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ordinary materials. To William Smellie belongs thecredit of first applying the binder in the right place,at the right time, and for the right purpose. In1752 Smellie realised that the emptying of thedistended abdomen might be accompanied by collapse,and that this was due to the rush of blood to therelaxed vessels of the abdominal contents. " The

pressure being thus suddenly removed, the head isall at once robbed of its proportion of blood, and theimmediate revulsion precipitates the patient into

dangerous lypothymia." He therefore used, after

delivery, a skirt with a broad head-band whichwas pinned firmly over a pad to compress the visceraand the relaxed parietes. He went so far as to orderan assistant to compress the belly until the binderwas in position. Prof. Phillips had records madeas a routine for seven years of the blood pressurebefore, during, and after labour, and was struckwith the frequency of a pronounced fall even innormal cases. He found that compression of theupper abdomen might be followed by an increase inthe systolic pressure of 10 mm. Hg. His practice is toapply a binder 7 in. wide to the abdomen above theempty uterus with a folded towel underneath.Admittedly this procedure is mostly unnecessary,but it can do no harm. Every obstetrician sooner orlater meets a case of extreme shock following normalor, particularly, abnormally rapid labour. Everyyear a number of women lose their lives from thiscause alone. It would certainly be worth trying toreduce the number of these deaths by the routineuse of a small binder. Such a binder need not beuncomfortable. It does not conceal the uterusbecause it does not come below the umbilicus, and itcan be removed after twenty-four hours when itswork will be done.

CAPILLARY BLOOD FLOW

THE question as to whether human capillariespossess a local occlusive mechanism, not dependentupon general circulatory conditions, has long beendebated. The Rouget cells which are alleged to beresponsible for capillary contraction in the frog havenot been demonstrated in man, and although theirabsence does not necessarily imply a lack of focal

contractility, it does suggest that different conditionsgovern capillary activity. The theory of spon-taneous intermittent activity of individual capillariesput forward by A. Krogh in 1922 was rejected in1926 by Sir Thomas Lewis, so far as the capillariesof the human skin are concerned. 1 Lewis’s conclusionswere based chiefly on observations of the vessels ofthe skin of the back of the hand, a region where thecapillaries are visible only with some difficulty..According to Bordley et awl. the skin over the tibiaaffords a better site for the study of cutaneous

capillaries, partly because in this situation the skin isrelatively transparent, and partly because the planeof many of the capillary loops subtends a very smallangle to the surface of the skin, so that the vesselshere pursue a reasonably long course more or lessparallel to the surface. Under these conditions ofoptimum visibility, Bordley and his co-workers haveobserved frequent and long interruptions in capillaryblood flow. The pauses in neighbouring capillariesare not simultaneous ; the flow in one capillarymay continue unabated, while that in an adjacentcapillary, arising from the same arteriole, may beinterrupted many times. These characteristic andindependent intermissions of flow continue to occur

1 Lewis T., Heart, 1926, 13, 1.2 Bordley, J., Grow, M. H., and Sherman, W. B., Bull.

Johns Hopk. Hosp. January, 1938, p. 1.

without material alteration when the venous pressureis raised by means of a pneumatic cuff round thelimb. The intermissions in capillary circulationare therefore not due to variations in any passiveresistance, but to some active local reaction which iseven able to overcome a moderately raised resistance.When the blood flow in a capillary stops, the arterialend of the vessel is generally empty, even in thepresence of an increased venous pressure. It seemsthat the capillary is occluded by some mechanismnot far from the arterio-capillary junction. Some-times a capillary seems to be occluded at several

points along its course. The capillary wall itselfis invisible under the conditions of the experiments,and Bordley and his associates are not able to offerany clue as to whether the cessation of blood flow is

brought about by the contraction of Rouget cellsor by the swelling of endothelial cells. They concludethat the observations indicate that the capillariesare endowed with an occlusive mechanism whichmay prevent the passage of blood through theirlumina. In the light of the observations of E. R.Clark and E. L. Clark3 this conclusion does not appearentirely justifiable. By using a transparent chamberin the rabbit’s ear the Clarks were able to see thecapillary wall, and frequently observed the changesdescribed by Bordley without ever seeing alterationin the diameter of the capillary lumen itself. Theyconcluded that there is no evidence that mammalian

capillaries in normal circumstances contract indepen-dently. This question is not yet settled, since H. K.Beecher,4 whom Bordley quotes, using the Clarks’stechnique in Krogh’s laboratory, observed contractionof the capillaries in normal circumstances.The difference between the observations of Lewis and

those of Bordley may arise from the fact that theyobserved different areas of skin. The skin of the

hand, observed by Lewis, plays a role in the dissipa-tion of body heat, and at the higher temperatures atwhich Lewis observed it might reasonably be expectedto display vessels wide open to favour the transferof heat. In the skin which Bordley examined theminute blood-vessels are of less importance in heatregulation and might open and close in response tolocal tissue needs.

THE OBSESSIONAL PATIENT

IT is impossible to investigate a special problemof psychopathology without being forced back to

general problems of normal mental life. A penetrat-ing study of the psychopathology of obsessions 5 byDr. Erwin Straus illustrates this. Beginning with thehorror of death shown by a severely obsessionalpatient, he refers this very characteristic symptom tothe disgust which decay universally arouses, and heexamines how far the quality of being in decay(das Veriresende) is a necessary or accidental (in theAristotelian sense of the word) manifest or hiddenattribute of the object which arouses disgust. It is,he concludes, accidental and hidden. In elucidatingthis he discusses the inconstant part played by theobject in determining the emotional aspect of the

perceptual process, and the pathology of those"

sympathetic relationships " to which he wouldrefer obsessional phenomena, and which he regardsas the link between obsessions and schizophrenia,just as the link with melancholia lies in the incapacityto treat the past as done with. On the time-disturbance he writes with brevity but much authority

3 Clark, E. R., and Clark, E. L., Amer. J. Anat. 1935,57, 385.

4 Beecher, H. K., Skand. Arch. Physiol. 1936, 73, 1.5 Mschr. Psychiat. Neurol. 1938, 98, 61.