(f) Sterilization. Define term, give directions for dry, moist heat, steam, and boiling sterilization, and give specific direction for doing the same.

(g)

Germicides.

(h) Care of excreta and tell how to do the same.

(i) Fumigation. Give directions for same.

9. Conclusions. With especially applied rules to prevent the spread of tuberculosis, using care to convey that what applies to one infectious disease may be applied to any other with modifications.

In closing I will say that I believe some physician in every village and city in the state should volunteer his services to the schools thereof, and whether he follows the above outline or one of his own which could be made more complete, would be a matter of choice. From my experience I am confident that if this matter were taken up as suggested, the results obtained in the next few years would be marvelous, far reaching, and what is of greater importance, permanent. These lectures will do more towards stamping out tuberculosis than any means employed today and at practically no expense to anyone.

Trusting you will not consider this paper a presumption, coming, as it does, from a young man, and appreciating the honor of being allowed to express my thoughts at this meeting, which is composed of the best intellect in the state, I thank you.

Treatment of Non-Septic Abortion

By J. S. LANCASTER, M. D., York, Nebr.

It is evident to the writer that too many practitioners do not consider the abortion cases under their care according to the merits of the individual case. Altogether too often are all cases treated alike (dilatation and curettage) whether they be only threatened or inevitable, complete or incomplete, septic or clean.

The following brief outline of the treatment of inevitable non-septic cases was emphasized to the writer in student days and has since proven a good sensible course to pursue when handling such cases:

(A) Cervix Closed-Fetus and Decidau "in Utero" Hemorrhage.

In these cases the main indication is to arrest the hemorrhage. Pack the cervix with gauze and the vagina with wet lysol cotton. Pack the upper vagina tightly. This stops the hemorrhage and hastens the abortion. At the end of 24 hours there will be three courses to pursue:

(1) The abortion may be complete and need no more active

treatment.

(2) Dilatation may not be sufficiently advanced and repacking indicated.

(3) Dilatation may be sufficient for more active treatment, as outlined in succeeding paragraphs.

(B) Cervix Dilated One or More Fingers-Fetus "in Utero” Hemorrhage.

If pains are strong and hemorrhage slight the case may be left alone and the abortion soon completes itself. With weak pains and hemorrhage the case should be terminated. With the index finger in the uterus separate the fetus and placenta thoroughly, and express the contents of the uterus by the Hoening method. Use two fingers of one hand in the posterior vaginal fornix, the other hand on the abdomen over the uterus -compress the uterus between the two hands. This procedure fails if the cervix is not dilated sufficiently to allow fetus to pass or if the fetus is not separated and is contraindicated if there be any inflammation or infection connected with the case. If of sufficient development the fetus may be seized directly and removed.

(C) Cervix Dilated-Fetus Expelled-Hemorrhage.

It is evident the abortion is not complete. Introduce finger, separate decidua and remove by traction or expression. (D) Cervix Not Dilated-Fetus Expelled-Hemorrhage.

Dilate the cervix and remove the contents of the uterus. The cervical and vaginal pack is the safest and most natural means of dilating. It is sometimes expedient to use steel dilators and complete the operation at one sitting. Tents are dirty and dangerous and should not be used.

The removal should usually be done by traction or expression after separation by finger; however, the curette is indicated in very early abortion, in chronic abortion with hard uterine walls, and in some cases with stenosed cervices when artificial dilatation is difficult.

(E) Complete Abortion.

When abortion is complete, the fundus and lower uterine segment are hard and the lochia gradually decreases in amount. Here there is no indication for entering the uterus for any purpose. If there is an endometritis wait two or three months before curetting.

Following all abortions ergot and hydrastis should be given to favor involution.

CLINICAL REPORTS

Two Cases of Sporotrichosis

The recent report of a case of sporotrichosis by Dr. Olson, in the Journal A. M. A., September 21, page 941, helped me to clear up the diagnosis of two cases.

Case I-Mrs. C., age 26, healty and strong, lives twelve miles from town on a homestead; came to me August 18, complaining of an ulcer on her left forearm, about an inch from the elbow. On examination I found a deep ulcer the size of a dime, with well-defined raised borders, angry looking, and containing some thick pus in the center. Around the ulcer, on the flexor surface of the forearm extending down to the wrist, there were five nodules varying in size from a large nail-head to almost a quarter, situated subcutaneously and slightly hyperemic. There was one also about an inch above the elbow. There was no pain nor tenderness, only just where the ulcer was, and no other subjective symptoms. She was otherwise well and worked hard on a ranch.

At first sight it looked like scrofuloderma, but neither the history nor the further study of the case warranted such a diagnosis. She couldn't account for that ulcer in any way only that she probably hurt herself on that place. On general principles I painted the ulcer and the nodules with iodine and dressed the former. I told her to come to the office every day, as I wanted to watch the effects. But she could come to town only once or twice a week, so I gave her a little iodine and told her to paint the affected parts every day. I saw her a week later and found the nodules somewhat reduced, but the ulcer about the same. I gave her potassium iodide internally in addition to the local treatment. Two weeks later she came again to the office to show me that the ulcer had healed and all the nodules disappeared.

The second case is a girl 12 years old who came to me, when school started, from thirty miles in the country, complaining that "her blood was impure," and having two ulcers on her right hand and one on her left foot which did not heal. On examination I found the ulcers on her hand exactly the same as in the first case, and nodules of different sizes on her forearm and a few also on her arm. She told me she had had the sores since early summer when she was on the ranch for a few weeks. With the experience of the first case, I treated her the same

with potassium iodide internally and the tincture of iodine locally. This case was rather more protracted, probably due to waiting too long before she came for treatment.

These two cases are typical of sporotrichosis. Unfortunately I did not make a microscopic examination to verify the spores. But the clinical evidence is so clear, if the disease is in mind, that the diagnosis is justified without the laboratory. Both cases came from the country where they had all the chances to be infected. After I knew the disease I inquired more thoroughly about the source of infection; in the first place, I was told, there were several horses which had sores on their feet, and in the second place, the girl played with a cat which ran after gophers and rats. The source of infection is undoubtedly due to coming in contact with the sores of the horses or the cat which carried the infection to the girl from an afflicted rat or gother. The disease is not rare but is passed without recognizing it. It illustrates the importance of reporting cases, as they might help many a doctor to make a correct diagnosis. M. H. NEWMAN (Cody, Neb.)

Thyroid Feeding in Mental Diseases

Eager (Journ. Ment. Scien.) has carefully watched the effects of thyroid feeding in forty-one cases of mental disease, and believes that in selected cases it is decidedly beneficial. Following the method of McPhail and Bruce, Eager administered sixty grains of thyroid extract daily, in three doses for two weeks, unless the pulse and temperature showed too great a reaction, when it was temporarily suspended. The patients were put to bed, and records were kept of pulse, temperature, urine, weight, etc. The final results obtained were thirty-four per cent recovered, twelve per cent improved and the rest not benefited. The largest percentage of recoveries occurred in patients under thirty-five years of age. Of the effects produced by the treatment, increase in the pulse rate and rise in temperature were almost constant. Loss of weight was pronounced, the greatest amount being nineteen pounds in two weeks. Desquamation of the superficial layers of the skin appeared after the treatment was stopped. Urinalysis showed the effects of increased proteid metabolism. The author feels that the beneficial results are largely due to stimulation of some internal secretion, probably that of the organs of reproduction, since improvement is most marked during the period when these organs are normally most active.

ABSTRACTS

Alcohol Antidote

The Medical Times for July, 1912, tells us that ammonium chloride is recommended as an antidote to alcohol, given in doses of 30 to 60 grains, with copious draughts of water to prevent gastrointestinal irritation. It prevents the effects of the alcohol, sobers the patient quickly, and is a valuable preventive against delirium tremens. Should the patient not become quiet after taking the remedy, bromide or chloral hydrate may be administered.

Common Salt Poison

O. H. Campbell, St. Louis (Journal A. M. A., October 5), reports a case of a healthy boy of 5 years who received an injection of strong brine as a domestic remedy for worms. The mother made the mistake of putting a pound instead of a tablespoonful of salt in a quart of water. In five or ten minutes the child was taken with pain in the head, intense thirst and vomiting soon followed by severe purging. In thirty minutes he had become unconscious, and one convulsion followed another until death occurred five hours after the injection. A post-mortem was refused. Campbell has found no other like case reported.

Horse Sense

As bearing on the views of most modern psychologists as to the very narrow limitations which should be accorded to the intellectual processes of the lower animals (the view contended for by Roosevelt and Burroughs as opposed to the decidedly imaginative writings of Seton-Thompson, Roberts and Long), the report of Professors Kraemer and Ziegler and the zoologist Sarasin (Deutsche Med. Woch. 38 1799, 1912) on Krall's trained horses is of great interest. It will be remembered that the first accounts of the wonderful performances of these horses were received with great skepticism by the scientific world and that the first men of science who investigated them reported that the whole thing was practically a set of tricks in which the trainer in one way or another suggested to the horses the desired answer. The present report, which is the result of several days' careful study, showed unequivocally that the horses could read French and German words, written phonetically; could