hour-glass stomach, resection is especially applicable.—Annals of Surgery, August, 1906.

IMPORTANCE OF THE EARLY RECOGNITION OF GALL-STONES.

My object in reporting these cases, and that of this paper shall only be to point out the importance of the early recognition of gall-stones with the hope of inspiring more thoroughness in our examinations. The treatment is practically the same, whether recognized early or late. I shall not attempt scientific details, but try to give the practical side as usually presented to us, keeping in mind the difficulty of a differential diagnosis.

In reporting the following cases I shall not give the symptomatic details, but only a history of the manner in which they have been dealt with by the physicians whom they have consulted. In each case, some of us have been mistaken in diagnosis. I do not think this is confined alone to our vicinity, but rather think it to be the universal rule. Some have instilled hope and confidence by therapeutics; some by massage; while others resort to dietetics. These modes of treatments will all sooner or later fail when the stones become active. So the radical treatment is usually the most rational and is almost invariably advised as soon as the correct diagnosis is made by the most conservative among us.

The relief and confidence of our patients should always command our careful and undivided attention. This confidence can only be maintained by being familiar with the true condition. The following mistakes are those of others; my own I shall save for the last as some of you may know of them :

While in my senior year at college I was called one morning to see Mr. K., a young friend of mine, who was supposed to be suffering from acute indigestion. After a careful examination I made the diagnosis of gall-stones and advised the family doctor to be called to do the treating. When he arrived he informed me I was mistaken, that the young man was subject to those attacks of indigestion and that this was only one of his spells. My

diagnosis was confirmed the next morning by three stones that had made their exit during his indigestion attack.

Mrs. B. had been treated eight years for gastralgia, supposed to be caused from indigestion. In the last few months I have been able to make a positive diagnosis by the presence of passed stones. She has suffered at intervals of from two weeks to many months. When the attacks came on, she called her physician, who relieved her pains by the hypodermic and made no further investigation.

Mrs. M. has suffered for fourteen years with all kinds of stomach troubles, and only a few of the number of doctors she has consulted have been able to establish a correct diagnosis.

At present I have in mind other cases where the diagnosis cannot be questioned, but they continue to suffer, hoping some one will relieve them by medical treatment. These patients usually go the rounds of all the doctors in their vicinity, and they will continue to do so as long as we differ so much in our opinions of their troubles, and until we learn to devote the proper time to the careful examination, without receiving any satisfaction. The fatness of the charlatan and quack is maintained at the expense of the general practitioner, due to neglect of this one thing.

The diagnosis we must all admit is obscure, and perhaps a positive one can only be made by finding the stones that have passed. I have never been able to skiagraph them but once, and that was on a very thin subject and with forty minutes exposure. I am inclined to think we place too much importance on the jaundiced! condition; I have never had it marked in any great way in but one of my patients up to this time.

As we have said before,the necessity of regarding the differential diagnosis is very great. Any form of colic, enteritis, inspissated bile or gastralgia, may be confused with it, and at present I have a young lady who has been treated for several months for gall-stones, and I find her to be suffering from chronic appendicitis.

Mrs. L. came to my office from the western part of the state complaining of a painful disturbed menstruation, neuralgic pains, with a very tender abdomen. I found her to be suffering from

She improved in

returning in three Another examina

a misplaced uterus and imagined I could outline a small cyst in the region of the right ovary. The abdomen was so tender she could not stand hard palpating, nor wear her skirts supported from the waist; complained of a very sickening sensation when on her feet all day. I prescribed a symptomatic treatment and advised her to return in a few weeks. some respects and in others grew worse months to my office wearing a loose gown, tion was made and I was sure I could outline a small tumor, and advised that she have it removed. She went to Dr. B. B. Davis at Omaha, who removed a number of gall-stones; some. she tells me, were as large as small apples; the exact number I have never found out. I have never heard of this mistake being made before, but I am confident it was the lower end of the gall bladder I was palpating instead of an ovarian cyst, as I had diagnosed. A. E. Reeves, M. D., in Virginia Medical SemiMonthly.

UNCINARIASIS IN MISSISSIPPI.-C. C. Bass, New Orleans (Journal A. M. A., July 21), by correspondence and otherwise, has obtained a record of 206 positive cases of uncinariasis in Mississippi, and of 39 of which the diagnosis was not so positive. These cases altogether represented 23 of the 76 counties of the state, and in 12 more ground itch was reported. He believes that the state is very widely affected and suggests a legislative inquiry as to the prevalence of the disease and the best means to disseminate knowledge in regard to it so as to check its ravages. He also recommends a method of finding the ova for diagnosis based on the fact that they will float on a solution in which the balance of the feces will precipitate. Without giving the exact figures of the specific gravity or saying what is absolutely the best solution, he claims that for practical work nine tenths of a saturated solution of sodium chlorid will suffice. He hopes to work out the technic more fully and to give results in a future publication. The article is accompanied by several tables and charts.

Obituary.

DR. B. W. HINDS, of New Hope, Madison Co., Ala., died at his residence on Tuesday afternoon, August 21. He was for many years a prominent and popular citizen of Madison County, and was County Commissioner at the time of his death. After an illness of some weeks from a complication of diseases, he died at the age of seventy-one years, greatly esteemed by his neighbors and the citizens of his county. He was one of the first subscribers to this journal in 1879, promptly renewing each year. His sons, Capt. Ernest Hinds, U. S. A., and Lieut. Walton Hinds, U. S. N., with his daughters, Mrs. H. R. Johnson, Mrs. Bush, Misses Bessie and Bertie Hinds survive him, to whom our sincere sympathies are respectfully tendered.

THOMAS DUDLEY WOOTEN, M. D., University of Louisville (Ky.), Medical Department, 1853, one of the most prominent practitioners of Austin, Texas.; local surgeon for the Houston and Texas Central Railroad; formerly president of the board of regents of the University of Texas; a member of the State Medical Association of Texas, Seventh District Medical Society, and its first president; Travis County Medical Society and the Southern Surgical and Gynecological Association; a delegate to the International Medical Congress; a surgeon in the Confederate service during the Civil War, during which he served successively as surgeon of the Second Regiment, Seventh Division, Missouri state troops, chief surgeon of McBride's division, surgeon-general of the Missouri forces, medical director of the Division of Tennessee, of the Division of Arkansas, and of the Western Army Corps, died at Eureka Springs, Ark., August 1, from gastritis, after a brief illness, aged seventy-seven.

DR. JAMES B. MACCAW died August 14, at Richmond, Va. He was eighty-four years old. Dr. MacCaw was a surgeon in the Confederate Army, and during the Civil War had charge of Chimborazo Hospital, in Richmond, where 76,000 Confederate soldiers were treated.

Editorial.

THE WALTER REED MEMORIAL FUND.

ABOUT $20,000 of the $25,000 has been contributed to this fund, and we regret exceedingly to say that but a limited portion is from the South. This is not as it should be. While the whole country and the world at large are and will be so greatly benefited by his remarkable addition to medical science, ranking fully with vaccination, asepsis, and anesthesia, to the South it has already proven of most inestimable value, and its citizens should promptly see to it that they have their share in contributing liberally to this fund which is being raised for the benefit of the surviving wife and child of Major Walter Reed, a surgeon in the U. S. Army who originated the idea and perfected the discovery of how yellow fever is communicated; his demonstrations thereof having been unquestionably proven by subsequent results, not only by a thorough sweeping out of the disease from Havana for the first time in two hundred years, but by its control later at other points in our own Southern land.

He possessed a character decided, sincere, and earnest, and an intellect above the average. When scarcely nineteen years old he graduated in medicine at the University of Virginia and soon after his majority he entered the medical ranks of the army. His benevolence was ever present and his benefactions found opportunity among the frontiersmen, whose families he attended from his army post. Nothing could deter him from bestowing upon such needy patients, not merely his sympathy but the best efforts of his skill. Among the imprisoned Indians his tenderness was so great that the half savage hearts grew to love him.

Dr. Reed died a poor man, by the measure of dollars, yęt won his niche in the hall of fame, where his place will never be shadowed by the future great ones who may assemble there. It is now the privilege of Southern people to take cognizance of the movement to pay a graceful tribute to his memory by contributing to the cause, already well launched by friends in the North and West. Those who may be moved by generosity now will, later on, be able to tell their children and grandchildren of how they honored the worth of this man, and they may then speak of Walter Reed, who will have grown to his full stature among the great benefactors of humanity.

Time is necessary to crystalize greatness and engraft it upon the imagination, the heart, and the appreciation of men. It is only in our fleeting day that we can honor him, and perhaps we are too close to him to have the perspective of time. Great men yet to come will scrutinize the footprint he has made on the sands of time, will make pilgrimages to the spot where he was born, in Old Virginia, and will bow in homage at his simple