Cincinnati, Oct. 21, 1904.
To the Editor.
—The excellent contribution of Dr. Parker Syms with the above title, in The Journal for October 15, serves me as a text to say something that I have frequently felt prompted to say on the significance of pain and tenderness as symptoms of cholelithiasis. The question is one of importance for the reason that, as I have had frequent occasion to observe in late and complicated cases that have been referred to me for operation, the delay on the part of the practitioner in making the diagnosis has been due to the absence of what he has been taught to look on as a "characteristic pain." Dr. Syms says of this pain that its characteristic features "are its acute onset, its colicky nature, and, as described by Lambert, the patient experiences a sense of something boring through the addomen to the vertebra." That