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tar which will mean so much to the young spastic. It

may even be an investment, reducing his subsequentcalls on the National Insurance funds.

Cerebral paretics the world over will always owe adebt to Dr. Winthrop Phelps and Dr. Earl R. Carlson,but the methods of attacking the problem and theestimation of its size which they have worked out forAmerica may or may not prove apposite elsewhere.If the American figures are even approximately applicableto this country, then the eighteen-month-old BritishCouncil for the Welfare of Spastics has taken on a difficulttask, for it would seem that something like two dozenbattalions of children with this form of handicap arewaiting to be assessed, trained, and equipped. Fortun-ately the council has an assurance of the warmest supportfrom the Minister of Education personally and from hisdepartment, and it cannot be doubted that this is thekind of problem to attract the sympathetic interest ofthe new regional hospital boards.- At a meeting of the section of physical medicine of theRoyal Society of Medicine, held on the same day, Dr. P. R.Evans pointed out that the British Council for theWelfare of Spastics is as much concerned with athetoidas with spastic children. The term " athetoid quadri-plegia " is used by some orthopaedists though it horri-fies many neurologists, not to mention scholars. By"

diplegia " one writer may mean paralysis of two limbs,while another means paralysis of four. A diplegia ismore than twice a monoplegia, and a monoplegia isonly half as extensive as a hemiplegia. Attainment ofstandard nomenclature so far as distribution of the

paralysis is concerned should not be hard, but agreementwill less readily be obtained in the diagnosis of conditionsassociated with athetosis. As Dr. Evans remarked,the names are important, for clinical classification mustprecede 2etiological analysis. Little’s disease is not onecondition but a group.At the same meeting Dr. J. H. Crosland discussed the

methods of treatment and emphasised the need for allconcerned, " from the porter to the person in charge ofit all," to work as a team. A bit of speech therapyhere, a lesson in drinking there, and a little physiotherapywhen the mother can manage to get the crippled child tothe department will not produce the best results. Thedifferent techniques must be integrated appropriatelyfor each individual patient.

THE FIRST TWO YEARS

PARENTS puzzled by the apparently irrationalbehaviour of their youngest children may turn for

enlightenment to Dr. Benjamin Spock.’ In explainingearly vagaries, he champions the infant with the forth-right vigour of a prophet. First, he condemns theenforced isolation of the mother from her newborn child,by which she comes to feel that " she is of little importanceto her baby and that its care can be entrusted only tomedical experts " ; and he commends the practice ofkeeping the crib in the mother’s room " so that she canbecome familiar with his noises, moods, movements andappetite, and so that she can feed him on the breastwhen he is hungry, rather than according to the clock."Babies know when they need feeding, and if given afree rein they soon work themselves into a regularroutine ; but as Spock says, a less forbidding title forthis practice than " the self-demand schedule " willhave to be found.The commonest problems during the first year are

those of feeding ; and these may be initiated soon afterbirth by arbitrary insistence on a prescribed formula." The baby who, every time he falls asleep satisfied,gets the soles of his feet snapped and the nipple stirredvigorously in his mouth begins to lose his enthusiasm

1. Spock, B. J. Amer. med. Ass. March 20, p. 811.

for food and to become balky and irritable"; and the end-result may be personality changes in both child andmother. The risk of feeding rebellion is greater whensolid foods are first started, for most infants at firstdoubt the virtues of the new regime ; and the minorityof babies who do not subdue this scepticism may enlargethe battle-front by refusing even liquid nourishment.Attempts at forced weaning for which the baby is notready " often cause bad feeling." Most infants who are

nursing at both breast and bottle show their ignorance ofnutrition in a preference for the bottle. On the otherhand, the baby who has been entirely breast-fed for thefirst few months is likely, if the breast supply is plentiful,to object urgently to letting a rubber nipple pass hislips. At about nine months infants commonly opposeattempts to supplant bottle by cup ; they " bat the cupaway suspiciously or, pretending they have forgottenwhat to do, let all the milk run down the sides of thechin." This derives from a developing shrewdnesswhich warns the child that the bottle may soon be with-drawn ; and forced withdrawal has unhappy results.Surprisingly to the uninitiated, the breast-fed babyrarely balks at weaning from breast to cup. There aretwo reasons for this : first, breast and cup are less similarthan bottle and cup, and " it is the shift to somethingsimilar that an opinionated baby resists in weaning " ;the second reason is that at nine months the babywants to be done with dependence. He wants to situp for his spoon-feeding or, if bottle-fed, to take thebottle from his mother’s hand and drain the contentswhile sitting bolt upright.The second year calls on the parent for fresh resources.

Automatic cooperation in the child gives way to a phaseof intense exploration, which is assisted by new-foundindependent locomotion. " He senses he is a separateperson, entitled to wishes and a will of his own. He

early learns to say No ’ and uses it on all occasions."In becoming more independent, he also becomes awareof his dependence ; and thus he may begin to cry eachtime his mother leaves the room. His wilfulness is

commonly expressed in choosiness at meals ; and here,Spock warns us, temporary dislikes are easily turned intopermanent hates by rigid adherence to a balanced diet.Equal tact is required in dealing with a recalcitrantbowel. " It is the child who is naturally irregular whosemother is tempted to put him on too often and to insistthat he stay on too long " ; resistance is keenest in thosebabies who have had painfully hard motions, and ill-

judged insistence increases the child’s obstinancy, anxiety,and guiltiness. Training should perhaps be deferreduntil towards the end of the second year.To many parents Dr. Spock’s opinions will smack

of dangerous heterodoxy. In the nursery tradition dieshard : whatever the rights of the case, most parents willdefend to the last ditch their rigid time-table for feedingand other functions ; and they are not likely to abandonlightly a wavering authority in trying to containtheir infants’ swelling ego. ,

THE DEATH PENALTY

WE trust that the House of Lords will endorse theCommons’ decision to discontinue the death penalty foran experimental period of five years. The argumentsfor and against capital punishment are too familiar toneed restatement, but it will always be impossibleto weigh them accurately until the deterrent effect ofexecution has been measured against that of otherpenalties under the particular conditions of our own

country. As a scientist the doctor will support sucha test, and as a humanist he will hope that the

- result may justify discontinuance of a revolting practice.Two wars have done much to make us callous, and it isheartening to see this small but significant effort toresume the task of making our society more civilised.