In an era before antibiotics, surgery resulted in a very high rate of postoperative morbidity and mortality, largely from postoperative infection. Among his patients at this time was Margaret Fisher, daughter of wealthy and famed Yale economist Irving Fisher, who believed in the hygienic movement of the period. Diagnosed by physicians in Bloomingdale Asylum as schizophrenic, which was before the modern development of some pharmaceutical agents, Fisher had his daughter transferred to Trenton. 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", 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.