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hospital is in the line of emergencies, for among the 5,000 or more working for the company there are frequent accidents.

Two soles ($1 gold) are deducted monthly from each man's salary and in case of sickness he is cared for at the hospital without further charge.

Cerro de Pasco is situated at an altitude of 14,300 feet above sea level, and there are certain troubles which result directly from its location. Few persons escape soroche-or mountain sickness-upon first arriving. This is not often serious and soon wears off, although occasionally, upon the physician's order, a man is hurried out on a special train, provided by the company, and taken to a lower altitude. This, however, does not often happen, as most of those who come here have been examined to determine if their hearts and lungs. are equal to the tax put upon them at such an elevation.

Pneumonia is almost certain to be fatal here, so when the disease develops the patient is taken down to a safer altitude at

once.

Altogether the Cerro de Pasco Mining Company is doing everything possible to further the health and comfort of its employees.

THE EXAGGERATED FEAR OF THE HOSPITAL AND OPERATIONS.

A part of the Vice-President's address, de-
livered before the Medical Society of the
County of Albany at the Semi-Annual
Meeting, October 13, 1909.

By A. H. TRAVER, M.D.
Reprinted from the Albany Medical Annals.

THE reason for my writing a paper on this subject is because of the great fear that so many people have of the hospital and surgical operations in general. This fear seems especially marked among people living in the country at some distance from a hospital.

The question naturally arises, is this fear a reasonable one or does it arise from the

fact that when a patient from any of the small villages goes to a hospital it is the "talk of the town." Should that patient die while in the hospital everyone in the village knows about it and talks about it much more than they would had he died in his own home. "He died in the hospital." The question does not occur to them, did he undergo an operation, or did he die of some condition that had already progressed so far that no operation could be performed? The fact to them is, "He was taken to the hospital and died there and I am not going there to die." The same thought is many times expressed as follows, "They took him to the hospital and operated on him and that killed him.” Of course it is considered that the operation. was the direct cause of death, even in the case of an inoperable carcinoma in which an exploratory was done without perceptible effect on the patient's strength, and it was the original disease that eventually caused the death.

This is an argument against doing ever so slight an operation on a hopeless case. If the patient dies, other people hear of it and fear a necessary operation, no matter how simple it may be, or how free from danger. In the minds of the public, all operations are serious and most patients are supposed to die who undergo them.

The history of the following case well illustrates the above statement. A young married woman came to me for examination who had a small adenoma of the breast. I endeavored to explain to her that it was not a serious condition and that it could be easily removed under cocaine and that she could attend to her daily duties just as if no operation had been per

formed. She said she would have it attended to in a few days. I heard no more of the case for several months. Then her husband reported that "because of her fear of the knife, she had consulted a cancer specialist. He had informed her that her case was serious, it was a cancer, but she need not undergo an operation as he could easily remove it with

his special cancer paste" She had the application made; the growth was removed and the entire breast as well, and she was confined to her house for three months. Her fear of a little operation that could have been easily performed under cocaine in five minutes caused her to undergo three months of suffering and the loss of the entire breast. To the best of my knowledge that "quack" is still applying his cancer paste to all foolish patients that go to see him. I say all patients, for did you ever hear of any person who went to one of those "cancer specialists" whom he did not tell that she had a cancer? What a great good the anti-vivisectionists could do if they would spend their energy and money in the good cause of prosecuting quacks and fakirs instead of endeavoring to get troublesome and needless bills passed by the legislature.

Among city people, or people who are frequently about the hospital, there is much less fear of an operation. They see the 99 cases that regain their health as well as hear of the one that died.

Is the time ever coming when the public will know that it is seldom the operation of itself that causes death. The cause of most cases of death is the fact that the disease has been allowed to progress too far before they will consent to an operation. Had the operation not been delayed because of needless fear until the patient or his friends could see that the patient would surely die unless operated upon, then operations could be performed with a much lower mortality and with much better prospects of the patient regaining perfect health.

I shall make no endeavor to make this a classical paper or burden you with long statistical tables, but simply make a brief statement of the conditions as I have met them. For statistics, I will take the report of the surgical department of the Albany Hospital for the year 1908, together with the last 350 consecutive cases of my own.

During the year 1908 there were treated in the surgical department of the Albany Hospital 1127 cases, with a mortality of

57 cases, or a death rate of about 5 per cent. At first thought, this might seem a rather high mortality rate, but most of the operations performed in the hospital are major operations, the smaller operations being performed outside of a hospital. Again, in cases of accidents, only the serious cases are sent to the hospital, the slight cases are treated at home.

This statement is made very evident by the examination of the hospital report. Of the 180 accident cases admitted there were 13 deaths. Several of these deaths resulted directly as result of the accident and cannot possibly be attributed to operation, for none was performed. For instance, three cases of death resulted from burns, three from crushing accidents, one from shock (cause not stated), five from multiple fractures.

It is of interest to note that some of the more common causes of death: 180 cases of accident resulted in 13 deaths.

112 cases of carcinoma resulted in 22 deaths.

8 cases of sarcoma resulted in 2 deaths. 73 cases of hernia resulted in 3 deaths (all three were strangulated).

87 cases of tuberculosis (surgical), 2 deaths (both were tuberculosis of the spine).

261 cases of appendicitis resulted in 8 deaths.

In appendicitis, this is surely a much better showing than five years ago, not so much because of the improved technique in operation, although the Fowler position, Ochsner rectal feeding, and the Murphy rectal injection, have been great aids; but more than either of these is the fact that the people in general have learned that appendicitis is a surgical disease and do not fear and delay being operated upon as they did a few years ago. If the public could also learn that tumors of every kind are surgical diseases, and most cases can be permanently cured if operated on sufficiently early, then we would not have had the high death rate in malignant growths, 120 cases with 24 deaths. Doubtless many of the

cases that left the hospital had allowed the condition to go so long before entering the hospital that the operation at best could offer only a temporary relief. To me it is a peculiar, yet sad, fact, that many a woman through a sense of false modesty, will let a tumor in some part of her body grow for a year or more before telling her friends or family physician and so destroy her only chance of recovery.

One word more while on the subject of malignant growths. Are the patients always the only ones at fault? Did any of the physicians present ever make a statement like this?: "Mrs. came to me about

six months ago for examination of a small tumor in her breast. I have been watching the case and endeavoring to decide whether or not it was cancer. I have come to the decision that it is carcinoma and have referred her to you for operation." The surgeon examines the case and believes it to be carcinoma, but he finds marked glandular involvement. Or, in other words, while the family physician has been studying the case in an honest endeavor to decide whether or not it was malignant, the favorable time for operation has passed. The general practitioners will kindly consider this as a friendly statement and not think that I am endeavoring to make them think that surgeons never make mistakes, for we do make lots of them. But if we take out a breast thinking it to be carcinoma and the laboratory reports it adenoma, we have not done the patient great harm; but if you delay sending us a patient thinking it adenoma when it was carcinoma, you have done the patient great and lasting injury.

So much is heard about operations nowadays that occasionally patients are anxious to undergo operations. These patients are sometimes (far too often) operated upon even when there is no clear indication for so doing. But instead of being relieved by the operation, they return for a second or third operation till finally they find out that they are not benefited by the operations. They now return to their homes and by their great complaining lead people to the

conclusion that operations do but little good anyway. In this class of cases it is much better not to operate, but in case an incision is made it is much better to close up the incision, admitting a mistaken diagnosis, than to do a needless operation, as a gastroenterostomy or an ovariotomy where there is no good reason for doing the same. In this class of neurasthenic patients the surgeon has the happy alternative of getting rid of them by stating, "I find no condition demanding operation. demanding operation. You had better return to your physician for further treatment."

EXISTING IGNORANCE OF HYGIENIC PRINCIPLES.

BY EDITH M. RICE, R.N.,

Albany, N. Y.

NOT the least among the nurse's troubles is the annoyance experienced by the ignorance of the laity concerning hygienic principles. In spite of all that is being spoken and written concerning hygiene and its relation to human life, there still exists a deplorable ignorance, and among people from whom we should expect a higher degree of intelligence.

These are a few instances:

In the first place the kitchens instead of being the most attractive spots in the home are invariably the least attractive. Tinware, agateware, groceries, conglomeration of cloths, are around in hopeless confusion. The kitchen seems to be a place to avoid and get out of as soon as possible by the ordinary housewife. If a nurse wishes to find a little soda or a spoonful of sugar it is usually necessary to hunt through an array of boxes, unlabelled tin cans, paper bags and drawers. There is an absence of system, order and regularity which makes kitchen work so objectionable.

Cooking utensils can be purchased now very reasonably. In the ordinary household there is no excuse for not having plenty of dishes, strainers, stew pans, etc., which make cooking so much easier and

pleasanter. Pretty, attractive dishes too are cheap; with a little forethought a pantry and kitchen can be models of neatness. A little white oilcloth tacked on the shelves, plenty of dishcloths instead of one, which is supposed to answer all purposes from lifting frying pans to polishing silver and glassware; labelled cans of uniform size for the groceries, holders for stove, a table which drains into the sink are simple suggestions which, if carried out, would transform our kitchens into the most attractive spots in the house, where germs find no place to grow in corners and on dishcloths. The most deplorable ignorance, however, is in regard to the care and feeding of children. A nurse was visiting in a home not long ago where the young wife and mother was very fond of reading light literature; every spare moment was devoted to the above pursuit. One dear little boy graced the home, the idol of the parents. urday night came. Now, thought the nurse, he will surely have his bath. Eight, nine, ten P.M. passed. No bath. mother read on and on while the poor little chap fell asleep on the sofa uncared for. In this same home hundreds of dollars had been spent on doctor's bills, but the simple hygienic rules of living were entirely overlooked.

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Another neglect is the teeth. Parents will buy all kinds of toys for the little ones and never think of teaching them to play with the tooth brush or to keep their nails in order. On the car the other day a very bright little girl entered with her mother; her hair was curled, her dress was of silk made in the latest fashion, but the black fingernails and the half-cared-for skin bespoke louder than words the lack of personal attention.

Children are fed with all kinds of things and according to what they cry for. It is a well-known fact that two-thirds of the diseases of children are due to digestive disturbances, but parents allow children to eat candy, peanuts, bananas, irrespective of the age of the child, the time of day, or gastric capacity. Everything goes. The

results are obvious-fatalities occur every day, because some one wanted the little dear to have just a little of this and a little of that. Bright babies and children are continually being sacrificed to ignorance, while the parents wring their hands over the tiny coffins and wonder why the Lord took them. Our Creator has given laws of health which are inexorable. If these are broken, have we any right to say it is His will that any of our little ones should perish?

What we need to-day is not more wealth but more education, more intelligent mothers and fathers who will dispel the dark gloom of ignorance and superstition.

A NEW METHOD OF MANAGING THE BREASTS.

AN interesting article is contributed to the Johns Hopkins Nurses' Alumnae Magazine, describing why bandaging the breasts during the puerperium has been done away in the obstetrical service of the Johns Hopkins Hospital. It will be quite a new idea to many midwives and nurses and one received with a certain amount of reserve and distrust, that nature should be left to its own resources when for any reason it is necessary to dry up the breasts, but the careful perusal of the subjoined article will show that there is much to be said for this method.

From the time the obstetrical ward was opened in 1897 until four years ago, one of the spectacular demonstrations always given by the head nurse to the pupils was the application of the breast bandage and the proper manner of giving massage in cases where it was necessary to check the secretion. We remember that belladonna ointment was first liberally applied, the breast then covered thickly with cotton. and pressed firmly against the wall of the thorax by a tightly fitted bandage. The careful fitting of this bandage, the number of pins possible to insert in it, and the mathematical precision with which the dis

tance between each was arranged, was the pride of the Head Nurse and often the despair of the pupil. We also recall that the sufferings of the patient were severe, that in renewing and reapplying these bandages, and the use of massage and of the breastpump many valuable hours were consumed.

How and why all this has been discontinued Dr. Williams tells his students in one of his ward classes, and in a series of "Don'ts" in one of the lectures on obstetrics now given to the pupil nurses is "Don't massage or bandage the breasts."

This is the history of the change in meth

Dr.

od. In 1904 Dr. Williams was spending his summer vacation in Rhode Island. In talking with a country doctor of long experience there, he was asked how the Johns Hopkins dealt with this condition. Dr. Williams gave the treatment with prideful detail. Whereupon the country doctor replied that he (Dr. Williams) was away behind the times; that he himself did nothing but give his patients small doses of potassium acetate three times a day, left them alone, and had no further trouble. Williams made more extensive inquiry, and on his return instituted in the maternity ward this somewhat radical change of method, to the amazement of his staff, and to the scarcely concealed disapproval of the Head Nurse. The new treatment was given a thorough trial, and proved so effective, and of such comfort to the patients, that from that time to the present, pressure bandages and belladonna ointment are unknown in the obstetrical ward. It was supposed at first that the potassium acetate acted as a diuretic, and consequently fluids were limited and purges were given. But after a series of observations, in which a group of patients not nursing received the potassium acetate, another not nursing small doses of sodium chloride, and another group were nursing normally, the conclusion was reached that the potassium acetate had no action whatever in checking lactation, and that all that was necessary was to give the breasts absolute rest, let nature pursue her own course, and when on the

third day the swelling and tenseness appear, put on, as she then does, her own restrictive bandage. Reference is also made to a treatise written in 1785 by Dr. Charles White, of Manchester, England, showing that this idea of leaving nature alone had been advocated before.

"If the patient does not suckle her child, no method should be used either to recall the milk or to invite it into the breasts, but she should be left absolutely to nature; she should live very abstemiously, little or no animal food, no strong liquor should be allowed her, and the intestinal canal should be left thoroughly open."

The routine now employed in Dr. Williams's service is as follows: When for any reason it is necessary to dry up the breasts, they are left absolutely alone for the days immediately following labor, or after nursing has been discontinued at a later period. About the third day engorgement takes place, often with much pain, but within from twenty-four to thirty-six hours the swelling begins to subside, the secretion grows less and disappears before the end of the week. If the pain is very severe, small doses of morphia or codeia are given, but generally this is not necessary, the application of an ice bag usually giving relief. If the breasts are large and pendulous, they are held in place by a loose bandage, no pressure being exerted. The patient is cautioned against handling the breasts. and massage of any kind and the use of the breast-pump absolutely interdicted. In no instance since this treatment has been used has a mammary abscess developed, and the discomfort to the patient has been infinitely less than with the old methods. As Dr. Williams remarks, it is probably the very simplicity of this physiological procedure that has prevented its general recognition and acceptance long before. British Journal of Nursing.

MORE importance is to be attached to the desires and feelings of the patient than to doubtful and fallacious rules of medical art.-SYDENHAM.

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