I think the profession will have to keep their eyes on the legislators, perhaps on the new governor, and see that this institution is not thrown into the waste-basket, so to speak, or converted into some other sort of institution, because we need a place of this kind. Even if Minnesota can go prohibition pretty soon—and I rather think it will—we shall not get rid of our drunkards for that reason. We shall still have to have a hospital for the treatment of the morphine, cocaine, and alcoholic habits. The doctors who send patients to Willmar, I think, ought to be careful, and not try to help some municipality out of taking care of old battered hulks, who cannot hope to recover, who cannot be made well simply because they have been drinking for so many years, and their other habits of life have resulted in such a deterioration of the brain that there is no possibility of bringing them back and making really good citizens of them. Those patients should be kept in a work-house or in a special department at Willmar or some other place. We should try to reclaim all of our young men and young women habitues.
Owing to the absence of proper writeups about this hospital it is not generally known throughout the state that pay-patients can be received and treated just as in any sanitarium and at very moderate rates.
Dr. Freeman (closing): I really have nothing to add in closing except to say a word with regard to prohibition. I have a second-hand statement from the police of one of the Twin Cities that he is positive in his city there are five thousand drug-users from his experience in the police court.
With regard to the maintenance of discipline at the institution: We have sufficient law or authority for discipline, but we have not the facilities. The thing in my opinion that we mostly require is a building where we can take care of a man who is incorrigible, or a man who runs away. For two reasons: In the first place, I have known a number of men who came there unwillingly, who later were greatly benefited by their compulsory stay; second, the effect of disciplinary measures upon the population in general. If a man knows that, when he goes there, he must stay, he naturally gets over his constant thought that he is going to sneak away, and put it over. The custodial cottage to take care of forty people would allow, in all, four classes of patients. We should have a reception-ward in which to examine all new patients; one ward for the incorrigible; and we should have two other places to care for two classes of men received. This would prevent the influence of the older men who have gone further in their habits upon the young boy who has just started.
DIAGNOSIS OF INTRACRANIAL COMPLICATIONS IN DISEASES OF THE MIDDLE EAR AND ACCESSORY SINUSES OF THE NOSE [3]
By Joseph C. Beck, M. D.
CHICAGO.
[3] Read before the Sioux Valley Medical Association, July 22, 1914, and published in these columns at the request of the Association.
The most important causes of intracranial complication from the middle ear and nasal accessory sinuses, are suppurations, consequently I shall confine my remarks to that subject, and not take up the neoplasms, trauma, etc.
In the diagnosis it is most important to recognize suppurative disease of the ear and sinuses, but this subject is not within the province of this paper, therefore I shall satisfy myself by mentioning only that the presence of the pus from the middle ear and nose, and Röntgenographic examination, are the most important signs of affections of these structures. The one symptom more than any other on the part of the patient of a threatening extension into the cranial cavity, is localized pain or headache, which is very persistent, instead of periodic. Especially important is this in connection with the cessation or diminution of the discharge. The knowledge of the pathological change present in the sinuses and middle ear and mastoid, is of additional value as, for instance, tuberculosis, syphilis, and cholesteatoma.
The frequency of intracranial complication in suppuration of the middle ear is much greater than that following sinus disease, about twenty-five to one in my experience.