399 CHILDREN WHO SPEND TOO LONG IN BED SIR,—Dr. McCluskie’s stimulating article of August 31 is a welcome addition to the growing body of commonsense advice about infant and child care. Hardly a single criticism he has made could not be illustrated from Most illustrative, any G.P. many cases known to " perhaps, of a typically successful " parental domination is the child of 3 that " lay from 6 A.M. until 8 A.M. in a wet bed playing with the blankets." It is this the unfortunate babe, from determination to " train the moment of its arrival, for the convenience of its parents’ pre-existing habits that has such lamentable psychological results. Instead of making an attempt to compromise, the parents endeavour (fortunately often without success) to mould the child hourly into their own adult groove. Thus, many modern maternity nurses teach mothers to leave their baby to cry, whatever their maternal instincts, between the rigidly set feeding times : how much this tends to destroy the rapport between mother and child is clear to see. I have known mothers to sit agonised, in obedience to this teaching, watching the clock creep round from 5.15 to 5.30, 5.45, before guiltily picking up the baby ten minutes early for its 6 o’clock feed, for a little overdue mother-love. One could cite such things ad nauseam-the rigidly measured feeds, to be taken each time, never an ounce to be left, nor an ounce extra given ; the agony of the weekly weight figures if there is a week’s stasis ; the anxiety if an 18-monther soils his trousers. In brief, the modern mother is invited to consider her baby as nothing more than a machine, requiring mathematical precision in treatment and nothing else. A great deal of the fashionable " training " seems to aim essentially at ensuring the minimal disturbance of that domestic routine which existed before the arrival of the first child, without due regard for the child itself. Two main themes of our instruction to mothers should surely be these : (1) A frank admission that parenthood means unselfishness and ’’ giving out," especially of love and individual understanding ; at the least striking a fair balance between needs of parent and child, and rather erring on the side of putting the children first " (an unfashionable phrase today) than dominating them for parental convenience. (2) While setting out the necessary feeding time-table, principles of child care and we should insist that the mother management, &c., recognises that they are only for guidance, and not to be slavishly adhered to like a railway time-table or legal code. Child psychologists would find their work lightened if the parents could be educated to ignore the " baby is a machine " school of management, and to rely on their own instincts and judgment in solving individual
sleep in one dose. But there is no harm in routine day-sleep above this age provided always (a) the length of the day-sleep is related to and not in competition with the night-sleep, and (b) that it is the child’s physiology
and not the teacher’s boredom that calls for it. Where there are two or more children who can play outside, day-sleeps can be tiring and exhausting for the mother, ’because they involve undressing, re-dressing, and remaking of beds. (The practice of putting children to bed during the day with their clothes on is a bad one because it causes overheating of the skin and sometimes
sweating.) " Rounds of pottings," indeed ! I have 3 children under six years who have never had a routine " round of potting " in their lives because they go to bed to sleep, not to be taught bad habits. There is too little respect for genuine motherhood in Britain and too much kow-towing to a nation-strangling
matriarchy. FAVUS IN DEVON or
G. F. TRIPP. Greenbithe, Kent. SIR,—My article-which incidentally is quite unworthy of the publicity it has received-does not describe a " time-table for infants and toddlers but a " plan " on which to base a time-table. It states quite plainly that " each child as he develops will soon give his mother an indication of how much day-sleep he requires " if the plan is followed. Rigid time-tables create an obsessive mind in both the mother and the child, and too much emphasis cannot be laid on the part played by motherlove in the successful handling of a child. The individual variation suggested by me is not 30 minutes but an hour, or more, or less. (Approximately 30 minutes is the time named, but some mothers may find it necessary to add ; others to subtract.) Nevertheless, having regard to Professor Biihler’s table of actual observations, which were timed not to the nearest halfhour but to the nearest second, this variation may be too large. I understand some American physicians are carrying out stop-watch nursery recordings and I await their results with interest. Between the fifth and the tenth months an infant who sleeps too long in the mornings becomes cross in the afternoons because he cannot sleep. It is easy for a mother to prevent an infant sleeping too long in the morning and so gain the benefit of the afternoon rest and no crossness. From years of experience with children I find that the healthy child of three years at home begins to prefer all "
SIR,—Whether it be due to an influx from elsewhere to an indigenous source of infection, there is some
evidence of an outbreak of favus in North Devon. Scutula are not always easy to find, nor are the nails often affected, but with Wood’s glass, a hand lens, and a microscope the infected hairs on the scalp, tiny crusts surrounding hairs, and incipient bald patches can be noted. Ringed lesions, from which the crusts have been removed by treatment, have led to the diagnosis of
of the glabrous skin.
H. W. ALLEN.
EFFECT OF PHOSPHATE ON CARBOHYDRATE ABSORPTION IN SPRUE
preliminary communication (Lancet, reported experimental evidence that in active sprue there may be a failure of the phosphorylation of glucose at the time of its absorption." It was our intention to continue our researches and publish the results in detail later, but unfortunately (or fortunately ?) the cases suitable for experiment have been too few to provide anything more than indications of Sm,.-In
1945, ii, 635)
JOHN A. MCCLUSKIE.
the direction in which future research should be devel-
oped. For the benefit of others who are more favourably placed for doing experimental work, it seems worth while recording our results of the effects of adding phosphate to carbohvdrate solutions administered to cases of
active sprue. In our first experiment a case of active sprue with characteristic history of loss of weight, flatulent dyspepsia, and glossitis was selected and placed on a simple milk diet. An oral sucrose-tolerance test was carried out and the usual flat glucose and normal fructose absorption curves obtained. To confirm that the flat glucose curve did not arise from hold up of the sugar in the stomach, the test was repeated, the sugar solution being injected by tube direct into the duodenum. The resulting glucoseabsorption curve was again flat and the fructose normal. Glucose was next injected intravenously, and, as Fairley has found in other cases of sprue, the curve of disappearance of the sugar from the blood was within normal limits. It was clear that in this case the flat glucose curve was due neither to delayed stomach emptying nor to rapid removal of the sugar from the blood, and was therefore presumably due to failure of absorption. We decided to investigate this failure of absorption by studying the points at which the complicated process of phosphorylation might fail. The accessibility of the phosphate ion We argued that if the phosphate was investigated first. were unavailable because it was absent (which was unlikely on a milk diet) or because it was present in some inaccessible form, then phosphorylation should be restored by the exhibition of the phosphate ion. We therefore repeated the sucrose-tolerance test, administering the sugar (100 g.) direct into the duodenum and adding to it 8 g. of a mixture of potassium acid phosphate and disodium phosphate buffered at pH 7-0. The result was startling. The glucose curve was now normal, the fructose curve remaining unchanged. A week later the sucrose test was repeated without phosphate