pensate for the remorse that may follow undue haste, nor justify the necessity for the precipitation of narcosis. The scales are too unevenly balanced to warrant vehemence; and it is infinitely better to err, if err at all, on the side of safety rather than that of a hasty and, perhaps, fatal radicalism.

I would not, and do not, advocate the employment of any one anesthetic to the exclusion of all others. We have yet to discover that agent which can justly be denominated ideal; and until such is found our only recourse lies in the selection of that one most adapted to the case in hand. While personally preferring chloroform, I never hesitate to use ether whenever indicated; and never have I attempted the administration of either without feeling a sense of relief when the ordeal was at an end and its victim restored to consciousness. Although possessing the required confidence, I have yet to undertake narcosis without some trepidation; and that omnipresent apprehension on more than one occasion has been my salvation. Who most fears danger is most apt to avoid it, and, all things being equal, success is directly commensurate with the care inculcated by solicitude.

To that redeeming element I attribute, to no small extent, whatever measure of success has been attained; and by virtue of its potency, in conjunction with that degree of vigilance necessarily implied, have not as yet had occasion to employ artificial respiration nor call into requisition the mouth-gag, tongue-forceps nor any other foreign appliance. Although approaching at times the brink of danger I have not yet toppled into the yawning chasm below. To date no fatalities have fallen to my lot, and each patient anesthetized has recovered from the influence of the agent used without having experienced that marked depression which, in common vernacular, we have misappropriately termed surgical (?) shock.

The surgeon can have no more faithful ally than a competent anesthetist; and as Dr. Westmoreland has succinctly said, whatever the narcotizing agent employed, greater danger is to be anticipated from the man attempting its administration than the anesthetic itself. In a vast majority of instances the anesthetizer and not the drug kills the patient.

I am particularly grateful for the liberal discussion given this subject, and deeply obligated to the Association for the generosity and charity with which it has been received.

Dr. Derry (in closing): I do not know that I have anything of importance to add.

In changing from the gas to the ether, I allow the patient to exhale the air in the lungs through the expiratory valve and very soon after I begin to turn on the ether very slowly. I then turn it off entirely, and then turn it on slowly again. In this way the patient takes it without any trouble.

UNCINARIASIS, OR HOOKWORM DISEASE, IN

GEORGIA.

BY CLAUDE A. SMITH, M.D., ATLANTA,

Uncinariasis, ankylostomiasis, or hookworm disease, has undoubtedly existed in Georgia for a great number of years, and in looking up the subject we find reference in some works to its existence in the South in the past, but we are unable to find authentic reports of cases occurring in Georgia.

In the light of our present knowledge I feel sure that the disease has existed all along but simply has not been recognized.

In December, 1901, the writer, while making a postmortem examination of a case at the Grady Hospital, found a great number of the parasites in the small intestines of a negro. There was some difficulty in tracing the history of this case, as the man was sent to the hospital from the city stockade and had no friends in the city. Upon investigation I found that he had been reared in Florida, and had never been out of the South. Upon ascertaining this I naturally came to the conclusion that the disease must be endemic, and that there must be other cases in the South.

As the disease was commonly supposed to exist among those who worked in damp clay, through the courtesy and kindness of Dr. S. H. Green, of Bolton, I was enabled to make an examination of the stools of twenty convicts who worked in the clay-pits at the convict camp on the Chatta

hoochee river, near Atlanta. Out of the twenty cases examined I found the eggs of the uncinaria in two. These examinations were made in January and February, 1902, immediately after finding the first case.

These cases were the first seen in Georgia of which there is any authentic record. Since that time any number of cases have been seen from different sections of the State, and it has been my fortune to see cases from all of the coast States from Virginia to Texas, with the excep tion of Mississippi.

In Georgia (and this applies as well to the other Southern States) the disease is far more common than the physicians suspect.

When I first encountered the parasite I presumed that it was identical with the old-world ankylostoma duodenale. To Dr. Stiles belongs the credit of first pointing out that the parasite in the South is a separate and distinct species from the old-world parasite.

After reporting these first cases at the meeting of the American Medical Association in June, 1902, I received a reprint from Dr. Stiles of a short article entitled, “A New Species of Hookworm (Uncinaria Americana) Parasitic in Man," read by him just a month previously at the meeting of the American Gastroenterologic Association, and in which he reported receiving specimens from Virginia, Texas and Porto Rico, which he had differentiated as the new species. At the same time he wrote to me requesting specimens from my cases to see whether they were similar to the other specimens he had received. After receiving the specimens from me he replied that he had found them to be identical with the specimens from Virginia, Texas, and Porto Rico, and which he had named the Uncinaria Americana.

DISTRIBUTION AND PREVALENCE IN GEORGIA.

From observations and investigations of the conditions under which the disease exists and spreads, I feel sure that I am perfectly safe in stating that the disease may be found in every county in Georgia. I do not believe that there is any section of any great extent that is free from it. It seems as if the entire country was literally saturated with it. It is found in the highlands as well as in the lowlands, on the mountains as well as on the seaboard.

Dr. Stiles seemed to be of the opinion that the disease was confined to the sand belt, as in some correspondence between us he wrote, "The disease undoubtedly follows the sand." Some of the most severe cases I have seen were up in the mountains of North Georgia.

That we find more of the extreme cases in the sand belt I believe to be true, and I presume Dr. Stiles was misled because the extreme cases were found so readily in the sand belt. That the disease is more common in the sand belt is due to the fact that the conditions are more favorable there for the development of the parasite.

SYMPTOMS.

No one set of symptoms can be put down as diagnostic of the disease, as they vary with the amount of infection and with different individuals.

For convenience I have classified the disease under three types: First, mild cases, which have had only one or two attacks of ground itch, and therefore have only a small number of the parasites in the intestines, not sufficient to produce any diminution in the corpuscles or hemoglobin. Second, the medium type of cases, which have had two or more attacks of ground itch, and have a much larger number of the parasites in the intestines sufficient to produce a reduction of the corpuscles and of the hemo