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In just under half the cases temporary changes occurredin the T waves, and in 7 cases there was some prolongationof the per interval, only once exceeding the upperlimit of normality and then only to 0.24 second. Inone case the electrocardiographic changes were slightlymore definite, and, with the clinical findings, suggestedthe possibility of " mild myocardial infarction," but theevidence is far from convincing. Comparable findingsare reported by Cottrell and Hayward 11 in an electro-cardiographic study of 32 New Zealand troops receivingemetine intramuscularly (gr. 1 daily for 10-12 days)and 8 receiving emetine bismuth iodide. Temporarydiminution or inversion of the T wave occurred in 25of the records after emetine, and in 12 there was slightprolongation of the P-R interval. No significant changewas noted in the blood-pressure or pulse-rate. The

consulting physician, Middle East Forces, remarked thathe knew of " only one certain case and one doubtful caseof toxic action of emetine on the heart occurring in thatCommand up to the end of 1944."

If the recognised limits of dosage are not exceeded,and if the patient is always kept in bed while emetineis being given, there seems to be little risk of toxiceffects on the myocardium. If it is forgotten that emetineis a potentially dangerous substance in large doses acci-dents may happen.

THE INSTITUTIONAL CHILD

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A YEAR ago the Government appointed a committee,with Miss Myra Curtis as chairman, to inquire into theprovision made for children who by loss of parents orotherwise have been deprived of a normal home life.This committee, which includes Mr. Somerville Hastings,F.R.C.S., and Prof. J. C. Spenoe, F.R.C.P., has now pub-lished an interim report on one group of workers havingcare of such children-namely,’ resident staff of thehouse-mother type in charge of groups of children insmall residential homes or in subdivisions of large homes.This group was studied first because, though they holda key position in relation to the children, none of thepresent arrangements for training staff in child care

are quite suited to their needs. There are courses fornursery nurses and nursery assistants, but for the house-mothers or house-fathers the only training offered is bysome voluntary bodies for their own staff, and before thewar by some local authorities, the Battersea Polytechnic,and the Vocational Training School, Bristol. Duringthe war the Ministry of Health ran courses of training,but these lasted only a week and were designed forwardens and matrons of hostels for children in receptionareas.

House-mothers, like other mothers of families, haveto undertake a good deal of domestic work, but thoseat present appointed-often capable housewives and

temperamentally fit to look after children-have rarelyhad the chance to learn much about the development andneeds of the child, especially if he fails to conform tousual standards. The house-mother should be taughthow to compensate him for the loss of his secure homebackground. TLe danger even in a good residentialhome is that children will be treated as groups ratherthan as individuals. The committee was warned bysome that formal training would rob workers of theirhomely touch and unfit them for domestic work ; butsuch predictions have not been borne out among workerstrained by voluntary organisations. The committeetherefore recommends that a Central Council for Trainingin Child Care should be set up to prescribe a curriculum,choose suitable residential homes for the training ofstudents, arrange teaching centres for the theoreticalpart of the course, appoint examiners, select students,and approve a course for tutors in the theoretical work.It is suggested that two years’ instruction, culminating11. Cottrell, J. D., Hayward, G. W. Brit. Heart J. 1945, 7, 168.

in a certificate in child care (part I), would fit the studentfor a post as a house-mother or assistant house-mother,according to her age ; while a further year, leading topart 11 of the certificate, would fit her for senior workand for promotion.A house-mother, the committee thinks, should be

able to take charge of a family group of 12 childrenranging in age from 2 to 14 or 15. The correspondingmale worker must be able to play the father’s part; heneeds an equal understanding of children though he willshare more in their outdoor pursuits and recreation thanthe house-mother. Candidates must have enough educa-tion to profit by the course, and they should be over 18and usually under 5, though some widows above thisage who have brought up families are well fitted for thework. In order to attract suitable candidates grants willbe needed to help them to take the course. Their salaryon qualifying should be commensurate with their training ;though not on a level with teachers or State-registerednurses, it will be above the level for domestic workers,.at whose rates they are at present paid.The scheme is attractive. Visitors to residential schools

sometimes notice a reserved wary look on the faces ofthe children, not compatible with a sense of security.House-mothers are often kind, well-meaning, and able,but harassed by lack of help-as the committee note-and inclined to have an appearance of anxiety unsettlingto the children who live beneath it. In the last few yearswe have seen some dreadful consequences befallingchildren taken from their parents, and though these mustnot weigh unduly against many happy and successfulfoster relationships, we should keep them in mind whenplanning to do better. The committee believes that itsscheme will not cost more than 1:5000 a year-a small

price to pay for a very wise measure.

TINEL’S SIGN OF NERVE REGENERATION

THE central problem in the treatment of nerve injuriesis to estimate the extent of the damage to the nerve.This conclusion began to emerge in 1914-18 and hasbeen reinforced by the experiences of 1939-45. Theproblem arises from the fact that in the early stagesafter injury similar signs appear when the nerve is

completely divided (neurotmesis in Seddon’s terminology)and when the axons only have been interrupted, leavingthe supporting tissues of the nerve intact (axonotmesis).If the nerve is not operated on spontaneous recoverywill take place in the latter case, but not in the former.Of course intermediate conditions may occur: some

bundles in a nerve may have suffered only axonotmesiswhereas others may be so badly damaged (without lossof continuity) that they will not recover spontaneously.

It is especially important for those managing suchcases to make a correct decision in good time, becausewith every week of delay the condition of the denervatedtissues becomes less favourable for regeneration. Sincethe manifestations of degeneration and denervation aresimilar in the two cases the surgeon must make as muchuse as possible of the earliest signs of regeneration.In this issue are published two studies of the hyper-excitability to mechanical stimuli which is characteristicof the very thin young axons. Unfortunately, the

controversy as to the value of Tinel’s sign, which isbased on this hyperexcitability, is not fully resolvedby these papers. Dr. Konorski and Dr. Lubinska, ofPoland, have succeeded, under the difficult war-timeconditions of evacuation to the U.S.S.R., in .making aquantitative analysis of the excitability at variousperiods of regeneration in animals. Their suggestion thatthe ambiguities of Tinel’s sign might be overcome bytesting the mechanical excitability of the exposednerve meets the serious difficulty that one can hardlyexamine any great length of nerve in this way. More-over, the time of examination is so critical that it is.