To test the hypothesis that haemoglobin concentration is a poor predictor of benefit from transfusion in preterm infants, and that red cell volume is the most important indicator of anaemia, 24 preterm infants receiving red cell transfusions had red cell volume, haemoglobin concentration, and cardiac output measured before and after transfusion. Red cell volume was measured either using dilution of autologous fetal haemoglobin with donor adult haemoglobin, or with a new technique using biotin as a red cell label. The two techniques give similar results. Mean (SD) values before transfusion were 27-4 (13.3), and after transfusion 45 0 (13.7) mI/kg. Cardiac output was measured using imaging and Doppler ultrasonography, and fell with transfusion from mean 286 (121) to 251 (95.6) ml/kg/min. The red cell volume before transfusion correlated well with changes in cardiac output following transfusion, infants with a red cell volume before transfusion of less than 25 ml/kg showing a fall in cardiac output, and those with a red cell volume of greater than 25 ml/kg not showing a significant fall. There was no correlation between haemoglobin concentration, packed cell volume, or change in packed cell volume with changes in cardiac output after transfusion.A red cell volume of 25 ml/kg seems to be critical in preterm infants with anaemia, and infants with values below this are those most likely to benefit from transfusion.

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Herpes zoster is a virus infection which attacks primarily the posterior nerve root ganglion and adjacent spinal grey matter. Head and Campbell (1900), though unaware of the causative agent, termed it an acute posterior poliomyelitis. However, more extensive involvement of brain and spinal cord, including motor neurones, may occur. It is an infection which usually gives prolonged immunity. Van Rooyen and Rhodes (1940) considered that recurrent zoster was extremely rare. When it does occur, attacks are usually separated by years. The three cases described below illustrate unusual clinical manifestations of the condition. All three had clinical evidence of myelitis situated at the central end of the nerves involved in the zoster. In two the infection pursued a migratory course, passing through several segmental skin zones with a few weeks' interval between the involvement, of each. The third case illustrates the precipitation of a zoster infection by trauma to a nerve. Such "' symptomatic " zosters are recognized, but in these cases the sequel of-an encephalitis or myelitis, which occurred here, is not usual.Case Histories Case 1.-A widow, aged 73 years, in July, 1947, developed an unpleasant tingling feeling in the skin of the left buttock. Within forty-eight hours a typical herpetic rash appeared, which spread to involve the right buttock, so that she had a saddle-area herpes zoster of the third and fourth sacral segments. Four days later she developed urinary retention with overflow, for which she was admitted to hospital. This required catheterization for five days. Thereafter voluntary evacuation was possible, at first with the aid of manual pressure. When she left hospital sixteen days after the onset of the retention she was passing urine normally except for a slight stress incontinence that had been present previously. She remained well for about two weeks. Then, some five weeks after the first zoster eruption had appeared, there was a second outbreak, after the usual prodromal skin sensation, this time below the shoulder blades in the sixth dorsal and parts of the seventh dorsal areas. This outbreak was also bilateral. A few days later she showed increased ptosis, complete on the left side, and developed an unsteady gait and difficulty in st4rting micturition. Examination revealed an extensor plantar response on the right side, and an absent plantar response on the left. These features persisted for a week, after which the ptosis cleared up, followed by the bladder symptoms and ataxia. In a fortnight's time the only remaining abnormalities were diplopia on looking to the left and the plantar responses as above. Three months after the onset of the second phase ofher illness the patient was up and about normally, but still complained of slight diplopia.

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The Glasgow 'Tobacco Lords' were the subject of a classic study, but there has been no overall survey of their successors, the Scottish cotton masters. This article draws on a rich and surprisingly underused source, the wills and probate inventories of Scottish cotton merchants and manufacturers, to give a fuller picture of a group, which played a key role in Scotland's early industrialisation. It also casts light on the early decline of the cotton industry in Scotland by demonstrating how, as profits declined, the cotton masters, who had always had diverse business interests, began to move into more lucrative areas of investment, such as coal mining, iron manufacturing, railways, shipping and overseas trade.