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first touched bone. It is not every patient who isaware, or at any rate demonstrates his awareness,that the operator has made contact with ganglion,roots, or branches.A somewhat similar result of contact between

metal and nerve is seen in stylomastoid foraminalentry for facial hemispasm, although compression andperhaps transfixion of the nerve are larger factorsthan mere contact in this case. If the spasm is inaction it ceases instantly the stilette is sufficientlywithin the Fallopian canal, and palsy is as instantlydemonstrated. If the spasm is not in action theremay be a facial twitch and then at once palsy ; but

palsy may occur without the twitch. Facial hemi-spasm may occasionally be stopped by contactbetween metal and nerve alone without the develop-ment of any palsy. The likely duration of such

palsy or relief from spasm I do not know, because thehabit is to reinforce with alcohol these effects ofcontact. I am. Sir. vours faithfullv.

Westminster Hospital, Dec. 9tb. HILDRED CARLILL.

DIPHTHERIA DIAGNOSED WHILE YOU WAITTo the Editor of THE LANCET

’

SiR,—Your leading article of Nov. 19th is of morethan ordinary interest to all concerned with thetreatment of diphtheria, suggesting as it does a

means which will assist the medical practitioner <

rapidly to decide on the need or otherwise for the ]injection of antidiphtheritic serum. It is not my (intention here to enter into the question of its !scientific reliability. In the City Hospital, Fazakerley, I

clinical observations are in process, and at the same <

time the corresponding bacteriological side is being 1checked by Prof. D. Hedley Wright, the city bacterio- :logist. Beyond that, it would not be judicious at this

’

stage to pass any comment. I desire, however, to jmention one sequence of the painting of the throat Jwith potassium tellurite solution : within a few hoursthe clinician, nurses, and the patient, if old enough,must be prepared for the production, from the throat,of a profoundly foetid odour suggesting a mixture ofgarlic and sulphuretted hydrogen-an odour which maypersist for some days.-I am, Sir, yours faithfully, 1

E. A. BURNS,Dec. 12th. Principal Medical Officer, City Hospital, Liverpool.

CHILDREN IN CATALONIATo the Editor of THE LANCET

SiR,-It is difficult for people to realise the urgencyof the situation arising with regard to the nutritionof children in Spain. A few statistics may help toopen their eyes to the magnitude of the problem.For instance, in Catalonia alone there are 1,100,000children under fifteen years of age, including refugeesand the civilian population. Of these, the workersof the International Commission for the assistanceof Child Refugees in Spain estimate that 825,000are in grave need. The remaining 275,000 are thechildren of country peasants whose minimum rationcan be supplemented by small amounts of localproduce, such as eggs and vegetables.

All the relief work that is going on in Spain to-daycovers only one-tenth of the children in most urgentneed. For instance, there is no source of milk avail-able for the city children between two and five yearsof age (of whom there are about 54,000) except thecanteens run under the auspices of the Society ofFriends, which cover about 5000 children in the cityof Barcelona. The State-controlled milk has perforceto be restricted to babies under two. Milk brought intoSpain by voluntary aid organisations is almost whollydistributed through the schools and this covers onlythe children from five to fifteen years of age.

The minimum rations obtainable in the marketsare not sufficient to supply basic needs. The dietobtainable is deficient in protein, fat, vitamins, andsome minerals especially calcium and iron. Theresult is that the children are rapidly using up theirreserves of body fat, and are beginning to showevidence of undernourishment amounting in somecases to semi-starvation. Nutritional ansemia, rickets,marasmus, and even starvation oedema are becomingcommon, especially among young children for whomthe available diet of coarse bread, beans, dried fish, andrice is particularly unsuitable. There is a great lackof fat in the diet and to this may be attributed thefact that rickets, which has been practically unknownin Spain where sunshine and olive oil have alwaysbeen abundant, is now manifest in about 60 per cent.of the children under two years of age. With theonset of winter the mild form of rickets at presentmet with cannot fail to develop into a more acuteform if present conditions are maintained.

There is just time for civilisation to avert a

catastrophe that threatens to compare with post-war Vienna in 1918.-1 am. Sir. vours faithfullv.

AUDREY RUSSELL,Delegate in Catalonia of the International Commission

for the Assistance of Child Refugees in Spain.

* * * Money may be sent to the National JointCommittee for Spanish Relief (4, Great Smith-street,London, S.W.1); to the Friends Service Council(Friends House, Euston-road, N.W.l); or to theSpanish Medical Aid Committee (24, New Oxford-street, W.C.l) stating the purpose of the donation.Gifts of warm clothing, and especially of children’sboots and shoes, will be gratefully received by theNational Joint Committee at 15, Great James-street,W.C.1. The address of the International Commissionfor the Assistance of Child Refugees in Spain is52 rue des Paquis, Geneva.-ED. L.

ADAPTING THE LIMB TO THE STUMP

To the Editor of THE LANCETSiR,-In your issue of Dec. 10th you published a

review of my new book " Back to Activity " under .

the above heading. In the latter part of it you state:The makers still complain that amputations are some-

times made too low down in the thigh or leg, and theycounsel higher operations in order to make the fitting ofan artificial limb easier. Surely this is putting the cartbefore the horse ; a design should be evolved which is

adapted to the amputation.Over 200,000 limbs were amputated as a result of

the late war, and during the last twenty years wehave been able to study the results obtained with alltypes of amputations. We do not complain thatamputations are made too low down because wecannot design special limbs to suit them. Twentyyears ago we were compelled to design 14 differentmodels of limbs to suit all the varied amputationswhich were done during the war, many of whichwere above and below the knee amputations wherethe stumps were too long.

It must be clearly understood that the mechanicaldifficulties caused by too long a stump are only asmall part of the problem ; the main difficulty beingthat with too long a stump it is very often impossibleto give the patient a comfortable fit, owing to thefact that with such a stump the circulation is oftenvery poor and causes swelling, and in some casesthe scar at the end of the stump breaks down andwill not heal. In addition, the limb has to be madea very ugly shape, and this can be an importantnoint for a. worr)H.Ti&mdash;T a,m_ Sir vours faithfnilv

Baker-street, W., Dec. 13th. E. R. DESOUTTER.