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breast-fed, or, in fact, to be fed in any way different fromthat adopted before the operation ?

Mr. Barrington Ward did good service by giving us

instructive statistics as to the immediate operative mortalityamong Mr. Lane’s hospital cases. Among 172 patients22 died, or, if cases under one year only be counted, 18 diedout of 144. So far as the patients are concerned, this wouldseem to be an immediate mortality of at least 1 in 8. But,as Mr. Ward said, by including the secondary and tertiaryoperations the number of operations can be raised to 369,and he thus arrives at the percentage mortality of 5.9 9

quoted by Mr. Lane. How many of the patients die withina few weeks or months of their leaving the hospital we havenot yet been informed.

But, after all, the actual mortality is not the main point.The main point is, do the children who survive the operation(and we know that some of them do) speak better or worsethan those who have been operated on in early childhood 7At present there is absolutely no proof that they speakbetter, and, judging from what we have seen, they apparentlyspeak worse. I may add that I have seen a considerablenumber of these " flap " patients besides the few that wereshown at the meeting. As far as I could judge, the generalopinion of those who were present at the meeting and whoheard the patients talk was well expressed by several of thespeakers, who said that, judging from the results shown,there could be no question that the patients operated on byLangenbeck’s method spoke much better than the others.Not one speaker ventured to express the contrary opinion.To prevent misconception, I may repeat again what has

been said many times, that we advocates of the Langenbeckoperation do not object to a very early operation in suit-able cases. There are cases of cleft of the soft palate andnarrow clefts involving the hard palate that can be closedwith advantage, even within the first year of life, byLangenbeck’s method. What we do believe to be wrong isthe performance of an extensive " turnover flap " operation,which has admittedly a high mortality, which does nothingto improve the child’s chance of life (although doing a gooddeal to diminish it), which is known in many cases to leavean extremely defective palate, and of which the advocateshave never brought forward any proof whatever that thespeech of those who survive is as good as, much less betterthan, that of those who are operated upon by Langenbeck’smethod in early childhood.

I am, Sir, yours faithfully,London, June 3rd, 1911. JAMES BERRY.JAMES BERRY.

DR. COOKE FUND.To t7te Editor of THE LANCET.

SIR,-May I through your columns acknowledge (onbehalf of my Barnstaple colleagues and myself) the splendidresponse which has been made to our appeal. To each andevery generous giver we tender our warmest thanks. Ienclose a communication from Dr. Cooke which I should

greatly thank you to publish. The net result of our appealis that we find ourselves in possession of some £2000-asplendid nucleus for such a fund as is foreshadowed inDr. Cooke’s letter.

It is only fair to say that the idea of a permanent schemefirst emanated from Sir Henry Morris-himself a most liberalgiver-but numbers of our correspondents have touched uponit and I gladly commend the suggestion to your advocacyand to the consideration of your readers. If only one of ourmedical benevolent or charitable institutions would take overthe .f.2000 and (after securing to Dr. Cooke some such annuityas he could procure by sinking the capital) make a furtherappeal on an extended basis and for a permanent purposethe result would in my opinion be assured. It would be

intensely gratifying to all who have so nobly supported the"Dr. Cooke Fund" if instead of the capital being sunk itcould be utilised as suggested and form a monument for alltime to the fraternal freemasonry of our profession.Thanking you for the space which I feel sure you will be

good enough to allow me,I am, Sir, yours faithfully,

JOHN R. HARPER,Barnstaple, May 25th, 1911. Treasurer.

[ENCLOSURE.] J

JOHN R. HARPER,Treasurer.

Westward Ho !, 24th May, 1911.DEAR DR. HARPER,- Will you please accept for yourself and your

Barnstaple colleagues my most sincere thanks for all you have done on

my behalf, and will you be good enough to express to those who hav&so generously subscribed to the Dr. Cooke Fund my heartfelt gratitudeand intense appreciation ? Such a magnificent response to yourappeal deserves to be chronicled to the lasting honour of the medicalprofession, and no words of mine can adequately acknowledge it, and Ionly wish I could personally thank and shake by the hand thehundreds of warm-hearted medical men and women who have been so-good to me in my distress.

I have been thinking how best I can show the reality of mygratitude. It seems to me that I can do so in no more practical andeffective way than by adopting the admirable suggestion that thecapital should on my death form the nucleus of a permanent fund forthe bezent of the medical profession which has so generously sub-scribed it. Will you formulate some plan for carrying this into effect,and if my blindness and the exceeding goodness of my medicalconf1’ères result in the establishment of some permanent addition toour medical charities it will surely help me to bear my aflliction withpatience and fortitude.Again thanking you, and through you every one of the many kind

contributors who have lightened my darkness and brightened my life,I am, very gratefully yours,

Dr. J. R. Harper, Barnstaple. CHARLES M. CoOxr,CHARLES M. COOKE.

GENIUS AND INSANITY.To the Editor of THE LANCET.

_

SIR,-As a soldier, Mr. Kenneth Campbell’s letter withrespect to the alleged epilepsy of Julius Cassar has muchinterested me. The original authorities containing materialsfor the life of Caesar are the eighth book of the Com-mentaries, Salhust, Catullus, Livy, and Varro. Appian,Plutarch, and Suetonius wrote about 150 years afterCæsar’s death. The only mention made of "6ts" is byPlutarch, who reports that Cæsar had his first fit whilst atCorduba. He was then 55-a rather late period of life

surely for epileps3 t) first manifest itself ! The whole storywas probably tittle-tattle. What did Thackeray think ofhistory ? "I say to the Muse of History, 0 Venerable

Daughter of Mnemosyne, I doubt every statement you haveever made since your Ladyship was a Muse."

I am, Sir, yours faithfully,M. C. GRIBBON,

Lieutenant, 67th Punjabis.Junior Naval and Military Club, June 3rd, 1911.

M. C. GRIBBON,Lieutenant, 67th Punjabis.

SENSATIONS DURING A STOVAINEOPERATION.

To the Editor of THE LANCET.

SIR,-I underwent an operation for varicose veins on

May 1st, and at 9.15 A.M. an injection of stovaine-was made between my second and third lumbar vertebræ,and after five minutes pain-sensation to a pin was lost up tothe nipple level. A curtain screened my view of the proceed-ings, and having the services of two surgeons the veins wereremoved within 50 minutes through six incisions (threebeing 5 inches). Thinking the patient’s sensations might beinteresting to others, I record them. Within a minute or soof injection a pleasant numbness, accompanied by theslightest of tingling, seemed to be taking possession of thelower trunk and limbs. These soon became dominated by apleasurable sense of ease which is difficult of description andwas augmented by the reclining posture with the head andshoulders in moderate elevation. Having seen no stovaine

operation, the incision was, I must admit, somewhatanxiously awaited, though, in fact, it needed not to be, for thelinear pressure of the knife felt only like a firm lead-pencihstroke, and my confidence was now complete that pain wasbanished. All the pressure impulses, though doubt-less dulled, were felt to accompany manipulationsof the limb, and were experienced as little pullsand pushes mingled with the slightest of prickings(like a gentle tug on a short hair). The power oflocalising these was also retained, though a little confusedby the simultaneous work proceeding in the varicose area.These were the only feelings except one other which led meto rem!nd them that the lotion was a hot one and belied one’s.sense of possessing a limb of leather. I maintained a con-versation with the anesthetist unhampered by any indisposi-tion, and the only other feature was the colouring of myconversation by the pleasurable sense already referred to.Of this fact I was also conscious, though unable, or at leastdisinclined, to inhibit. It was, however, quite fit for a.

modern theatre. Loss of motion in the limbs accompaniedthe anaesthesia and returned in two hours, ordinary sensations-

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- being restored in three. No unpleasant symptom occurredduring the operation, and the dose was 7 c.c. stovaine

(Billon).

In contrast to the above experience it is only fair to addthat neuralgic pains in both lower limbs and in the head<(frontal region) were severe for three days, intermittent intype, relieved by aspirin, and had cleared up at the end of aweek. Most of the varicose veins recently in my left leg areshown in the accompanying illustration._

I am, Sir, yours faithfully,May 9th,_1911. M.B. LOND., M.R.C.S.

ERRATUM.-Our attention has been drawn to a misprint ina letter from Dr. E. C. B. Ibotson on "ExtraordinaryInjuries," which appeared in THE LANCET of June 3fd. Iniine 12 the word " lower" should read" liver."

M.B. LOND., M.R.C.S.

THE GERMAN CONGRESS ON INTERNALMEDICINE.

THE Twenty-eighth German Congress on Internal Medicinewas held in Wiesbaden from April 19th to April 22nd,,Professor KREHL being in the chair.

Communication of Varioecs Infeations by the Tonsils.Dr. P&Auml;SSLER (Dresden) said that the condition of the

tonsils did not receive sufficient attention from medical men.He examined the tonsils of every patient, and in a great’number of cases found a permanent source of infection con-sisting in the presence of an abnormal secretion and theformation of plugs within the cavities of the tonsils. Thesesymptoms seldom occurred alone, but were usually followedby some secondary infection, especially by acute articular’rheumatism, with its complications chorea minor, endo.carditis, and myocarditis ; other sequel&aelig; of tonsillar disease’were nephritis, cyclic albuminuria. and septic&aelig;mia; therewas also probably a connexion between appendicitis and,tonsillar infections. Removal of the tonsils put an end to

the risk of their contributing to the development of the abovediseases, but radical extirpation was necessary, and successwas, of course, obtained only when no other point ofinfection existed in the teeth, the prostate, or the femalegenitals.

Professor KREHL said that he concurred with Dr. Passler’sopinion as to a connexion between anomalies of the tonsilsand such diseases as rheumatism and endocarditis, but hedid not think that removal of the tonsils was necessary.

Abnormal Peristaltic Movements of the Stomach.Dr. SICK (Stuttgart) said that in stenosis of the pylorus

strong peristaltic movements of the pyloric antrum becamevisible on the radiographic screen ; after some time the move-ment ceased but began again in a few minutes. There wasno antiperistaltic movement in stenosis of the pylorus, andthe statements which had been made to the effect that suchmovements existed were erroneous.

Professor VON TABORA (Strasburg) explained that acid, whenpassing from the stomach into the duodenum, produced areflex occlusion of the pylorus, and that the presence of fatconsiderably retarded the evacuation of the stomach.Clinical observation showed that hyperacidity and the useof fatty food increased the amount of residual material inthe stomach. Professor von Tabora has found by radiographythat the addition of acid to a bismuth emulsion producedvery strong peristaltic movements, so that the evacuationof the stomach became retarded by the contraction of thepylorus. The administration of oil, on the other hand,stopped the peristalsis, so that the chyme left the stomachvery quickly through the open pylorus. The paresis of thestomach lasted for two or three hours. By repeated adminis-tration of oil the movements might be stopped for severaldays, and gastric ulcers might be absolutely immobilised inthat way.

Professor KLEMPERER (Berlin) said that, in his opinion, acomplete paresis of the peristaltic movements of the stomachwas not produced by oil. When 100 c.c. of oil were

administered to a healthy person and the stomach wasevacuated two hours later, only 25 c.c. were discharged,75 c.c. having passed the pylorus. The results of the treat-

ment by oil in cases of gastric ulcer were not superior toother methods.

Professor VON TABORA said that the paresis of the peri-staltic movement was absolutely proved by radiography.

Dr. SINGER (Vienna) read a paper on the Action of theBiliary Acids on the Peristaltic Movements. He said thatan enema containing bile caused immediate defalcation indogs. The active agent was cholic acid, which directlystimulated the colon, as was ascertained by clinical observa-tion and by rectoscopy showing contractions of the colonafter the administration of suppositories of cholic acid. Inthe human subject it was proved by radioscopy that after aninjection containing biliary acids there was an immediateforward movement of the faeces. The indications for theadministration of biliary acid, either by the mouth or bythe rectum, were habitual constipation, paralytic ileus, andpost-operative paresis of the intestines.

Dr. HOLZKNECHT (Vienna) reported experiments on theaction of morphine on the movements of the stomach. Inthose experiments healthy persons swallowed on a certainday a certain quantity of carbonate of bismuth, and on thenext day the same with the addition of 0-01 grm. of

morphine, and he found that the time required for theevacuation of the stomach, which was normally from threeto three and a quarter hours, became three or four timeslonger. The cause was neither a paresis of the muscles noran increase of acidity, but a primary spasm of the pylorus,because the administration of atropine together with

morphine made the spasm and the troubles of motilitydisappear.

Experiments on Radium.Professor LAZARUS (Berlin) said that emanation of,

radium administered by the mouth penetrated through thewalls of the gastro-intestinal canal; and that inhaled emana-tion was partly discharged by the skin. There was a

definite relationship between the amount of inhaled emanationand the amount of emanation dissolved in the blood andeliminated by the lungs, the kidneys, and the skin. In its

physical relation to the blood the emanation resembled agas; its coefficient of absorption was, however, ten timesgreater than that of oxygen. Emanation administered by.