Dr Walter C. Alvarez in 1968 wrote an editorial, "Why Do We Physicians Do Certain Things?"1 One of the "certain things" had appalled him throughout his professional life. As an intern in 1905, he observed that purging patients in preparation for elective surgery was causing great suffering and, apparently, many deaths. Those who required emergency surgery escaped this purgatory.
I watched and kept records, and soon found that the patients who had had no "preparation" did much better than the ones who were purged all night with big doses of jalap plus calomel plus magnesium sulfate. Many of these, after a night on the toilet, came to the operating room so utterly fatigued, so dehydrated, and in such a degree of shock that—unable to stand a big operation—they soon died.
He asked his surgical colleagues why they required that their patients be purged before the removal of a goiter,