e time of operation.

Among the most favorably received papers of the California Medical
Societies have been one by Emmet L. Rixford, surgeon of the Stanford
University Medical College, read before the Southern California
Medical Society at Los Angeles December 8, 1916, and one by W.D.
Alvarez at the California Medical Society, Del Monte, 1918,--both
condemning the use of purgatives as a routine measure before
operations. An article entitled the "Use and Abuse of Cathartics" in
the "Journal of the American Medical Association" admirably summarizes
the disadvantages of purgation at such a time.[53]

[Footnote 53: "1 Danger of dissemination of infection throughout the
peritoneal cavity, in case localized infection exists.

"2 Increased absorption of toxins and greater bacterial activity by
reason of the fact that undigested food has been carried down into the
colon to serve as pabulum for bacteria, and that liquid feces form a
better culture medium than solid feces.

"3 Increased distention of the intestine with gas and fluid, when it
should be empty....

"4 Psychic and physical weakness produced by dehydration of the body,
disturbance in the salt balance of the system, and the loss of sleep
occasioned by the frequent purging during the night preceding the
operation. As Oliver Wendell Holmes says: 'If it were known that a
prize fighter were to have a drastic purgative administered two or
three days before a contest, no one will question that it would affect
the betting on his side unfavorably. If this be true for a powerful
man in perfect health, how much more true must it be of the sick man
battling for life.'

"5 Increase in postoperative distress and danger: thirst, gas pains,
and even ileus...."--_Journal of American Medical Association_, Vol.
73, No. 17, p. 1285, Oct. 25. 1919.]

Four years ago I was called to a near-by city to see a former patient
who two days before had had a minor operation,--removal of a cyst of
the breast. She was dazed, almost in a state of surgical shock and
very near collapse. I found that she had been put through the usual
course of purgation before operation and starvation afterward, and I
diagnosed her condition as a state bordering on acidosis, or lowering
of the alkaline salts of the body. I ordered food at once. She rallied
and recovered.

A few months later this same woman had to undergo a much more serious
operation for multiple fibroids of the uterus and removal of the
app