that is the source of infection. I believe it is true that it has not been proven that the disease begins in any other way than by the entrance of the parasite through the skin; there is a possibility that it may enter by food or water, but it has not been proven. The point made by the essayist that the privy should be used and the fecal matter destroyed so that it can not contaminate the soil, is a most important point in looking to the eradication of this disease. If we will treat these cases properly and teach the people to prevent soil pollution we will in a short time entirely eradicate this disease and redeem a large part of our population.

Dr. H. R. Slack, LaGrange: I enjoyed hearing this paper of Dr. Fort's very much. While the hookworm is not indigenous to the soil in the section of the State from which I come, still I have had some experience in the treatment of the disease. Patients come with secondary anemia, and some have been referred thinking they were suffering with malaria, but the use of the microscope of course shows the egg in the feces. I agree with Dr. Fort entirely as to the line of treatment. A point I would emphasize particularly is the absolute neces sity of giving the thymol in very fine powder; it will de twice the work when powdered very fine that it will in the granular form. In 1906 I was at Harvard and heard Dr. Cabot lecturing on intestinal parasites state that Dr. Harris and Dr. Smith, along with Dr. Stiles, were the highest authorities on this subject in America. It should. stimulate our State pride very much to hear our Georgia men thus praised in Harvard.

Dr. W. F. Westmoreland, Atlanta: For a number of years I have noticed that a certain percentage of obstet rical cases run a very low per cent. of hemoglobin, anċ it occurred to me that this might not be due to malari;

but to the hookworm, and in our surgical cases in patients that did not suspect the disease we have made the hemoglobin test, and where it is low we follow it up with an examination of the feces, and it has been surprising what a large percentage of these cases have shown the disease. Now, these cases we know from a surgical standpoint do not stand operations well; the shock is excessive, as in all cases where there is a low hemoglobin percentage. We endeavor now to build up the hemoglobin before operating, and have been astonished to see the difference with which they stand surgical operations since we have been doing this. Before we began to deal with it in this way I am sure we have lost some patients from what we called shock where the trouble was due to this condition. It is surprising how quickly the hemoglobin will reestablish itself after the worms have been removed.

Dr. C. E. Thrash, Atlanta: I would make the point of the close relationship between this disease and the child labor problem. This disease gets in its worst results in factory districts. Where the children have the benefit of the country they do better, but in the mills the disease tells upon the patient; he becomes anemic, and philanthropists think the child is overworked. Work doesn't effect the child so much, but when investigations are made, these children are found to be suffering from the hookworm disease. If the physicians in touch with factory districts will look into this matter it will go a long way toward solving the child labor problems.

Dr. W. W. Battey, Augusta: I have had the pleasure of listening to several lectures by Dr. Stiles, and recall one point which he emphasized most emphatically, and that was not to use oil in connection with thymol, for the results would be very poor. Further, he said that the dose should depend upon the age of the patient and the condition of the patient's vitality.

Dr. I. H. Goss, Athens: Dr. Stiles visited all the mills in Athens and found the children healthy, and then went into the University of Georgia and found three students infected with this disease. He said all the mills in North Georgia that he had visited showed the children in a good condition of health. I don't think I am giving away a secret when I mention a statement made by Dr. Stiles, of the Government Bureau at Washington. He had been on a long tour of inspection (several months) investigating hookworm, and after a thorough investigation of this disease in South Georgia, and more especially in and around Andersonville, where the great mortality occurred during the war between the States, he said to me that he was almost ready to make the statement that this great slaughter of human life was from the hookworm instead of the food furnished the Union soldiers, or neglect from any other cause. If this theory is correct it should bring about a different feeling in the North concerning the treatment of Union soldiers at Andersonville, about which so much has been said.

Dr. H. F. Harris, Atlanta: As regards the point just brought up, I may say that so far as I know I am the only person who has investigated the subject in North Georgia, and so far as I could learn the disease is very prevalent in this region. In Middle Georgia there seems to be a belt in which it doesn't exist to any extent.

In a recent conversation Dr. Stiles made a most startling statement to me. He said that after a thorough investigation of a large number of the cotton mills of the South, and after meeting doctors living in the hookworm districts, he was thoroughly convinced that seventy-five per cent of the mortality in these regions was due to this disease. Certainly Dr. Stiles has had a better opportunity of observing the conditions all through the hookworm

belt than any one else, and his statement deserves the thoughtful consideration of every physician.

Another point: it seems that the physicians throughout the State are not generally aware of the fact that there is a State Board of Health laboratory in Atlanta for the purpose of making examinations of specimens for all sorts of infections, free of charge. We will be glad at any time to examine feces for hookworms, or any other specimens for bacteria or animal parasites. You simply put a small quantity of feces in a bottle and send it by mail and a report will be promptly sent without cost to the doctor or patient.

Dr. Kenyon, Weston: I would like to ask what is the relation between the number of hookworms found and the amount of anemia produced? I have treated a few cases of this disease and in some have found very few worms with very pronounced symptoms.

Dr. A. G. Fort, Lumpkin (closing): I think that Dr. Harris will retract his statement of yesterday that he knew of but one disease that could be positively diagnosed with the microscope-malaria-and will add hookworm disease.

As to Dr. Kenyon's question as to the relation of the number of parasites to the amount of infection, we find patients who simply have just enough vitality to keep going, and then there is added infection with the hookworm, and they do very badly, while others may not be so much affected, with a great many more parasites.

DRAINAGE IN SUPPURATIVE CONDITIONS

ABOUT THE ABDOMEN.

BY W. S. GOLDSMITH, M.D., ATLANTA.

That the reopening of the question upon the merits of the various methods of draining suppurations about the abdomen is not with the view of indulging a personal exposition of anything unusual in practice, but to bring forward our daily routine, adopting that which may be good and rejecting those which may be unnecessary and harmful.

The results secured during the past few years have taught us a great deal about drainage, abdominal as well as elsewhere. Experience and improved technique largely eliminates hesitation and the observance, for instance, of the niceties of the toilette of the peritoneum and contiguous structures, and a working knowledge of pathology quickly clears the way for positive action.

DIFFUSE SUPPURATIVE PERITONITIS.

The extremity of the conditions met in these cases makes us shudder at the prospect and grope and grasp at any reasonable suggestion which may be offered us. The desperate illness emphasizes the necessity of the most prompt surgical intervention, and the operator faces a situation of gravest danger and frightful mortality. Bold surgery is indicated in that various avenues of escape of purulent products must at once be made and intense and direct efforts to modify and lessen toxemia. But bold interference does not mean unnecessary visceral manipula