fully are found to be hook-worm disease. I think that Dr. Smith has noticed instances of this kind.

From the standpoint of prophylaxis, the microscopical examination should be made. Good results in the treatment of this disease can be obtained by one or two exhibitions of thymol. Fifty per cent. (50%) of patients carrying but a few worms may spread the infection, and the presence of but a few worms may not be determined without a careful microscopical examination; it is only by such a careful examination that one may be sure that he has secured entire freedom of the worms. One is always justified in asking that a microscopical examination be made, not only in those who are known to have hook-worms, but in the suspects as well. It is only by using such care that we can ever expect to eliminate the disease.

Dr. Claude A. Smith, Atlanta (closing the discussion): I heartily endorse all that has been said and especially do I commend the brilliant work that has been done by Dr. Schnauss; he has made more practical advances in this line of work than any man in the service; I wish to congratulate him upon the carefulness and thoroughness of his work. I think he understands the treatment of hookworm disease better than any man.

With regard to, ulcers on the shins, these are usually found in patients with an extremely low haemoglobin percentage, with a circulation that is interfered with: then we find, as a rule, these ulcers of the shins and sometimes on the hands.

With regard to the spreading of information about hook-worm disease it seems to me that I am going over the things today that I went over eight or nine years ago when I started out in this line of work; the greatest difficulty lies in getting proper newspaper education; not only do we have trouble in educating the laity, but very often in educating even members of the medical profession. It is only by such an education that we can hope to

stamp out hook-worm disease.

With regard to the negro being immune; undoubtedly they appear to be less infected than the whites; it may be that they avoid exposure and take certain precautions which the white people do not; the latter are more careless in exposing themselves to this infection.

With regard to the hook-worm being coated with mucus, in my experience I have found that, especially in the duodenum and small intestines, these parts were loaded with considerable quantities of mucus. In such cases you can often give treatment and get no results whatever. Success in the treatment of such cases follows only the thorough cleansing of the intestines with a large dose of calomel or some purgative. Then thymol should be administered.

With regard to the diagnosis of hook-worm by inspection, one should not depend upon empiricism; be scientific. Go back and get the history of a suspect; ask him if he lives in the country and where; does he live in a small village, or in the outskirts; when was the last time he had ground itch; if within eight years, use the microscope. These are a few of the questions which will enable us to make a diagnosis.

Eggs will appear in the stools of these patients about six weeks after infection. Under proper treatment they can be wiped out as easy as "A-B-C." Eggs can be found in the stools about six weeks after the eruption appears on the skin.

Dr. F. W. Schnauss, Cecil (closing the discussion): I heartily endorse what the pathologst from Savannah, and my friend and former teacher, Dr. Claude A. Smith, has said. I think that he has solved the problem of hookworm disease.

So far as the negro is concerned, it may be that from a certain standpoint, examinations were not made as often as they should have been. A friend reported six hundred (600) cases and among these two-thirds occurred

among negroes. He lives, however, in one of the old slave districts and chiefly among the negro race in Southern Georgia. In my district there is one negro to about one hundred (100) whites. I further wish to state that I do not know the difference between a negro's dollar and a white's man's dollar. I make an examination of the stools of all as a routine treatment, the same as I examine urines. It is of vast importance in the eradication of hook-worm disease that a routine examination of the stools be made, and not an occasional examination.

I agree with what Dr. Smith has stated in regard to the presence of mucus. I believe that the secret of success in these cases of hook-worm disease lies in the thorough evacuation of the bowels, especially the small intestines; clean them out thoroughly; hit 'em hard! Then give a very liberal dose of B-Napthol.

With regard to the use of sugar of milk, every practical man knows what a sticky mess will be made; besides it makes a very bulky mass for the patient to take.

The presence of eosinophilia has been mentioned; such a condition is a valuable adjunct in the diagnosis. However, an outlay of about one dollar and ninety cents ($1.90) will enable you to know just what you are treating; we should not guess so much. The treatment we employ is unpleasant; the patients do not like it. I treated myself for tape-worm once and I know what I am talking about.

Always follow up your patient for at least four weeks after treatment. Give him the proper instructions. Have him return to you every four weeks for further treatment until he is cured. I take these cases for so much; I am honored by them; I want them; it pays me to cure them; I do not want a case to go away and fall into his old ruts.

Water and air are myths so far as the causation is concerned. The female lays the eggs and they are passed to the soil.

When I am trying to infect myself I want to know what I am doing. I want my stools examined to be sure that I have not hook-worm disease; I want to know if any ova are present. The ova should be looked for every two or three months.

SUBMUCOUS OPERATION FOR SEPTAL SPURS;

WITH SPECIAL REFERENCE TO THE BUTTON

HOLE INCISION AND MODIFIED NICHOLS'
SPOKE SHAVE.

Hugh M. Lokey, M.D., Atlanta, Ga.

The removal of spurs from the nasal septum is one of the most minor operations made in the nose, and, yet, the results can be of either greatly added comfort or discomfort to the patient.

The indications for removal of septal spurs are usually to relieve respiratory interference or intranasal pressure. The location of spurs producing such indications is genearlly of the anterior or cartilagenous portion of the septum. These spurs are sometimes of cartilage and sometimes of a fibrous or osseous nature.

It has been generally recognized that the old time operation of sawing off a spur as you would a knot off a log, leaving a large unprotected raw surface to cover over with cicatrices, frequently produces a very uncomfortable nose, susceptible to irritation, and to formation. of annoying and scabby accumulations. To overcome this various submucous operations have been devised, all of which are good, and each better applicable to certain forms of spurs than others. All these methods are to make a flap, usually triangular, uncovering the spur, and then to remove the projection with chisel, saw, rasp or dental burr.

The method I suggest is to anesthetise the area over the spur with a 10% solution of cocaine and 1 to 1000 solution of adrenalin, and with the nostril held open with a self-retaining speculum, make a single linear, or