To the Editor.— A recent letter to the Editor from Colokathis et al reported implantation of a permanent cardiac pacemaker in a 92-year-old woman, following which the patient returned to normal activity. We share their opinion that gratifying results are obtainable in patients of advanced age, and that a "generation gap" in this direction need not exist. In support of this contention we would like to report that in the spring of 1967 we implanted a permanent cardiac pacemaker in an alert 103-year-old white man, who thereafter returned home to his usual level of activity which, at that time of year, consisted principally of casual strolls amidst the flowers of his garden. Several months later the patient sustained a severe fecal impaction, for which he was re-admitted to the hospital and successfully treated. However, his 80-year-old daughter, with whom he had lived for several decades, no longer felt equal to