No other place in the body is so liable to infection, outside of the intestinal wall. So the radical operation is a preventive of trouble. Every case of deafness in children, of earache, suppurating discharges from the ears, adenoid tissue, and enlarged tonsils, should be classed in the same line of work as the prevention of tuberculosis. Now, a word as to the reaction of the operation. It is an extensive operation, and yet we have operated in our hospital on 370 cases for extirpation of the cervical glands in tuberculosis alone, and without a death. We have only had one case of secondary hemorrhage. As far as the magnitude of the operation is concerned, it is as great an operation, if thoroughly performed, as is often done in surgical work. When you are all through with the operation on the glands, you have many nerves and the common carotid exposed. So we have combined in this all the difficulties in many operations in surgery. As far as recurrence is concerned, do the best we can, and there is nearly 10 per cent recurrence. Why is it? It is local. You have removed the lymphatic glands and fascia, but left a gland or two, may be, in the parotid region. That is where we get the recurrence. We cannot quite look upon tuberculosis as in the form of a malignant disease. We do not take too much chance of running into the facial nerves in the parotid gland unless there are positively enlarged nodes in the structure of this gland. I have one interesting case of purulent suppuration in the parotid, which was cured by the infection of erysipelas.

DR. C. A. KELSEY (Minneapolis): I had hoped to hear from other surgeons on this subject. I am very glad to hear a discussion from so prominent a member of our association as the last speaker. I would be glad to hear from more, and for this reason: Several years ago at a meeting of this association held at Duluth our very celebrated surgeon from St. Faul read a most beautiful and poetical paper upon this same subject, in which he spoke of these glands as being the policemen of the system. I refer to the paper of Dr. Wheaton of St. Paul. If I understand the doctor correctly he no longer approved of this operation that is being so widely urged in this paper and discussion. So from that point of view I wish we might have had an opportunity to hear a more extended discussion of this subject. So far as the removal of large tonsils and adenoid growths is concerned, I certainly feel there is no mistake made in the very early removal of any of these growths that resist ordinary treatment. I beg leave to mention a trial I made, which has but little weight, from the fact that I have been unable to repeat it in many cases, but it was a trial in the special field of the static machine, throwing the positive current directly into the enlarged cervical glands. The case that impressed me most favorably was one that had been operated upon once, perhaps imperfectly. I am sure it was so because I performed the operation

myself, and I did not do it as thoroughly as it should have been done. I began this treatment, and repeated it with a gradual subsidence of the enlarged glands, until they finally entirely disappeared, and this occurred something like two years ago with no repetition of the trouble. Whether the strong electrical current destroyed the germs, or whether there was real value in it I do not know, but certainly the result in this case was very happy, and I have repeated it in a limited number of cases with like happy results. I suggest this as being worthy of trial. It is easily done, and the only drawback is a little loss of time over that in which an operation could be done.

Dr. W. A. DENNIS (Essayist): I simply want to say a word in regard to Dr. Wheaton's idea concerning this operation. I think very few people do the complete operation. Dr. Wheaton, when I was with him, was not in the habit of taking out all the fascia, as well as the glands. His views were expressed on that part, and not on complete extirpation. Statistics for that reason are very unsatisfactory, as they do not state the nature of the operation. Some men are much more complete in their operations than others. I never saw elsewhere such a complete and fine dissection as that of Dr. Mayo, made at Rochester, and when that is universally done I think the statistics will be much better. His operation is better than any I have found in the literature on the subject.

THE INEBRIATE, A MEDICAL AND SOCIAL PROBLEM.

ARTHUR W. DUNNING, M. D.

St. Paul

Inebriety is, under proper conditions, amenable to treatment; and with reasonable hope of cure in a large per cent of cases. There are, however, few, if any, curable diseases which afford so unsatisfactory results from treatment as does inebriety. This is because under existing social and legal conditions the first essential to successful treatment is impossible to obtain. I refer to absolute and complete control of the individual for a sufficient length of time. Every practitioner of experience knows how utterly hopeless a task it is to try to build up, and restore to health and normal conduct, a man who has once formed an uncontrollable appetite for alcoholics. Delusions of strength, and an over confidence in that strength, are among the very symptoms of inebriety, and to induce such a man to place himself voluntarily under control for more than a few days beyond the period of actual intoxication is usually an impossibility.

The time required to bring about a cure, on the other hand, is from six to eighteen months. To secure this period of control legal measures are necessary for the reasons cited above. The state cares for its insane, its cripples, its criminals, and its defectives, but for the inebriate there is no law to control, and no place of detention, until such a time as criminal action lands him in the jail or the penitentiary, or until dementia supervenes and the hospital for the insane claims its own. A law then that will provide for the early control of all in

ebriates, and for the detention, care, and maintenance of the indigent inebriate, will result in the cure of a large percentage of this class of unfortunate individuals,—and in doing so will accomplish a vast saving to the commonwealth in several ways. For instance, instead of dissipating his fortune it may be saved to himself and his family, thereby not alone securing their comfort and wellbeing, but in many instances saving the state itself the support of a pauper family. This will compensate for the expense of his care during the period of detention. Then through the prevention of criminal acts, a large percentage of which are attributable to alcoholism or its effects, a considerable saving to the state also is secured. Through procreation by alcoholic parents defective children are produced for the state to rear, to say nothing of the lesser effects upon offspring, which escape even proper recognition, but which are none the less potent in the degenerative tendency of the race. These results would be in a large measure avoided; and who can compute the ultimate saving in revenue to the state from such reduction of defectives? Finally, the state is accustomed to computing the loss by death of each able bodied citizens at $5,000. I am sure that no one will take issue with me when I aver that every man inebriated, if uncured, is worse than dead so far as his worth to the state is concerned. Therefore in the early cure, and saving from insanity, criminalism, pauperism, or ultimate dementia and death of these individuals, the state is greatly the gainer financially.

Taking all these various gains into consideration, then is it not a fair proposition that, looking into the future twenty-five or fifty years, it would be excellent policy from a business standpoint alone for the state to provide for the proper control and care of this class of unfortunates? That such provision is a duty which the state owes to society is apparent to every thinking person; and the great benefit to society which would result from such provision is unquestioned.

The state hospital for the insane is not the proper place for the care of this class; and it was undoubtedly in itself an act of justice to those institutions when some years ago the legislature repealed the law that provided for their care in those hospitals. That law should not, however, have been repealed without immediately enacting another providing for a special hospital for the inebriate. It was certainly a step backward on the part of our usually progressive commonwealth. The present situation in this respect is truly a deplorable one, for while a simple case of inebriety does occasionally find its way into the state hospital through commitment for insanity, it also not infrequently occurs that cases of true insanity, either alcoholic or otherwise, are debarred the benefits of hospital care. This is the result of an over zealous care on the part of the probate court of the state, and the difficulty which often occurs in determining whether the alcoholism is not merely a symptom of a pre-existent or developing insanity.

To summarize them:

Inebriety is, under proper conditions, amenable to treatment.

The condition essential to successful treatment is absolute control for a considerable time.

In the nature of things it is impossible to secure this control without legal measures; therefore a law is required that will provide for the early control of all inebriates, and the detention, care, and maintenance of indigent inebriates. This is not asking too much from the state, because both from a business and a sociological standpoint it will prove a paying investment.

On account of their ignorance as to the true nature of this malady and its remedy, neither the citizen, the taxpayer, nor the legislator is in a position to recognize this necessity as does the physician; therefore it becomes the duty of every physician to become a moulder of public opinion on this subject, and to urge everywhere the