564 NOTES, COMMENTS, AND ABSTRACTS.

towns the burgh prosecutor can investigate fireoutbreaks if requested by the town council or onspecial report by the firemaster that wilful fire-raising is suspected. As matters thus stand, the RoyalCommission’s recommendations are an obstacle to theextension of the City of London practice. Indeed theancient usefulness of the coroner as an investigatorof crime is latterly somewhat belittled. Section 20of the Coroners (Amendment) Act of 1926, which putthe coroner out of action when once the examiningjustices have taken in hand proceedings in cases ofsuspected homicide, was a serious break with the past.

BRITISH DERMATOLOGY.To the " Annals of Medical History " (Vol. III.,

New Series, July, 1931), Dr. Haldin-Davis con-

tributes an article of real historic interest settingout the foundations of British dermatology, fromwhich we learn how comparatively modern is anythinglike rational treatment of skin diseases. From thevery dawn of medicine affections of the skin musthave received attention from doctors, for the sufferersfrom skin diseases are more urgent than any classof patients in their demands for relief, while it is alamentable fact that a substantial proportion of themcan only be offered remedial measures of a partial ortemporary character. But there is hopefulness inthe fact that with the general development of path-ology more and more dermatological defaults,following upon the discovery of their origin, are

yielding to intelligent therapeutics. Dr. Haldin-Davis attributes the progress of the last centurymainly to the publication of Robert Willan’s treatisein 1808. This was an attempt at the rational classifica-tion of skin diseases based upon characteristiclesions, and the author completed half of the projectedwork during his life-time. His pupil, Thomas Bate-man, completed the treatise which was publishedunder the heading " A Practical Synopsis of CutaneousDiseases, according to the Arrangement of Dr.Willan." The basis thus introduced into dermato-logical classification has largely remained ; wherepossible the scientific procedure of classifying byaetiology has replaced Willan’s classification byappearances ; but, as Dr. Haldin-Davis points out,our knowledge of the aetiology of skin diseases islamentably deficient at the present day, exceptin the case of a few infective agencies, compellingus largely to classify skin diseases according to theirappearances. Reading this article it becomes clearthat Willan was a very remarkable man, for withoutthe microscopic aid by which so many advances in thisfield of medicine have been made, he devised a systemof classification 130 years ago which to-day is themain medium for intelligent converse between experts.

BLOOD PRESSURE IN THE CAPILLARIES.

RESEARCH which produces important results isof obvious value, but just as useful is the work whichrepeats research in order to confirm or disprove it.This checking of results will often prevent a wholecrop of errors.For a long time attempts have been made to measure

the pressure in the capillaries. Many differentmethods have been applied, but so far no satisfactorysolution of the problem has been found. RecentlyA. Sokolowski and M. Kubiczek 1 have undertakeninvestigations into the method designed by Kylin-a method of compression, which has hitherto beenaccepted as giving the most accurate data. Theyapproached the problem from two aspects, consideringfirst the technical difficulties arising from imperfectionsin the apparatus, and secondly, the results as

interpreted in the light of the anatomy and histologyof the part investigated. The imperfections in theapparatus, they found, made comparative studyimpossible and by certain modifications they triedto overcome them. Then they succeeded in makingseveral interesting observations. For example, theynoted that after the initial compression the capillaryloops continued to contract despite a rapid diminution

1 Ann. de Méd., 1931, xxix., 408.

in the pressure. This suggested. an active contractionon the part of the vessels as a result of irritation ofthe vasomotor nerve-endings in the vessel walls; .consequently, any results obtain with this apparatuswould be influenced in great part by the vasomotornerves. Again, when an attempt was made to getrepeated readings for comparative study-as, forexample, when testing the effects of certain drugs-it was found that after each compression a strongvascular hyperæmia ensued, necessitating a pauseof four to six minutes between each reading.The second half of the work consisted of a careful

examination of the anatomy and minute histologyof the part which had been investigated-namely,the skin just behind the nail bed. Sections of variousthicknesses were taken and stained by severalmethods. Correlating the results, they came to theconclusion that readings obtained by Kylin’s methodof compression, and, in fact, all compression methods,did not give the pressure in the capillaries, but gaveactually the pressure in the afferent arterioles ; inthe area under examination the arteriole was theone described by and named after Spalteholz. Again,the results were influenced by the thickness of the skinof the subject investigated, and by several other factors.The main result from these investigations is to

show the innumerable difficulties in the way of anyattempt to measure capillary pressure, and theinaccuracies of an accepted method.

ANÆMIA IN PREMATURE BABIES.As a further supplement to the work of Dr. Helen

Mackay 1 comes the report of some investigationsby Dr. G. Sanpaolesi,2 of Florence, carried out inProf. Czerny’s clinic in Berlin. He examined theblood of twelve premature babies at approximatelyweekly intervals, beginning from two days to threemonths after birth. He enumerated the total redblood corpuscles present, estimated the amount ofhaemoglobin, and calculated the water content by theindirect method of determining the total solids.All the babies were born normally, ten were onemonth premature and two were two month premature.In one case congenital heart disease was presentand another suffered from a congenital syphiliticinfection. Otherwise the children were normal anddeveloped normally except for slight digestive troubleswhich were without influence on the weight curve.None of the children showed evidence of the so-calledexudative diathesis, held by some authorities to bethe cause of the hydræmia from which they all

appeared to suffer in the third month of life. In thefirst four weeks Sanpaolesi found normal values fortotal solids and water content of the blood but inthe second month began a decrease in the solids andincrease in the water content, associated with aparallel decrease in the number of red blood corpusclesand amount of haemoglobin present. This was notaccompanied by any alteration in the weight curvesand in the child with congenital syphilis the decreasein total solids was more marked than in the normalbabies, while the patient with congenital heartdisease had only a minimum decrease. In two caseswhere vegetable additions to the diet were earlyintroduced the decrease in total solids was very slightand there was a correspondingly quick recovery afterthe third month, although no influence of the diet onthe total red cell count and haemoglobin content couldbe detected. Sanpaolesi thinks that iron deficiencyis not of great importance in the anaemia of thepremature baby which seems to be due rather to adisturbance of the water-regulating mechanism ofthe body. Further observations on the total bloodvolume are necessary to settle this point and theypresent great practical difficulty. For the momenthe merely draws the conclusion that there is certainlya dilution of the blood in the third month of life inpremature babies and that this plays a part inproducing what may be called the physiologicalanaemia of prematurity.

1 See THE LANCET, July 25th, p. 195.2 Jahrb. f. Kinderh., 1931, cxxxii., 277.