820

and they precede any signs of this by an average of sixweeks. Moreover in some cases of nerve injury theyappeared, but after a period of development towardsthe normal showed no further progress, thus suggestingsome interference with recovery ; and in such cases

subsequent operation revealed a neuroma.Serial electromyography also proved of value in

prognosis. Fibrillation potentials might be observedthroughout recovery, and sometimes persisted in smallamounts even after full clinical recovery and were

therefore of little prognostic value ; but discrete low-

amplitude potentials of short duration were seen on anaverage 8 weeks before any clinical contraction. Thesediscrete potentials were present even when clinical

recovery was finally poor, but where final recovery wasgood they were followed in a few weeks by polyphasicpotentials of longer duration. So here also the milestonesof good recovery seemed to be clearly indicated.

These two methods are to -some extent complementary.The electromyograph will give more detailed informationabout that small sample of muscle accessible to theelectrode ; and if this is luckily placed it may give theearliest indication of recovery. The strength-durationcurve will give a more coarse assessment of a largersample : it will be less likely to miss the evidence ofrecovery, though it may record it rather later. Both

represent an undoubted advance on older methods.For accurate interpretation, however, they requiretechnical skill, and, especially in the case of the electro-myogram, considerable experience.

1. Lister, W. A. Lancet, 1938, ii, 1429.2. Bowers, R. E. Brit. med. J. 1951, i. 121.3. Walter, J. Lancet, 1951, i, 475.

HÆMANGIOMAS

ANGIOMAS of the skin disfigure but are seldom

dangerous. It follows that their treatment, under-taken for cosmetic reasons, should be harmless, but thisis not always so. Among the potentially hazardoustreatments which have been recommended are variousforms of radiotherapy and injections with sclerosingfluids, including boiling water. Cases of aplasia of thebreast or of stunted growth of a limb are seen from timeto time to remind us that such risks are still taken.In some centres, notably on the Continent, frankincredulity is expressed when the visitor remarks thatmany angiomas regress spontaneously 1-3 ; and here all

angiomas in children are treated, so’ there is no oppor-tunity to see what happens if they are left alone.

The " strawberry " type of lesion is the one most

likely to disappear spontaneously. It may often be leftto do so in areas not subject to friction or to the observa-tion of over-anxious relatives. Ulceration does notaffect the good prognosis and may in fact acceleratefibrosis. Very rapid growth is an indication for treat-ment, particularly on the face, where a bulky tumour candistort the growth of nearby structures. In most casestreatment with carbon-dioxide snow, used with patienceand discretion, is quite sufficient. In others more

complicated methods may be needed, and here the

surgeon, the radiotherapist, and the dermatologistshould be aware of what each can achieve.The " portwine stain," on the other hand, shows

very little spontaneous improvement, except in themildest examples. Sometimes a gratifying amountof blanching may be obtained with Grenz rays withoutthe risk of late radiation sequelae, but this treatment isnot widely available. (3-radiation, in the form ofthorium-X paint, has also been used. There is a

growing awareness that penetrating (3-radiation and

y-radiation may occur in this treatment, and the investi-gations of medical physicists must be carried furtherbefore this method can be considered as harmless aswas formerly supposed. In women the lesions can be

successfully concealed with opaque cosmetics designedfor this purpose, but in men the effect may cause

embarrassment if more than small areas are involved.

Conway 4 has described the camouflage of naevus

ftammeus by tattooing pigments into the skin. This isa technique which has been used in the restoration of thevermilion border of the lip and in the " matching "of facial grafts. The treatment is relatively painlessand an area of from 4 to 6 sq. in. can be treated at a

sitting. In seven years 310 patients applied for treat.ment, and of these 85% were selected as likely to benefitfrom it : 159 obtained a result satisfactory to the

surgeon and themselvesńi.e., about half those who camefor an opinion. If the lesion is too superficial, thepigment is rapidly swept away in the blood; and

presumably patients with thick, tumid lesions of the lip,for example, do not obtain conspicuous benefit. Withinits limitations, however, this seems to be a harmlesstreatment worthy of further trial.

4. Conway, H. J. Amer. med. Ass. 1953, 152, 666.5. Nutrition. Summer, 1953. Published by Newman Books Ltd.,

68, Welbeck Street, London, W.1.

WEANING

FROM the moment we are pushed willynilly from thewomb we start to live dangerously ; indeed, this merepassage to the outer world is our first great hazard.After that come breathing hazards, feeding hazards,and hazards of elimination, all before we have left ourmothers’ arms. One very serious risk, which Mr. F.Le Gros Clark 5 thinks we are inclined to underestimate,comes at the time of weaning. Animals, as they wander,accompanied by their young, through their largelyedible world, manage the tricky business much better :the young need only watch and copy the parents inorder to fill their bellies with appropriate and digestiblevictuals. How different is the lot of the human infant,whose internal arrangements seem much worse adaptedto deal with contaminating bacteria than those of a

lamb, a calf, or a puppy ; and who is consciously andanxiously fed by a mother whose ideas derive from thesocial customs and food resources of her community.

In countries where the milk-supply is clean and safe,and mothers are reasonably well educated, the risks, ofcourse, are much reduced : for clean cow’s milk is aconvenient and digestible transitional food for a babyold enough to be weaned. But milch herds are a late

acquisition in the history of man, and even today mostof the people in the world have little or no milk exceptmother’s milk. Suckling and weaning among manysuch peoples has assumed, Mr. Le Gros Clark says, amagic or ritual significance. Only in a few tribes is itcustomary to stop suckling the child before the end ofhis first year : he is more usually breast-fed for anythingup to four years. If maternal milk was his only nourish-ment during that time, he would suffer badly frommalnutrition ; but since other foods are given freely,and even stuffed into him, almost from the start of life,he commonly suffers from indigestion as well. In sometribes the mother denies the child the breast for thefirst few days, or even the first fortnight of life; but

gives him other provender such as chewed banana pulp.This practice at least ensures that only the toughsurvive. In Rome, Ethiopia, and India butter may bethe first food given to the child, while the Basutosstart him off on millet gruel. Among the Chagas ofEast Africa breast-milk is supplemented, from the secondday onwards, with a pap made of milk or butter mixedwith unripe bananas and soda (used instead of salt);and from his third month the baby gets a taste ofeverything going, including meat. Being used to thismixed diet, he hardly notices weaning, except as a

disciplinary action-which, in fact, is the usual use

made of it.