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{Reprint from “Denver Medical Times.") 
THE “MEDICAL RECORD’S ” POSITION EDITO- 
RIALLY, AS TO THE VALUE OF EX- 
SECTION FOR HIP DISEASE. 
W. R. WHITEHEAD, M. D., OF DENVER, COLORADO. 
When a medical journal has acquired through the enterprise 
of its publishers and the talent of its editor the extensive circulation 
and wide spread influence of the “Record,” its editorial department 
yields a power for good, or for evil, that is of the gravest import- 
ance to every thoughtful physician who wishes to see truth prevail, 
and error repressed. 
It is a debatable question, in my opinion, if it would not be 
safer and better for suffering humanity, and for the profession, if ed- 
itorial comment should be so guarded as not to trench arbitrarily a 
subject of such vital importance as that of exsection for hip disease. 
It will appear to the least observant surgeon that possibly the edi- 
tor of a medical journal, however capable, may not always be able 
to determine accurately all of the facts of any special or particularly 
difficult subject, and the columns of his journal, rather than the ed- 
itorial space, would be a more fitting place for the proper illumina- 
tion of such subject. A decided expression of opinion editorially, 2 
precludes,at least in the journal that utters it, further discussion,and 
with a large number of its readers, so shapes opinion as to effectual- 
ly decide the merits of any question, without a hearing from those 
who may have given special attention to it, and who might claim 
the right to dissent from the conclusions of the editor. Fortunately 
however, there is a goodly number of thoughtful and self-reliant 
physicians who are not so pliant; and who, in the matter of statis- 
tics even, do not entertain for statistical reports generally, that pro- 
found respect which is shown for them by the editor of the “Rec- 
ord.” 
In the “Medical Record” of March, 27th, 1886, is a leading ed- 
itorial entitled “The indications for exsection for hip disease The 
Editor informs us that in the “Annals of Surgery” for Jan. 1886, 
“Dr. Leroy M. Yale has reviewed this subject in a thorough man- 
“ner, and has collected statistics which enable one to reach tolera- 
bly positive conclusions.” After commenting on Dr. Yale’s article 
and quoting his statistics, the editor remarks that “Assuming there- 
fore that about one-third die, and one fifth relapse, it follows that 
the successes in excision amount to only about fifty three per cent* 
“This is about the same per centage of cures given by Cazin in 
“eighty cases treated expectantly, the cases being followed up for 
“five years.” To quote the “Record” further : “No very brilliant 
“results, as far as cures are concerned, therefore can be attributed to 
“excision.” “As to the claim for better functional results, this has 
“not at least a very strong basis. We arc inclined to believe, says 
“the editor of the ‘Record,’ from the evidence so far accumulated, 
‘‘that patients treated expectantly, as a rule, get a better limb.” At 
the same time, significantly remarks the editor, the operation of ex- 
cision occasionally gives most brilliant results: (the italics are my 
own.) 
My feelings may be better imagined than described, when I 
explain that I read this remarkable editorial just after having that 
day done an excision for hip disease, and the second one of two ex- 
cisions for hip disease, which I had performed within the period of 
three weeks. 
I confess that I was much disturbed for a while, but soon rc- 3 
covered my equanimity as I reflected that I was personally acquaint 
cd with these eminent statisticians, with the exception of M. Cazin; 
and indeed I was quite reassured when I found that I had not whol- 
ly lost my individuality in the confusion of thought, which the startling 
statements I have quoted momentarily created within me. However 
I was eager for a crumb of comfort, and I snapped like a hungry 
trout at a fly, at the consoling remark of the editor, “that the oper- 
ation of excision occasionally gives most brilliant results,” and I 
naively asked myself,—Why ! But I also thought of my good 
friend, Dr. Louis A. Sayre, and how 1 had profited by his writ- 
ings, and that his excellent practical work on orthopedic surgery 
was about to be translated into German, and appreciated across 
the water, and that surely his statistics, I could rely on as I 
could my own energy, will, painstaking care, knowledge and 
self-possession. Thereupon after these brief reflections, I sat down 
and poured out on paper the overflowings of my thoughts to my 
good old friend on the general futility of statistics, as ordinarily 
collected by the average gatherer of statistics; aud I received from 
Dr. Sayre an equally characteristic letter as my own ; and if I suc- 
ceed half as well in eliciting the interest of my readers in what I 
have to say to them, as I did in calling forth that of Dr. Sayre’s, in- 
terspersed here and there with the remarks which I propose to of- 
fer, with some of the appropriate and terse expressions used in his 
letter, I shall have accomplished my object; that is to partly 
undo some of the evils of an injudicious editorial. 
Nothing would, at first sight, seem more convincing than a for- 
midable array of statistics. Buckle formulated certain general laws 
of political economy based on statistics ; notably that the number 
of marriages depends on the price of corn. Congressmen, when 
they wish to make an impressive and convincing address, over- 
whelm us with statistics. And following the fashionable lead of 
statesmen and historians, medical men formulate rules of practice 
based on statistics, and thus attempt to restrict or enlarge our pow- 
ers of usefulness by statistical rules. That statistics are valuable 
to show what is the average general result of the action of certain 
physical or natural forces, operating under well defined conditions, 4 
is an accepted fact. But the want of accuracy in determining the 
influencing conditions, even when the conditions are related to the 
most common and readily collected facts, has often impaired the 
value of statistics to such a degree as to make them utterly worth- 
less. The special object of this communication is briefly to point 
out the falsity of statistical rules, based on unknown and imper- 
fectly stated conditions, as a guide to surgical treatment. We arc 
told that this eminent hospital surgeon, or that, that general practi- 
tioner, has operated so many times for ovariotomy, or -for •exsection 
in hip disease, with such and such results; but we are left in entire 
ignorance of numerous details, or of circumstances, which remarkably 
influence the treatment, besides, often we take no account whatever 
of the individuality of the surgeon, which is one of the largest fac- 
tors in the result. We are probably reminded of the fact that the 
operating surgeon is a titled and eminent author or professor, and 
we are told, of course, his results are consequently of the most sig- 
nificant value, evidently we forget that, as Junius remarks, to the 
Reverend Mr. Horne, “distinguished talents are not necessarily con- 
nected with discretion; ” and that some obscure country doctor,well 
grounded in the principles of pathology, and having a fair knowl- 
edge of anatomy, and possessed of good common sense, is some- 
times more than the peer of the eminent author in any case of sur- 
gical emergency. In fact, the very conditions that often most influ- 
ence the result, are inherent in the surgeon himself, and of which 
statistics can make no mention. 
The value of statistics to determine what the average man can 
or will do under certain well defined circumstances; whether,for ex- 
ample, he will live to three score and ten years, whether he will go 
crazy or die a drunkard, is of interest in a general way to soci- 
ety. The results of the after treatment of a surgical operation, which 
requires as much judgment, industry, scrupulous care, common 
sense and untiring energy as is demanded for the proper treatment 
of an excision in hip disease, are of extreme interest to the sur- 
geon, and yet the results are gathered much in the same way as are 
collected the statistics of the number of babies born; and learned 
statisticians thereupon establish rules for the treatment of hip dis- MEDICAL TIMES. 
ease on the expectant plan. In connection with this subject, I can- 
not do better than to quote from Dr. Sayre s letter to me : 1 o 
talk,” says Dr. Sayre, “ of conservative surgery, with its years of 
anguish, finally resulting in a hideous deformity, with an anchylosed 
and often useless limb, in comparison with the immediate removal 
of all diseased tissue, and the rapid improvement of the general 
health in all cases, and the frequent perfect recovery with a useful 
limb, and in many cases with almost perfect motion, is the veriest 
nonsense.” 
To know what the average man can do, and will do under 
stated conditions, is certainly an interestingquestion for the specula- 
tive student of man’s place in creation; and it would be equally iiv- 
teresting, but more pertinent to the present subject to know what 
the average doctor can, and will do in the treatment of a difficult 
case of ovariotomy, or of exsection for hip disease. I hope 1 may 
not be thought to be too presumptious if Iexpress it as my opinion, 
that the result will not be altogether the best that could be desired. 
I may be told that the cases of hip joint exsection tabulated, were 
not treated by average doctors, but by eminent surgeons ; I do not 
doubt this, but I refuse to accept the proposition that eminent stand- 
ing is in every case the companion of proper qualification, or of 
good judgment,either in the surgeon,himself, or in his alleged skilled 
assistants, not to mention other qualities of character equally im- 
portant. Indeed, I am so bold as to assert, that I believe that such 
men as Sayre, in America, and Bryant and Holmes, in England, 
rprtainly so far as exsection for hip disease is concerned, are far 
above the average of surgeons, and that if we did not have such 
men to lead us, and we were not willing to be led by them, that so 
far as regarded this operation and surgery generally, that under the 
teachings of the expectant plan, that hip disease and surgery gener- 
ally, would soon be relegated to the barber’s care, as it was a few 
centuries ago. 
That this statement is not exaggerated, I have only to ask 
whatis it that the average man in the most civilized community can 
do when left to himself, outside of a very few things ; possibly one 
of them to draw up a table of statistics. Paralyze the efforts gener- 6 
ally of the most active, industrious and reflecting men by a general 
mandate of the profession encouraging the expectant treatment, 
to accommodate the lazy, envious and conservative human creatures 
that are opposed to laborious and emulative effort; and what would 
be the condition of surgery, even if there remained a few earnest 
and indefatigueable workers, their efforts would not be appreciated 
by the average doctor, and possibly the actual cautery would again 
take the place of the ligature in amputations, and amulets and charms 
replace the most judiciously compounded prescriptions; just as the 
Spaniards, under Hernando de Soto, after being reduced to dire 
necessity, were found marching and fighting, dressed and armed 
lik e savage indians. 
The h ighest degree of surgical progress cannot be transmitted 
by a small number of surgeons, be they ever so great as leaders and 
teachers ; they must have the co-operation of the profession; there 
must be a division of labor, which fits each individual doctor into a 
complex and effective organization for the general good of the 
world. Even the maker of surgical statistics may fit his place in 
this organization, like a well fitting peg under the direction and 
mental guidance of a master mind; but if left to himself is only fit 
to tell poorly what the average man can do. 
As Edmund About remarks, the merest trifle that costs next to 
nothing in "a civilized land, such, for example, as the modern means 
of obtaining fire from a match, has been the product of incalculable 
labor, yet what would the average civilized man do if he had 
no matches, or other civilized means of obtaining fire; rubbing two 
sticks together would cause exhaustion sooner than a spark ; and 
the ancient fire drill is unknown to him. 
What would the average surgeon do without the constant guid- 
ance and instruction of such leaders as those cited, left alone with 
his patients to the pitiless teachings of expectant surgery. Publish 
throughout the length and breadth of this country that expectant 
surgery is the best treatment for hip disease, which I deny, and all 
the indolent and incompetent doctors, and conservative old ladies of 
the profession, of the male sex, who are opposed to progress ; and 
who are appalled at the pains-taking care, labor and sharpening of 
the wits required to conduct properl v the after treatment of an exsec- 
tion for hip disease, would applaud the teachers of expectant treat- 
ment.