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submitted to the Council on Medical Education of the American Medical Association.

AUTOPSIES AND PUBLIC HEALTH

Closely connected with the problem of correct vital statistics is the question of medical competency. Many death certificates do not give the true cause of death because of the carelessness, neglect, or intent of the physician; many, however, and these are numerous, are faulty because of the ignorance of the physician as to the real cause of death. Definite proof in many instances can be furnished only by autopsies.

This brings us to a subject in connection with which it is entirely within the facts to say that the advancement of medical science and the promotion of public health is greatly hampered in the United States by the groundless though understandable prejudice of the general public against the extension of the privileges of hospitals in the matter of performing autopsies. This prejudice arises largely from ignorance of the importance of post-mortem examination and from popular confusion of autopsies with anatomical dissections. Unfortunately, there is a continuous effort on the part of zealous but misguided individuals and organizations to increase this prejudice by misrepresentation of the facts.

The great value of autopsies, not only to the medical profession but also to the members of the general public whom that profession serves, is beyond question. If we wish to add to our store of medical knowledge, if we wish to turn out good physicians, if we are to have reliable mortality statistics, there must be more post-mortem examinations in the hospitals.

A comparative study of this subject which the Public Health, Hospital, and Budget Committee of the New York Academy of Medicine recently published shows to what extent American physi

cians are deprived of this important source of technical skill and exact knowledge.

While eighty to ninety per cent of the persons dying in English, Canadian, German, and Austrian hospitals come to a necropsy, the per cent of autopsies in the largest hospitals in this country is about ten, and in some instances it is considerably less than that. Studies of the number of correct clini cal diagnoses as revealed by autopsies show that many important diseases fall below fifty per cent in recognition, and some even below twenty-five per cent. The trustworthiness of some of our death statistics, under the circumstances, may easily be conjectured. Professor Bashford, director of the Imperial Cancer Institute in London, asserts that returns from Ceylon with regard to cancer, are more reliable than those of New York ! The same is true of other important diseases.

There is a general belief, which is supported by such statistics as we have, that certain diseases, such as cancer, affections of the kidneys, and heart disease, are rapidly increasing in this country. Whether they actually are increasing at any such rate as seems to be indicated cannot be determined until provision is made for far more ample postmortem examinations. In view of this fact, the Committee has recommended that a campaign of education be undertaken by medical organizations to acquaint the public with the dependence of medical progress and education upon the extension of post-mortem examinations in hospitals, that effort be made to secure legislation similar to that of European countries in reference to this subject, and that meanwhile hospital rules be so framed as to facilitate the performance of autopsies in cases where they are likely to prove of value. By aiding in this movement the public at large will serve its own interests by helping to advance the cause of medical progress.

(This article will be followed in the next issue of The Outlook by another on the same general subject, written by the same authors.)

THE SITUATION IN MEXICO

BY AN AMERICAN RESIDENT

This article comes from a man who has for many years been engaged in business in Mexico. We print it, not because we agree with all its conclusions, but because it gives a first-hand and vivid impression of conditions as they appear to an American who knows the country well. Elsewhere we discuss the subject editorially.-The Editors.

W

HILE the American newspapers are daily carrying several columns of matter relating to Mexico, to one who has been living in that country the amazing ignorance and misunderstanding which exists not only in the mind of the ordinary citizen, but, judging from Washington reports, in the Department of State itself, as to the actual conditions and situation there, is astonishing.

In all previous revolutions in Mexico, with the exception of Juarez against Maximilian, when Juarez was backed by a national sentiment of more or less strength, it has been one man against another-some one man on the outside trying to oust the man in power. But to-day that is not the case. It is not one man against the Government, but a dozen men all working without organization or cohesion, but more or less to the same end, viz., the overthrow of the existing Government. Carranza, a man of considerable ability, controlling several thousand men, raises the standard of constitutionalism. Maytorena in Sonora cries "Secession;" Contreras and Pesequira," Restoration and justice;" and Zapata, really the only consistent one in the lot for the last three years, says, "The cause," meaning the settlement of the land question.

These various leaders and others mentioned, some being men of good ability and intelligence, are seeking power and control of the country only for their own personal interest, but they are holding their men and gaining recruits daily by an appeal to the socialistic instinct which lies dormant in every poor and downtrodden man such as the peon of Mexico.

To-day the revolution in Mexico is a class revolution, not one of individuals or principles, and the absurdity of our Government trying to "mediate "bespeaks an al nost pitiful ignorance of conditions.

Our Ambassador to Mexico, Mr. Henry Lane Wilson, has been absolutely right in his position and attitude, viz., either acknowledgment of the Huerta Government or interven

tion.

An acknowledgment of the Huerta Government within two or three weeks of its installation would have been better for all Americans and American interests in Mexico, so far as sentiment is concerned; but, as a matter of fact, it would not have changed things very much. Huerta might have been

able to get a little more money or he might not. Bankers are cautious people, and the nations which have money are holding on to it pretty well for their own use; but even so, it would only have prolonged matters a little. At the same time Huerta was the only Government there was; he had a Cabinet of the most representative men in Mexico, and the sentimental feeling in Washington regarding the death of Madero should not have been allowed to interfere with more practical questions.

Our present Administration is rather positive on the point that when an American goes into a foreign country to invest his capital and work, he does that at his own risk— which attitude may or may not be proper; but, carrying out that idea to a logical end, it should also hold the view that any one taking the Presidency of Mexico most assuredly does it at his own risk, too.

Madero's murder was deplorable, but it is argued that there was no other course to the successful revolutionists. Madero was an idealist, and more or less of a crank, as we would express it; but there was not a drop of cowardly blood in him. He-would not sign a resignation, and consequently some one had to sign it for him, and he could not be left free to deny his signature! Had he really resigned, it is said, there is no question that he would have been allowed to leave the country.

The condition of the country to-day is hopeless. There is hardly any State that is not disaffected, and the Government controls only the territory immediately adjacent to the railway as far north from the City of Mexico as Zacatecas. For five months there have been no trains through from Laredo, Piedras Negras,

or Juarez, or any other border point except, for a short time, from Matamoras. North of Zacatecas there is not a mine or manufacturing industry of any kind that is running, and south of Zacatecas there is nothing doing ten miles away from the railway.

The Government is bankrupt; the railway system of some 13,000 kilometers is bankrupt, and it will take $20,000,000 to put its physical condition back to where it was two years ago. If the truth were known, most of the banks would be found to be insolvent, and thousands of men supposed to be and rated as wealthy are pawning their jewelry. Take, for instance, the town of Sombrerete, a place of some 10,000 or 12,000 inhabitants; you cannot buy a spool of thread or a lead pencil or a yard of cloth in it; even the shelving in the stores has been gutted; and 3,000 men who might be and should be working there are drifting into the revolutionary ranks. The miner as a rule is not a natural revolutionist; he prefers to work and take his chances on stealing a little rich ore to help out; but present conditions are forcing him into rebellion or outlawry, and the longer he keeps at that the harder it will be to induce him to return to legitimate work.

So far as the lives of Americans and other foreigners in Mexico are concerned, they are comparatively safe as long as they consent to have their horses and mules, money, and general supplies taken from them without protest; but the slightest resistance outside of talk is a death warrant.

Take, for instance, the case of Gorro, a Russian by birth and a naturalized American citizen, an engineer in charge of a mine who thought he was there to protect and save his company's property. A bunch of Federal soldiers came to his property and demanded certain stocks and supplies. In the course of the argument a Federal soldier was killed or wounded and Gorro was badly wounded in both arms and one leg, so that he was practically helpless; he succeeded, however, in barricading himself and could have held out probably for some little time.

He was growing very weak, however, and after a parley, in which they promised to spare his life, he let them in. Now Gorro was a man who took great pride in his personal appearance, had spent large sums on his dentist, and had practically a full set of solid gold bridge-work. One of the soldiers took a fancy to the gold teeth, and, putting a finger in his mouth, tried to pull them out,

but Gorro, in a last effort, bit the man's finger through, if not entirely off; so the soldier picked up a rock about the size of a paving-stone, smashed his head in, and broke his jaws off and got the teeth. And these were Federal troops, not bandits.

Ambassador Wilson is somewhat in error in characterizing all opponents of the Government in arms as "bandits." Some of the leaders are men of more than ordinary intelligence, with good ideas as to organization and discipline among their men. As an example take Natera, the man who took Zacatecas. He had a force of 1,000 or 1,200 men, poorly armed and equipped and short of ammunition. The Federals had 500 or 600 men only, but they were well armed and equipped, had rapid-fire guns and all advantage in position, but at the end of the second day's fighting Natera rushed the town and took it gallantly by assault, the Federals making their escape as best they could.

Within twenty minutes after getting control of the city he had the place thoroughly policed, with a man at every corner ordered to shoot without question any one who showed signs of looting or brutality.

The next morning he called the leading citizens together and told them how much money he wanted, and that they could form a committee and apportion it as they saw fit. By eight o'clock that evening he had it— something over $200,000; but on learning that the school-teachers and lower municipal employees had not been paid in some time, he turned back $35,000 to be used for that purpose. He also opened all the pawnshops, letting the people have their pledges back at 25 per cent of their original loan.

Natera was in Zacatecas some ten days, and there was not a case of drunkenness among the men, not an instance of ill-treatment of any citizen or looting of any kind.

He did take all the arms, ammunition, uniforms, saddles, and other Government property he could carry, and he did take all the good horses there were in town irrespective of who owned them, but he was very civil about it, apologized for the necessity, and gave a receipt and left other poor, halfstarved horses in their places.

When he went away he took about six hundred new voluntary recruits with him.

Natera had a staff of about twenty men, comprising some of the best telegraphers, electricians, and mechanics in Mexico; and it would seem that his conduct in this instance

at least should remove him from Mr. Wilson's bandit class.

Huerta's strength lies in four things: first, his personality, which is that of a strong man, seeking an end by direct methods; second, the support of the Catholic party, which is the only party in Mexico with organization and dependable membership-it is very strong, but it is not in the majority, and for that and for no other reason its members are supporting Huerta, waiting for a chance to slip in some man closer to their reactionary ideas; third, the support of the Haciendados, or large landowners, who see in Huerta the only man who stands between them and spoliation ; last but not least, Blanquet. Blanquet, now Minister of War, is one of the old Diaz type, absolutely fearless and absolutely merciless. Blanquet is the man who was sergeant of the firing squad that executed Maximilian, and it was he who gave him the coup de grâce. Blanquet is the man who was intrusted by Diaz with every hard job of political murder and extermination, and Blanquet is the man who arrested and made Madero prisoner. He is commander of the Twenty-ninth Battalion, a regiment of men absolutely devoted to him and who comprise the Palace guard; and so long as he is loyal to Huerta, Huerta will retain control of the Federal District. Blanquet may not be able to make a President, but he can unmake one in ten minutes if he wants to.

Huerta's weakness lies in the fact that he is seeking the impossible and does not understand the situation. He thinks he can crush the rebels by force of arms and return to the old Diaz régime of centralized government, but that day has passed away forever in Mexico.

With such a condition of anarchy, it is almost criminally absurd for the United States even to dream of bringing these people together and restoring order by any legal procedure. To talk of an election, when even in Mexico's most peaceful days an election was a farce, is beyond the power of derision; and to keep hands off and acknowledge Carranza as a belligerent and lift the embargo on arms means chaos in place of anarchy.

If Huerta resigned and Carranza was made President to-morrow, it would not change the situation a particle. Not a single leader of the revolutionary forces trusts the other to divide the spoils fairly or to carry out any particular legislation which their people ask. There might be a few weeks of comparative

quiet, until each saw what he was going to get, and then it would commence all over again.

If the foregoing statement of conditions is correct, there can be but one outcome; and whether the President and his Cabinet like it or not, whether Congress likes it or not, and whether the people like it or not, that outcome is intervention. There is no other pos

sible solution.

Intervention would be serious, but not to the extent which many suppose. There is a large element of responsible Mexicans who are secretly wishing and praying for it, and if it was once fully understood and believed that we did not wish to take or annex their country, it would not be long before there would be a very strong element giving open assistance to the restoration of order.

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Why are such representative men Mondragon, Felix Diaz, de la Barra, and others leaving their country in its hour of direst need on flimsy and trumped-up diplomatic or business missions? Simply because they are afraid for their lives. Why is Huerta allowing them to go? Simply because it's the easiest way of getting rid of them, and at that Mondragon would never have reached Vera Cruz alive had he not been accompanied by his friend the British Minister, who went to the coast with him to see him off. It would have been a little raw and unpleasant to have had an accident to or a rebel assault on Mondragon's train, with a chance of injury to Stronge.

The serious side of intervention is, not the fighting and possible loss of life, which will be negligible, but the administrative questions.

It is hardly conceivable that the Mexicans will admit us to their country even for the purpose of policing it without protest or resistance, although if they had any patriotism or love of country one side or the other would do it; therefore the natural first step will be to take all their ports, both sea and inland. This will be a matter of twenty-four to fortyeight hours, and probably without the loss of a single life.

Next, advances must be made to the interior from, say, Laredo, Tampico, and Vera Cruz; and, presumably, wherever Mexicans in office are found who are willing to assist in pacification and keeping the wheels of gov ernment running, they will be retained and protected without regard to whatever party or faction their sympathies may incline. The

Mexican likes office and has no sense of humor; he likes to talk about his country and his last drop of blood; but after a few weeks it will not take a great stretch of the Mexicans' imagination or casuistry, in connection with good gold money regularly paid, to convince them that those who are really serving their country best are the ones who are assisting the Colossus of the North to restore order even at the sacrifice of their personal pride.

Within thirty days thereafter we will be in the City of Mexico in control of all governmental departments, and there our troubles begin. The administration of a government for fifteen millions of people is not easy under favorable conditions, but how much harder where there will be both open and underhand resistance? Then will come the problem of getting together a Congress that will pass and put in effect land laws more or less a

combination of those of New Zealand and Ireland, which are vitally necessary to the pacification and prosperity of the country.

It will not take long, nor will it take many men, to open and maintain communication over the principal railway lines; but it will take several years before a large proportion of the men now in arms drift back to their usual orderly occupations, and before the bitterness and hatred engendered by the last three years of fratricidal strife have become forgotten or at least dormant, and until elections as we understand them can be held. and the people taught to respect and submit to their results.

The financial expense to the United States will in the end be nothing. Mexico is a rich country, and, well administered, she will have no trouble in paying the interest and principal of the hundred millions or so which she will finally owe this country.

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