you physicians in order to enlist your sympathies, for I know that in your capacity of trusted family physician you are in a position by counsel and admonition to do much toward ameliorating their miseries and bettering their condition. During my practice among these people I have observed that infant mortality is high. This is due to want of cleanliness and entire ignorance of the principles of infant feeding. Among bottlefed infants the mortality is appalling. Owing to the very poor physique of the average Mexican parent many of these infants are at birth sadly below par in vitality. Among adults we find the profoundest ignorance regarding the most important factor in physical development, i. e., a proper diet properly cooked. Growing boys and girls are dwarfed from lack of nourishment. Dyspepsia is common. This matter of diet, together with illy ventilated and overcrowded houses, and I may add early marriages, are mainly accountable for the small, withered, stunted specimens of manhood and womanhood we are rearing in this valley. the puerperium of the syringe, or even soap and hot water, one cannot but bow with added reverence to beneficent Nature, so purposeful and so perfect in all her work. The loss of relatives, friends, fortune, is borne philosophically-even stoically. After a fatal case the physician is often addressed in Spanish thus: "The doctor did well, but God, the Great Physician, willed otherwise." This characteristic, and indeed many others, is accentuated in the Mexican by his implicit faith in religion as taught him by the Jesuit missionaries. I have often been told that no native Mexican died of pulmonary tuberculosis. I have seen six die of this disease. Three of these could be traced to one focus of infection. The Mexican has a greater tolerance for syphilis than the white, secondary and tertiary symptoms being more easily prevented and more readily cured. But gonorrhoea shows him no special favor. Lastly I wish to note the fact of the few illegitimate births. They are exceedingly rare. Moreover, I have never been approached by a Mexican woman, married or single, nor by her husband or seducer, to perform the atrocious crime of abortion. I find these people not very highly sensitive to either bodily pain or mental suffering. They bear minor surgical operations well without anaesthetics, also the most difficult cases of labor. I once saw a woman who had been in labor, with a shoulder presentation and the arm protruding, for four days. After the diffi- By JOHN G. SHELDON, M. D., Telluride, cult delivery of a dead child, from a mother almost moribund I had but little hope for her recovery. However, on the fourth day I found her walking about the house. Puerperal septicecemia is exceedingly rare. I have not seen one fatal case. When one considers the large number of births, the absence of clean white clothing, the filthy sheep skins on which they are confined, pole and dirt ceilings, mud floors with the accumulated filth and expectoration of generations, the absence in THE AVOIDABLE MORTALITY OF SURGERY. Colo. Those familiar with the mortality of modern surgery appreciate fully that many of the deaths to-day following operative treatment can be attributed to delay in performing operations, the performing of operations that do not meet the pathological indications, or to the faulty technique of a man inexperienced in operative work, and incompetent to do successful major surgery. As a rule, those who perform surgical operations are not to be held responsible for the mortality following operations when treatment has been unduly delayed. Operations done to Operations done to relieve suffering or prolong life in cases of advanced malignant disease or acute but well advanced inflammatory conditions, may be expected to be followed by a large immediate and remote death rate; and those who perform such operations should, in no sense, be held responsible for the mortality, and they should receive no blame if the patient succumbs to surgical treatment in cases of this character. The mortality of surgery that follows when an operation has been performed that has not met the pathological conditions present in the case is, in a sense, an avoidable mortality; but these instances are uncommon in occurrence, and it seldom happens that one competent to practice surgery feels that a mortality could have been avoided on account of an error in diagnosis or a serious mistake in technique. It is not the gross and uncalled for error in the operative selection of cases, or mistakes in diagnosis, that I wish to consider as the avoidable mortality of surgery; but it is the work of the generally successful surgeon that I desire to comment upon, and to point out a few factors that, in a large number of cases, result in a post-operative mortality that can be truly considered, by those who, as a rule, are successful surgeons, an avoidable mortality. The duration of anesthesia and operation is a most important, but too often neglected, factor in producing surgical mortality. This is, in a sense, an avoidable cause of death. The time of anesthesia and operation should be shortened as much as possible. The general condition of the patient and the seriousness of the operation play no more important a part in the final outcome of the case than do the length of the operation and the duration of complete anesthesia. Of course, it must be admitted that many, if not the majority, of surgical cases will recover if anesthesia and operation are prolonged unduly twenty or thirty minutes. This, in no sense, diminishes the danger incurred in unnecessarily prolonging anesthesia; neither does it show in any way that the patient is not materially injured by the sometimes unnecessarily prolonged narcosis. The reports of deaths following the late effects of anesthesia should impress upon us that the briefest possible anesthesia is the most desirable. The reports of Bastianelli, Bandler, Ballin, Brackett, Stone, Brewer, Cohn, Erlach, Guthrie, Stocker, Mintz, and others, are sufficient to convince one that obscure degenerative changes in the parenchymatous organs, and particularly the liver, and perhaps post-operative inflammatory conditions in the lungs, are dependent in a great measure upon prolonged anesthesia and operation, and are responsible, in a measure, for a post- operative mortality that is many times avoidable. No anesthetic should be administered until the pre-operative preparation has been all but completed. In all but exceptional instances the patient should be placed upon the table before the anesthetic is administered, and in all cases the operation should proceed immediately when the stage of narcosis is reached. The ten to twenty minutes that is so often allowed to elapse after the patient is under the influence of the anesthetic but before the operation is started, can be avoided in every instance. This unnecessarily prolonged anesthesia does a great injury to the patient. There is absolutely no excuse for its occurrence; and many times, it is directly or indirectly responsible for a post-operative mortality that could have been avoided. Every one who does major operative work should plan his operative technique rules. Occasionally we see an acutely inso as to meet the pathological indications flamed lymph gland removed and the with the least possible manipulation in the wound closed without drainage. This is shortest possible time compatible with not good surgery. not good surgery. It is true that these thorough operating. The surgeon who patients do not die, but the post-operative wastes time should improve his technique, course is less satisfactory than it would and the man who is unnecessarily slow will have been if temporary drainage had been do an injustice to himself, to his patients, provided for. and to the profession, if he attempts hazardous or complicated surgical proced The surgeon who requires fortyfive minutes to do an uncomplicated appendicitis operation can, in all probability, do many things to better advantage than he can do surgery. It is true that such a man may meet with success in a large number of his surgical undertakings, but his mortality from hysterectomies will be unnecessarily high; the results of his pylorectomies will be discouraging; while the number of deaths following his extirpations of the rectum will be appalling. While it is not always advisable to strive for a dexterous and rapid technique, many surgeons to-day do not apreciate the importance of a brief anesthesia and a quickly completed operation in all cases, and especially in cases that offer poor operative risks. There is, at the present time, a post-operative mortality in certain surgical conditions that can be eliminated by a proper understanding and appreciation of drainage. It is generally admitted that we should always provide for drainage in operating upon any inflammatory condition. of the extremities or superficial structures that is sufficiently severe to produce a rise of temperature in the patient. We have learned that if drainage is not resorted to in these cases the post-operative course of the wound will be unsatisfactory in almost every instance; while if drainage is provided for a short time the general and local conditions in the case will progress favorably and speedily. It is true that there are some that do not observe these The same surgical principles are true in operating upon acute intraperitoneal inflammatory conditions and there are many to-day who would do more successful abdominal surgery if they would drain acute inflammatory products to the exterior of the body instead of allowing the patient to overcome their toxic effects. An appendicitis sufficiently severe to produce a general rise of temperature is invariably associated with peri-appendicular changes, and in these cases a toxic, inflammatory exudate accumulates in the post-operative field. If this is not drained to the surface, it must be overcome by the natural resources of the patient. Since we have learned that the peritoneal cavity is capable of dealing with considerable quantities of infectious and toxic material, the patients subjected to abdominal operation for inflammatory conditions. have had their resisting powers unnecessarily taxed. Some, even to-day, advise complete closure of the abdomen without drainage after operations for inflammatory conditions that have advanced to suppuration. The fact that these patients, as a rule, recover is in no way convincing as to the correctness of the treatment, and does not mean in any case that the patient has been given the best opportunity to reCover. Such cases, many times, demonstrate the resisting powers of the patient instead of testifying favorably to the judgment of the operator. A rule which I invariably follow, and to which I have found few, if any, exceptions, is to provide for post-operative drainage in all cases in which an operation ondary operations in such cases is not of sufficient consequence to contraindicate the performance of incomplete but palliative operations in many acute and serious inflammatory conditions. is performed for an inflammatory condition sufficiently serious to produce a rise of temperature at the time the operation is performed. In applying this rule in abdominal surgery the post-operative course of the patients is almost invariably shortened and unpleasant complications extremely rare. I have never regretted drainage after operating in acute abdominal inflammatory conditions; and I know of two post-operative deaths that I believe might have been avoided if post-operative, temporary drainage had not been neglected. I am satisfied that the man who drains best in acute inflammatory conditions of the abdomen cures best; and that the present post-operative mortality in all operative work, and especially in abdominal surgery, can be avoided in certain selected cases by draining all cases that run a temperature at the time the opera- CONSTITUENT SOCIETIES tion is performed. While at the present time it is undoubtedly true that only a small part of the post-operative mortality can be looked upon as avoidable, I believe that to-day not a few lives are unnecessarily lost. A careful consideration of the factors that produce death in patients who have submitted to surgical treatment is sufficient to convince most operators that the duration of anesthesia and operation, drainage after abdominal operations, and performance of palliative operative procedures, hold an important place in reducing the mortality of surgery. SECRETARIES OF LOCAL SOCIETIES Hereafter you are requested to send all reports pertaining to your Society proceedings, as well as changes in membership, to the Secretary of the State Society, Dr. Melville Black, Majestic building, Denver. He will in turn It occasionally happens that a life can be saved by doing a palliative operation that would have been lost if a radical procedure had been attempted. Few men at the present time make mistakes by attempting more than the patient can withstand. Palliative drainage for acute, suppurative conditions is a generally accepted mail to the editor of this journal such portions procedure. Drainage of an acute cholecystitis is rapidly replacing removal of the gall-bladder; enterostomy has a well recognized place in the treatment of intestinal obstruction, strangulated hernia and peritonitis; while drainage of an acute cystitis preparatory to prostatectomy has been shown to have decided advantages. One should keep in mind that toxemia is the most important factor in producing death in cases of acute infection; that palliative drainage in serious cases can, as a rule, be quickly and easily done; and that removal of the inflammatory chemical products is accomplished by drainage, and meets the immediate pathological indications. The necessity for performing sec as are intended for the editorial department. It is also especially urged that local Secretaries send news items pertaining to the doings of the medical profession of their respective localities. It is hoped that the news column and the society reports will occupy a much larger space in Colorado Medicine in the future than it has in the past. Immediately after each meeting please do not fail to report upon the cards provided you by the Secretary of the State Society the changes which take place in your membership. This will always insure prompt mailing of Colorado Medicine to the newly elected members. Colorado Ophthalmological Society. The annual meeting occurred on April 28, 1906, at Dr. E. W. Stevens' office, Denver. The Secretary's report showed a member ship of one honorary and 20 active members; that seven meetings had been held, with an attendance of 70 per cent; that three papers had been read; 40 cases exhibited; and 45 cases reported by members; a resolution had been passed and published condemning the acceptance of commissions or division of fees; and that the constitution had been codified. In seven years the Society has grown sevenfold in numbers, and developed from a local to a state organization; with corresponding growth in influence throughout the state and even beyond its borders. Drs. G. F. Libby and Melville Black were re-elected Secretary and Treasurer, respectively, and Dr. Jackson was elected Chairman of the Executive Committee. A case of unusually excellent result from the operation of blepharoplasty for entropion of both upper lids was shown by Dr. Stevens. The condition had followed trachoma, and was of 10 years' duration. A graft of mucous membrane from the lip was inserted between the split margins of the lids. Dr. Bane presented a case of hyalitis of the right eye in a patient who had just lost the sight of, and then the entire left eye 10 years before, as the result of steel in the vitreous. Examination of the right eye showed vision of about 6-9, fine opacities, three flame. shaped hemorrhages and a membranous deposit in the vitreous. A case of binocular albuminuric neuroretinitis in a woman aged 28 was shown by Dr. Libby. There were unusually well-marked retinal changes, the vision being almost nil in one eye and 4-45 in the other. The patient had scarlet fever in 1898, nephritis being diagnosed two years later. There was an apparent remission for about two years, during which time she was married, but has not been pregnant. About three years ago polyuria and edema of the legs developed; and since January 1, 1906, there has been severe headache, paralysis of both external recti, dilated pupils, hemorrhagic neuroretinitis, and loss of vision. Dr. Black presented a case of blindness of one eye due to severe traumatism a month previous. At first the ophthalmoscopic examination was negative, but it now showed white atrophy of the optic nerve and loss of direct light reflex. The probable cause of the nerve injury was thought to be fracture at the optic foramen. A case of traumatic cataract due to the en trance of a bit of steel, was reported by Dr. Black, who believed that the foreign body was still in the lens, and advised removal of the lens. Dr. Bane reported a case of iritis of 10 days' standing, with an ulcer involving two-fifths of the cornea, which he thought due to atrophic disturbance of the fifth nerve. Dr. Ringle gave an account of his recent observations in the Chicago eye clinics. GEORGE F. LIBBY, Secretary. The regular monthly meeting of the El Paso County Medical Society was held Wednesday, April 11, at the Antlers. The President reported to the members the death of Dr. D. K. Smith, a member of the Society. The President appointed the following committee to draft resolutions on the death of Dr. Smith: Drs. J. A. Patterson, D. P. Mayhew and M. P. Reynolds. The Secretary was instructed to convey to Dr. S. E. Solly, who has been seriously ill for sometime, the greetings of the Society and the best wishes of the members for his speedy recovery. A spirited discussion was indulged in by all members present, regarding the regulation of fees for life insurance examinations. The matter was finally passed up until the next meeting. Dr. A. C. Magruder was enrolled on the list of members on a transfer from Teller County. Colorado, Society, and Dr. H. C. Moses on a transfer from Preble County, Ohio. Dr. Charles F. Stough presented a case of cancer of the lip on which a Grant operation had been done, with a very gratifying result. Dr. Frank L. Dennis gave a very interesting and instructive talk on his recent visit to the eastern clinics and those of Vienna, Berlin, and other points of Europe. There being no further business, the meeting was adjourned to the dining room where a lunch was served. M. P. REYNOLDS, Secretary. Fort Collins, Colo., April 4, 1906. Larimer County Medical Society, regular meeting, met in the City Hall; present, Drs. Kickland, Roth, Taylor, Fee, Upson, McHugh and Stuver. A communication from Dr. Black, Secretary of the State Medical Society, asking the Society to appoint a member to prepare a paper for the meeting of the Colorado State Medical Society next October, was read |