I BELIEVE that I am the first paediatrician to be honoured by giving this lecture. We shall never know whether Graves himself would have approved of your choice but there is no doubt that he would have approved of the principle. His writings show clearly that he was concerned with children's diseases, and he wrote authoritatively about a number of childhood symptoms. He indicated that disorders of children were not to be equated either aetiologically or therapeutically with similar disorders in adults. A section of Graves' Clinical Lectures on the Practice of Medicine was devoted to a consideration of infantile convulsions in which he discussed, inter alia, the vomiting infant. Graves' view that the vomiting of curdled milk immediately after a feed is a sign of health in infants is not one to which I can subscribe in the light of this lecture, but even in the same paragraph he wrote so sensitively and so clearly about neonatal physiology, with careful obssrvations from his own experience, that one feels he was in truth a paediatrician before his time. (Graves, 1848). One particular, identifiable disorder which produces vomiting in infancy is infantile hypertrophic pyloric stenosis (IHPS). A very few early descriptions had been published but the works of Graves suggest that he was unaware of the condition, and indeed it was not until 1888 that Hirschsprung's account established it in the medical literature. Hirschsprung was then Professor of Children's Diseases in Copenhagen, and a very influential figure in European medicine. Perhaps it would be wise to remind ourselves at this point of the main clinical features of the condition, which is the commonest alimentary disorder requiring surgery in the infant. It usually presents at the age of 4 to 6 weeks with projectile vomiting, and the diagnostic features include visible gastric peristalsis and a palpable olive-like lump, the so-called 'tumour' at the pylorus. Histologically, this tumour represents thickening of the circular muscle layer at the pylorus, with an abrupt margin at the duodenal end but usually merging gradually into the gastric antrum. Males are more often affected than females. If untreated, some children with relatively mild symptoms may recover, usually after the age of 3 months. The remainder become wasted, alkalotic, and dehydrated, and will die. Treatment may be medical, with atropine methylnitrate often having a beneficial effect in stopping the vomiting, but in these islands the usual treatment is surgical. The standard operation, that of Ramstedt, has an elegant simplicity, consisting of an incision in the long axis of the pylorus which does not include the mucosa. This pyloric incision is not sutured, only the abdominal wound being closed. It is now 60 years since Ramstedt devised his operation, and no modifications or improvements have been necessary. The vastly ira