 However, because Cotton attributed her condition to a "marked retention of fecal matter in the cecal colon with marked enlargement of the colon in this area" for which she was subjected to a series of colonic surgeries before dying of a streptococcal infection in 1919.The danger of surgery was recognized by some patients in the institution, who, despite their mental illness, developed a very rational fear of the surgical procedures, some resisting violently as they were forced into the operating theater in complete contradiction of what are now commonly accepted medical ethics.A paternalistic attitude and the permission of the family of seriously insane patients was the basis of intervention at the time.