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then bichloride. Towels were boiled and placed around abdomen. Instruments were boiled and put into a solution of carbolic acid.

After making hands aseptic, an incision four inches long was made in the median line; after cutting through the skin and integuments, and after all hemorrhage had been arrested by artery forceps, the peritoneum was picked up between two forceps and cut between; the finger was then used as a guide and the opening enlarged with scissors. On digital examination a five months' foetus was found lying amongst the bowels, and there were also a great number of clots and quite a quantity of serous fluid, showing that the sac had ruptured. The foetus was removed through the opening. On examining the placenta it was found to be quite adherent and was separated with great difficulty, and there was very severe hemorrhage, which was controlled by boiled hot water and artery forceps. The cavity was then packed with iodoform gauze for a few moments, and on removal it was found that all hemorrhage had ceased. After drying the cavity with prepared lint a drainage tube was inserted, and the peritoneum was brought together with silk, then the muscles and skin with silkworm gut and a dressing of boracic acid and iodoform, absorbent and gauze, and a many-tailed bandage.

The patient was very weak after the operation, but on giving her strychnine hypodermically, and brandy per rectum, she revived. We would have given her an intra venous injection of salt solution but did not have the appliances with us. Her diet after the operation was brandy, milk, egg albumen, and beef juice, that is, beef just warmed and then squeezed.

She made a good recovery, and she now wears an abdominal silk belt and is going around.

The temperature on the fourth day went up to 100, but when the bowels were moved it went down to 99.

I would like to enumerate some of the many difficulties a country surgeon has to contend against:

1. The patient was nine miles from our office.

2. Country people have a great abhorrence of an operation, and if you do an operation and it terminates fatally you are done for in that locality.

3. It is impossible to have trained nurses, as nine times out of ten operations have to be done in poor families, and they are unable to get them. We had two neighbor women assisting us. You have to act as nurse, generally, yourself.

4. It is very hard to get country people to go to a hospital; they think when you mention hospital to them that their time has come, and will start to make prej aration for the "great beyond."

Generally the places you have to operate in are not very aseptic, and it is a wonder sometimes how they escape septic trouble.

Communications.

TREATMENT OF INEBRIATES.

TO THE EDITOR OF THE CANADA LANCET:

SIR,-In the June number of the LANCET you publish a letter in which I am criticized for not favoring the Keeley method of treating inebriates, for not visiting Keeley Institutes in the United States, for recommending the utilization of local hospitals for the treatment of inebriates, and also for suggesting the appointment by the Government of an inspector of inebriate institutions.

From the character and tone of t is communication it is very evident that it was neither written by a medical man nor by a Canadian, and that the writer is more concerned for the interests of the company controlling certain proprietary remedies than for the interests of the unfortunate inebriate.

Although a reply seems almost superfluous under the circum-tances, it may possibly serve a useful purpose, it, with your kind permission, I should state some of my reasons for not favoring the Kel y treatment.

A little over a year ago a lady called upon me to secure my interest in the Keeley treatment for inebriate prisoners. She was fortified with a number of documents and publications that placed the Keeley treatment in a most favorable light. I was so well impressed with her presentation of the case that I took some trouble to have her name placed on the programme for a paper to be read on the subject before the National Conference of Charities and Correction which met in Toronto in July last, notwithstanding that the programme hat already been arranged for. spoke favorably of the Keeley treatment to a member of the Ontario Government, to the Inspector of Prisons, as well as to the members of the Prisoners' Aid Association.

During this time I accepted the statistics furnished me as trust worthy. After a careful investigation, however, I was forced to the conclusion that if not absolutely inaccurate, they were at least misleading. For instance, it is claimed that by the introduction of the Keeley treatment in the branches of the U.S. Military Homes for Disabled Volunteer Soldiers, from 80% to 90% of those taking treatment for inebriety are permanently cured of their inebriety. I have letters from three of the surgeons of these branches. The first stated that the Keeley treatment was never used in the Home with which he was connected, as they found other treatment quite as effective. The other surgeons state that although the environment of the soldiers in these Homes was most favorable to reformation while taking the Keeley treatment, special privileges being granted to Keeley "graduates," yet not more than from 20% to 25% appear to be permanently reformed. One of these surgeons pus the proportion of "cures at 25%, and the other at only 20%.

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I also found that at the Washingtonian Home, Boston, during the last

few years fully 50% of the patients have taken some form of “Gold Cure" treatment, and at the Walnut Lodge Hospital, Hartford, these cases amounted to 70%, while 50% have taken the Keeley Gold Cure; some of these have taken the “Keeley Cure" several times.

While on a visit to the Massachusetts Reformatory for Women last winter, I asked the lady superintendent if she had had any experience with, or knowledge of, the Keeley treatment. Her reply was to the effect that from what she had seen of the results of the treatment it was far from being satisfactory. I put the same question to the secretary of the Massachusetts Prison Association. He said, I have known scores to take the Keeley Cure,' but I know of only one case where the cure was permanent." On the other hand, on asking the secretary of the New York Prison Association the same question he said, in effect," The Keeley cure is all right, but the treatment of Dr. ———. of of, Ont., is quite as good. Don't bother about the Keeley treatment."

The Rev. Dr. Buckley, editor of the Christian Advocate, New York, through physicians and clergymen, obtained the results of treatment of 534 cases of inebriety in "Keeley Institutes." Of these, 251 relapsed within the comparatively short period of nine months, 13 became insane, 11 died and 2 committed suicide.

Your correspondent finds fault with me for not visiting " Keeley Institutes" in the United States. I went where I had reason to believe I could obtain reliable information, and I was not disappointed. I saw Dr. Lett of Guelph, Dr. Crothers of Hartford, Conn., Dr. L. D. Mason of Brooklyn, Dr. Hutchison of Foxboro, Mass., and Dr. Ellsworth of Boston. These gentleman have attained an eminent position in their specialty and they have made valuable contributions to the literature of the inebriety question, and, moreover, their practice is in accordance with the tenets of legitimate medicine. I did, indeed, visit the "Keeley Institute" in Toronto, as well as two other so called "Gold Cures," one in Canada and one in the United States, and although I was most courteously treated by the gentlemen in charge of these institutions, the amount of scientific information vouchsafed could be put in a very small compass. As already intimated, I had correspondence with the Keeley Company at Dwight, Illinois, and I had the Keeley literature and their so-called statistics placed at my disposal.

Under these circumstances I fail to see any advantage in visiting the individual "Institutes." I intended visiting some of the United States Military Homes where the Keeley treatment had been in operation, but I ascertained that the Keeley treatment had been abandoned in all these Soldiers' Homes, and that representatives of the Keeley Company or Keeley Institutes had been prohibited giving treatment to the inmates of these Military Homes. I may say that I obtained this information from the Report of the Board of Managers of the National Home for Disabled Volunteer Soldiers," 1897, page 194. The publication was kindly sent me by Gen. W. B. Franklin of Hartford, Conn., the President of the Board. This does not look like an endorsation of the "Keeley Cure" by the United States Government. I may add here that I also failed to find that the Keeley treatment is in use in any penal institution anywhere, although the Keeley Company claim that such is the case.

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I am, on principle, opposed to the adoption of proprietary remedies, but notwithstanding this, had I found that the representations of the Keeley Company could be substantiated, that the remedies were harmless, that their statistics were reliable, and that 80 or 90 per cent. of their "graduates" abstained permanently from intoxicants, I would have felt it to be my duty, in the interests of humanity, to report favorably to the adoption of the Keeley treatment for the relief of pauper inebriates and inebriate prisoners. For seven or eight years the Prisoners' Aid Association has been urging the Ontario Government to establish one or more Reformatories for inebriates, but the Government hesitates to do this on account of the very large expenditure necessary both for buildings and for maintenance. It can readily be seen that this expenditure would be avoided if 80 per cent. or 90 per cent. of prisoners and paupers can be permanently cured by a course of four or five weeks' treatment.

Unhappily no treatment has as yet been devised that can effect such a desirable reformation. Had I found that the " Had I found that the "Keeley Cure" could accomplish this, I would gladly hold up both hands for its immediate adoption, notwithstanding the fact that as stated to the Prisoners' Aid Association by a representative of the Toronto "Keeley Institute "-the minimum charge would be $30 per patient.

Yours, etc., etc.,

A. M. ROSEBRUGH.

[This letter must close the discussion in these columns. The subject is important but does not come properly within the sphere of the CANADA LANCET, and would make too great demands upon our space.ED.]

ON THE TREATMENT OF CONSUMPTION.

TO THE EDITOR OF THE CANADA LANCET.

SIR,-When we think of the many points which must be considered, the many indications in the treatment of consumption, the indispensable out loor or pure air, the special diet, the needs of the skin, the degree of fever, and nature and amount of exercise required, etc., the absurdity of certain physicians "coming out," one every few months or weeks, with a new "cure," is very striking.

Almost every case of consumption, even in the second stage, will recover if we can properly and practically meet all the indications suggested by the various symptoms in each individual case, without any specific or special new cure whatever.

Almost every physician of a few years' practice has been surprised to find an advanced case get better and practically well, when he has had no hope of such result. Amongst the multitudes of remedies long known, hygienic and other, certain ones had been prescribed which just met the particular requirements and conditions of the case; while the patient had been a "good" one, and able to carry them out, as prescribed, which very few are able to do.

And it is just here that nearly the whole secret of "cure" lies, and of what would be the recovery of a large proportion of consumptives who now die on our hands, or, alas! far from home, when they should have remained in Canada where already acclimatized.

However long close and careful the examination and after-study of each particular case by the consulted physician, of the whole history and the precise present condition of all the various physiological functions : the amount of air breathed, the remaining digestive, and especially assimilative powers, and the condition of the skin, between which, i.e., the oxygen inspired, the food assimilation, and the skin function there is such close relationship; the study of the patient's strength and temperature, as bearing upon the exercise to be recommended, whether active or passive, etc; of the extent of the pre-bacillary auto-intoxication, the after selfinfection and the present virulency of the bacillary action, and of numerous other points. And however well the many indications may be now met by the physician in his detailed advice in all the special points of treatment for this particular case, the great difficulty now usually looms

up.

Is the patient in a position, have he and his friends the intelligence, the possible facilities or means, to have the advice of the physician properly carried out in the necessary detail? Can he keep out in the open air all day and be practically or almost so at night, by proper ventilation of the bedroom? Can he carry out rules for increasing the air or oxygen supply in the blood and tissues-the super-respiration now required-the lung gymnastics if necessary, or other means of supplying a sufficiency of oxygen? Can he command the proper food? Or the proper tempered baths in suitable forın? Or the massage or extremnity movements it pas sive exercise be advisable? Will the special medication for special troublesome, wearing-out symptoms be properly attended to?

In not one case in ten can these questions be safely answered in the affirmative.

When we shall have learned clearly that, as shown many years ago in a pamphlet on my own collective investigations in respect to the chest measurement of consumptives, and much more recently by Dr. J. E. Squire, Physician to the North London Hospital for Consumption, that those patients, in the "early stage," breathe only about one-third as much air as average persons in health, learned that this hypo-respiration is the cause of the disease and that the bacillus is post-hoc (although later becoming virulent and a more or less active infection) more attention will then be given to an increased oxygen supply in the diseased body, in some form, as the first and indispensable remedy, and less to new cures and fads.

Already we have learned that phthisical patients can be properly treated only in special sanatoria or hospitals.

It now remains for us to endeavor to have these provided.
Yours, &c.,

EDWARD PLAYTER.

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