything under control, and just accepted a couple of glasses of good sherry—Mildara Supreme, as it happens—before clambering into her powerful Mercedes and rushing off, we know not where. That episode took place in 1980, towards the end of my career, if that is the word. Towards the beginning, in 1950, a much more momentous event occurred: the first publication of Blood Groups in Man by Race and Sanger. The sixth edition, in 1976, was the last, the authors explaining in their Preface that the subject had grown to need more than their two pencils. Victor McKusich graphically shows the problem. In 1968, about 68 genes had been assigned to the X chromosome, and in that year the first gene was located on a specific autosome: Duffy on chromosome 1. The total now stands at more than 1450. Blood Groups in Man—that marvellous book—came into being because, as Sir Ronald Fisher said in his Foreword dated 17 May 1950: "The need for an exact and comprehensive text book had been increasingly evident during the rapid progress of the previous decade.” He also said that no authors could be better qualified for the task, and today, forty years later, it seems obvious to me that every blood grouper in the world is forever indebted to them. Certainly, I myself am. Most workers know Race and Sanger through their writings, but I was privileged to be among the lesser number who knew them personally, and through most of my working life. Their enthusiasm, generosity in exposition, honesty, brilliance, and humour could scarcely fail to have a profound effect. My attitude to blood groups, their investigation and genetics was shaped by the text book, and by talking to (and being talked to by) Rob and Ruth in the 1950s. I distinctly recall being treated to a quartet for male and female voices, two pieces of chalk, and a black board. Difficult music. It concerned anti-f, so it must have been in the mid-50s. At about that time we were investigating the Chimera presented by the Ward twins, and in the relevant chapter of the text book there subsequently appeared a typical nugget, which I should like to quote: “The nine-banded armadillo is apparently born regularly in sets of monozygotic quadruplets. It was doubly surprising to learn that skin grafts are not accepted between a set of quadruplets. The first surprise was to read that armadillos have skin.” Just a brief peroration. As you know, this offering is entitled Old Men Forget. According to Shakespeare, thus spake Henry V when pepping up the troops at Agincourt on St Crispin’s Day in October 1415. Incidentally, Crispin is the Patron Saint of cobblers, young and old. But King Henry went on at once to make an exception in favour of the few, the happy few, who fought beside him. These, he said, would remember with advantages, especially when in their flowing cups. So the trouble is perhaps not that old men forget, but that they remember rather too well, and with knobs on. So bear in mind that though all the tales I tell are true, some may be more true than others. There is a final exhibit: a flowing cup of New Zealand dry white, produced not 100 miles from where I have the good fortune to live. With it, I should like first to propose a toast to our Society, its officers and members—may we all prosper. Last, but not least, to Ruth—to her continued well being, with my best wishes, gratitude, and great affection, as always.
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