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The Pharmaceutical Journal
Vol 269 No 7211 p226
17 August 2002

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Onlooker

Banana business [more]
Ancient surgery [more]
Quest for safety [more]


Banana business

It seems, from recent reports, that the banana has taken on a new lease of life and become one of the favourite fruits in the United Kingdom. As I recollect, it has long been something of a joke, with arguments over whether too curved a fruit is permissible, compared with a straighter specimen, as an article of commerce.

Of course, ridiculing bananas goes much further back in time. I can recollect that in my schooldays we were in the habit of singing a refrain borrowed from the music halls that ran "Oui, nous n'avons pas de bananes: Nous n'avons pas de bananes aujourd'hui" to demonstrate our devotion to la belle France.

There were other strange sidelights to consider. Banana skins were part of pantomime slapstick, and found their way into political discussions. "Banana oil" was a synonym for nonsense in Australia. The pejorative term "banana republic" has been applied particularly to Central American states. In theatrical parlance a leading comedian was a "top banana" while a secondary role was ascribed to a "second banana". To "go bananas" is to go crazy with anger, as apes are alleged to do when given sight of their favourite fruit. And, of course, some phallic significance has always been associated with bananas.

Musa is a native of Malaysia and Indonesia, used as food from earliest times. It spread to and through the Old World, and was mentioned by Alexander the Great and by Pliny the Elder. By the 14th century it was cultivated in Africa and the Pacific islands, and then massively in Central America in the 19th century. Today, the humble banana, comprising a series of many cultivars of Musa, is ranked as the fourth largest fruit crop in the world, exceeded only by grapes, citrus fruits and apples.

In my own sheltered part of the country, Musa is to be found in old gardens, though it does not bear edible fruit there. The plant reaches a height of some 12m in its tropical and subtropical situations, and bears white flowers surrounded by red bracts. The great bunches of fruit are well known for sheltering huge spiders, which often find their way to Europe through shipments.

In East Africa, selected banana species are used to brew beer. The flowers are used in Asian cooking, the broad leaves being employed to wrap other foods during cooking and preserve them afterwards. Leaves are also cut into strips, plaited into mats and bags, and their fibre used in making ropes and paper. The product known as Manila hemp has been widely adopted to make what we term Manila envelopes.

Unripe banana fruits are rich in starch, and dessert fruits contain about 18 per cent sugar when ripe. Seventeen esters are said to be present, including isopentyl acetate and eugenol, with a number of vasopressor amines, notably serotonin, tyramine, dopamine and noradrenaline. Few medicinal uses of the banana seem to have been adopted. The ripe fruit was at one time used as an anthelmintic, and the expressed juice as an antidote to snake bite.

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Ancient surgery

A remarkable instance of surgery involving the skull is revealed in a letter from scientists at an Italian museum, published in The Lancet for 22 June. At the site of a prehistoric village near Pescara in Central Italy, established in the fifth millennium BC, human skeletal remains include part of a skull that is estimated by anthropologists to have belonged to a mature woman. It exhibits extended modifications of the cranial vault, with two large funnel-shaped depressions, one above the interparietal suture, the other near the centre of the left parietal. Small holes in the two depressions completely cross the braincase at their bases, and are evidently artificial in origin.

Macroscopic, microscopic and radiographic analyses have shown that the cranial vault was scraped with a rough lancet, presumably of stone, with round concentric strokes which eroded and detached the periosteum and excavated the cranial bone surface. A line of increased bone density in the left frontal region probably indicates a healed and well cicatrised fracture, which was the probable reason for the operation. The woman probably suffered complex damage to the skull, with multiple fractures of the vault. Evidence of the resorption and new formation of bone indicate that she survived a year after treatment.

The question is how the surgeon controlled the profuse bleeding that occurs with scalp cuts, how he induced sedation of the patient, and how he controlled the likely infection. For work performed using a stone lancet, the outcome seems to have been extraordinarily successful.

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Quest for safety

One characteristic of our time, possibly one of the least intelligent, is the demand that, whatever we do and wherever we go, we must eliminate the element of risk. Agreed, there is no sense in which we should be subjected against our will to unnecessary risks to life and limb. On the other hand, life on this earth is one long catalogue of risks, which we cannot avoid by hiding in a feather bed in a subterranean recess without contact with other inhabitants, and the brute elemental forces of the universe. Some of our regulatory safeguards in a civilised society are, nevertheless, perverse and pointless.

According to a report published in JAMA for 17 July, delegates attending the World Health Organization's conference on injury prevention and control held in Montreal this spring have adopted a resolution entitled "People's right to safety". Right is always a tricky concept. The resolution defines safety as a fundamental human right, essential for attaining health, wellbeing, peace and justice.

Trauma is the second leading cause of death after cardiovascular diseases, with some six million persons worldwide dying annually from unintentional injuries. There have been moves, in both the United Kingdom and the United States, to outlaw the word "accident" on the ground that most injuries are in fact preventable given the appropriate precautions. Advocates of a basic human right to safety have criticised the design of homes, vehicles and places of entertainment and sport. They have condemned terrorism practised by despotic governments and multinational corporations that exploit third world countries for gain. Introduction, expression, or continuation of hazardous situations in an environment, it is argued, should be based on informed consent, attained without undue influence of any kind. Whenever the risk or threat of injury exists the responsible authority should provide compensation.

As with human rights in general, any universal right to safety involves the observance of responsible behaviour at all times by everyone concerned. To achieve this must be something of a utopian ideal. Moreover, we need to avoid the situation of "mollycoddling", where no one dare move a finger for fear of injury and legal redress becomes automatic for any undesirable outcome of an activity or inactivity. Again, we should be thinking in terms of personal responsibility rather than personal vulnerability.

It is a far cry from that boast of Shakespeare's Henry VIII regarding his successor: "In her days every man shall eat in safety, / Under his own vine, what he plants; and sing / The merry songs of peace to all his neighbours."

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