Dr. Packard: I think it has struck everyone who has listened to the cases reported that the prominent feature has been failure of diagnosis. I believe that this is bound to be the case in the majority of instances, because of the obscurity of the symptoms. Diagnosis will usually be made by antemortem or post-mortem examination. I have pondered on the matter a great deal in the recent past, since pancreatitis has been before us prominently, as to whether there is anything in the list of symptoms usually available that may be a guide to us in diagnosis. There is time in chronic pancreatitis to analyze symptoms, but there is not much time in acute pancreatitis. It is something that comes on with amazing rapidity. A person is well one day and almost dead the next. Profound collapse comes very early, subnormal temperature, weak, thready pulse, and cold perspiration. It is sooner than in any mishap except internal hemorrhage in tubal pregnancy. In the next twelve hours or less there is a reaction and the temperature rises above normal and the pulse becomes appreciable.

Where these symptoms persist with other symptoms which have been mentioned, I believe we have the strongest evidence of pancreatitis. I do not know any other diseases of the abdomen that have those symptoms. In all others collapse is the final condition. It is almost the first in acute pancreatitis.

As to surgical treatment, the outlook is not hopeful except in suppurative pancreatitis. A pancreatic abscess should be opened and drained. In acute hemorrhagic pancreatitis, by the time the surgeon reaches the case it is usually too late to do any good. The function of the pancreas is destroyed and operation only hurries the patient's end. Drainage of the gall bladder is a doubtful expedient and can be of service only when the natural outlet of the bile is obstructed by stone in the ampulla of Vater, evidence of which will be apparent long before by the development of icterus. The predominance of biliary symptoms, even then, are likely to lead to error in diagnosis. In the absence of icterus I cannot look upon drainage of the gall bladder as a rational procedure for the relief of pancreatitis.

Dr. Moore: I have in mind a case occuring in a woman sixtyfive years of age, who came down sick first with a progressive jaundice. The other prominent condition about this woman was an increasing loss of strength and a suggestion of a tumor in

the abdomen, a few inches above the umbilicus. The severe jaundice and loss of strength were the two chief features. Dr. Shattuck was called in consultation, and his diagnosis. was malignant disease of the head of the pancreas. He ad vised exploratory incision and it was made by Dr. Boothby, and the diagnosis was verified. The wound was closed up and showing the very hemorrhagic tendency in all these diseases of the pancreas, although the pancreas was irritated. as little as possible the patient died that night from internal hemorrhage

Where we find a progressive jaundice fast increasing and can find no evidence of gallstone or any condition of the gall bladder or gall ducts to account for it, it is suggestive of malignant disease of the pancreas in which the head is involved, thus obstructing the lumen of the common duct.

MASSACHUSETTS SURGICAL AND GYNECOLOGICAL SOCIETY.

The sixty-fifth session and twenty-ninth annual meeting of the Massachusetts Surgical and Gynecological Society was held at the Copley Square Hotel, Boston, on Dec. 13, 1905. The President, Dr. James B. Bell, called the meeting to order at 3.50 o'clock P.M. The routine business was transacted, and the election committee reported the following officers for the ensuing year:

President, Dr. T. Morris Strong.

Vice Presidents, Drs. George H. Earl and Jane S. Devereaux. General Secretary, Dr. Frederick W. Colburn.

Associate Secretary, Dr. Herbert D. Boyd.

Treasurer, Dr. Isabel G. Weston.

Auditor, Dr. Edgar A. Fisher.

Censors, Drs. Orren B. Sanders, Waldo H. Stone, David W. Wells.

Following the Business Session, the Bureau of Gynecology, Dr. William F. Wesselhoft, chairman, presented the following program:

1. The Surgery of the Prostate: American and European Methods Compared. Horace Packard, M.D.

2. Value of Blood Examination in Pelvic and Abdominal Conditions. William H. Watters, M.D.

3. Dangers in Curetting the Uterus. Thomas E. Chandler, M.D.

4. Use and Abuses of Office Gynæcology. John P.Rand, M.D. 5. Procidentia. William F. Wesselhoft, M.D.

At 7.15 P.M., one hundred and seventeen members and guests sat down to dinner, after which the President's address was delivered by James B. Bell, M.D., on "Our Relations as Professional Brethren and Sisters: first, to each other; second, to our patients."

Following the President's address, the Necrologist, Dr. John P. Rand, made his report on the death of Dr. Joseph W. Hayward of Taunton, who died Nov. 21, 1905.

The meeting then adjourned.

F. W. COLBURN, General Secretary

OBITUARY.

After a long illness, DR. JOSEPH WARREN HAYWARD died in his home, at 148 High Street, Taunton, Mass., Wednesday, the 25th day of November, 1905; and so passed to his reward, a noble, upright man; a useful citizen, an able physician, and skillful surgeon; a true friend.

Dr. Hayward was born in Easton, Mass., July 11, 1841. After graduating from the Bridgewater Normal School in 1860, he taught school until he commenced the study of medicine, when he entered the office of Dr. Dean in North Bridgewater. During the winter of 1862 and 1863 he was a student in the Harvard Medical School.

His patriotism and ambition to do for his country and fellow man led him early in the spring of 1863 to apply for a medical position in the Army; and having passed a successful examination he was appointed a medical cadet of the United States Army. Later on, he served in the Brown General Hospital at Louisville, Ky.

After receiving the degree of M.D. from Bowdoin Medical College in 1864, Dr. Hayward was appointed by President Lincoln Assistant Surgeon of United States Volunteers. He was appointed surgeon to the Fourth New Jersey Battery, and was on duty at the battle of Petersburg, and promoted to the position of Staff Surgeon, when General Butler relieved General Ord. In March, 1865, was brevetted Major of United States Volunteers, and was present at the surrender of General Lee. At Richmond he was detailed upon the staff, as Medical Director, a position which he held until he resigned from the Army, in November, 1865.

After a post-graduate course in Bellevue College, in New York, Dr. Hayward located in Taunton, Mass., where he was associated with Dr. George Barrows, a partnership which continued for six years.

Soon after entering upon active practice in Taunton, he was commissioned Surgeon in the Massachusetts Militia. This position he held until in 1874 he was commissioned as Medical Director of the first Brigade, with the rank of Lieutenant-Colonel.

In 1878 he was appointed lecturer on military surgery, fractures, and dislocations, in Boston University School of Medicine, where afterwards he was made full professor, a position he successfully filled up to the time of his death, and I have been repeatedly informed by the students that

his lectures were plain, practical and thorough. In fact, he was an ideal lecturer.

He was honored by the Massachusetts Homœopathic Medical Society, in electing him president of that body.

Taunton was also honored by electing him for several successive years as a member of the school committee of that city.

From the opening of the Morton Hospital in Taunton he served as one of the directors, and on the surgical staff of that institution, until the time of his death. For several years he was associated with the late Dr. Boothby in his private hospital, and afterwards with others in a hospital of his own.

In 1877 was appointed United States Pension Surgeon. He was a charter member of Ionic Lodge of Masons, and one of the first three officers

I might tell of many other societies and institutions of which he was an honored member, but neither time nor space will permit of all.

After the expiration of his partnership with Dr. Barrows, Dr. Hayward opened an office of his own in Taunton. His great love for, and the knowledge that he obtained of surgery while in the army, together with his great ability, gave him as the years went by, the reputation of being a fine operator and skillful surgeon. This reputation extended, and was acknowledged by all schools of medicine over southeastern Massachusetts, and beyond.

As a physician, too much cannot be said in his praise. He was a fine diagnostician, and as a prescriber was excelled by none. He was careful but positive in his diagnosis and prescription; was not bigoted, but always ready and willing to profit by suggestion, or do anything to relieve suffering. In his daily life he was more than generous, always neglecting himself, without hope of fee or reward, that the poor might not suffer; thus discharging his duties in health, or in sickness, even to the last day of his life As a friend and companion, I have in Dr. Hayward lost one, who, for forty years has been to me as a brother; one in whom there was no guile; a memory too sacred to even forget.

Dr. Hayward leaves a daughter and three sons, his wife having died in October, 1904. One son, Dr. Walter B. Hayward, suceeds his father in practice.

"Earnest toiler thy work all done;

Faithful soul, into glory gone;

Beautiful life, with its crown now won;

God giveth thee rest.

Rest from all sorrow and watching and fears,

Rest from all possible sighing and tears,

Rest through God's endless, wonderful years,
At home with the blest."

Newton, Mass., Dec. 10, 1905

JAMES UTLEY, M.D.

FRIENDS of the late D. J. W. Hayward will be interested in the following extract from the report of Dr. J. P. Rand, Necrologist of the Surgical and Gynæcological Society:

"His conversion to homeopathy came about in this way: While he was in Richmond, Va., an allopathic physician who was on the board of health told him he wanted to find out what the homoeopaths used for cholera, saying that in two epidemics which he had observed, they had been much more successful than the allopaths in their treatment and he thought they had stumbled on to a specific for the disease. In Dr. Hayward's search for the remedy he discovered that it was the knowledge of how to use the homoeopathic remedy, and the application of the law of similars which gave them their success, and Dr. Hayward became a homoeopath accordingly."

BOOK REVIEWS.

Medical, literary and scientific publications will be reviewed in this department. Books and journals should be marked NEW ENGLAND MEDICAL GAZETTE, and sent to 80 E. Concord St., Boston.

Practical Dietetics with Reference to Diet in Disease. By Alida Frances Pattee, Graduate Boston Normal School of Household Arts, etc. Third edition. New York: A. F. Pattee, publisher. pp. 311. Price, cloth $1.10 by mail.

This manual is designed for use by physicians, nurses, and students. It contains information as to food values and the classification of foods; a large number of receipts for liquid, semi-liquid, and solid forms of nourishment, with minute directions for their preparation. A large number of diets are given, and these have been taken from the best authorities. Hospital dietaries are included, and suggestions for the feeding of infants and young children. A. T. L.

A Practical Treatise on Fractures and Dislocations. By Lewis A. Stimson, B.A., M.D., LL.D., Professor of Surgery in Cornell University Medical College. Fourth edition revised and enlarged. Lea Brothers & Co. This text-book is an old acquaintance to every surgeon and the new edition needs no introduction. Distinct advance has been made in incorporating knowledge of fractures which has been gained through X-ray examination. This edition is not materially larger than the edition of six years ago. It contains only about thirteen pages more of printed matter. Some of the chapters, however, have been rewritten and brought up-to-date. This is particularly true of the chapters relating to fractures of the carpal bones and fractures of the lower end of the humerus in the young. Both of these conditions are difficult of diagnosis without X-ray examination. The author gives due credit to this aid to the diagnosis of fractures by incorporating very many fine X-ray plates. Altogether the work is a credit to both author and publisher and should find a place in the library of every physician. H. P.

Surgical Diagnosis. A Manual for Students and Practitioners. By Albert A. Berg, M.D., Adjunct Attending Surgeon to the Mount Sinai Hospital, New York. pp. 543. Illustrated. Lea Brothers & Co. New York and Philadelphia.

In the preliminary part of the volume are given four diagrams illustrating Head's areas of cutaneous hyperæsthesia, corresponding with lesions of internal organs. The importance of hæmatologic and bacteriologic investigation is indicated. That which immediately follows is not unlike the routine descriptions in many other texts. As would be expected, appendicitis is treated in detail. Disease of the pancreas receives more relative attention than is given to it by many, this being in accord with the present inclination to more carefully study its lesions. The most valuable parts of the book should be those that treat of urinary and of bone diseases. In the former the use of the cystoscope and the cryoscope is strongly recommended. In the latter many illustrations from X-ray plates give added value.

To the surgeon many well-known facts will probably appear in new surroundings. To the student, and to him who is in practice, such information will be obtained by the study of the volume.

A large number of engraving and plates adds much to this very attractive example of the bookmaker's art.