Mexico weekly ledger., 1881-12-08
aARFIELD's FATAL oUsp.
-Four Ezninent Surgeons Discuss the Case
Three of Them Practically Agree That
Death wal Inevitable The Fourth
Denies That it was.
York Time.

u eminent surgeons-Dr. J. Marion
Sims and DIR. w. A. Hammond, of New
YORK; DIR. John AshhuIst. Jr.. OF PhiJa-
delphla, and DR.. John 7. Hold gen, of st.
Louis, contribute papers to the December
number of the North American Reriew.
published to-day, on 1.-THE Surgical Treat,
ment of President Garfield Three of
the four practically agree that the Presi-
dents case was hopeless from. the start.
The exception to this accord is found in
DIR. Hammond. DIR. Sims declares that
GarGeld's wound was "as certainly NOR
tai" al was Lincoln's, which was s.in-
stantly fatal" and concludes bis article
in these words: "View the Presidents
case as we may, he had not the least
chance of recovery under any circum.
stances or any treatment. Without the
wound of the vertebra it would have
been impossible for him to die. With it
it was impossible for him to live" DR.
Sims prints a diagram to show show
difficult, almost impossible, it was to
probe such a rectangular, zigzag canal as
the ball made in this case." "And how
could any one" he asks, Sind the course
of the ball lift were impossible to fol-
low its track with a probe?" even if
the course of the ball could have been
aoeSii1i1iSus Xix iCcuit, uc Bays, NOuIu
have been precisely the same. The sur
geons could only have kept the pus
pouch between the fractured ribs and
spine and the one extending down into
the pelvis empty and clean This they
did all the time, as the history of the
case and the autopsy show. They could
haye lone nothing whatever for the
results Of the compound, comminuted
fracture of the two vertebra. From the
very nature of this part of the wound,
death was sooner or later inevitable"
Again he says: But for the injury to
the spine the President would have re-
covered. and l must here repeat that
with this injury it is a marvel that he
lived so long" DIR, Sims adds that the
attending surgeons have been severely
and unjustly treated by some newspa-
pers and even some members of the
medical profession. and then continues:
"A correct diagnosis is essential TO sue
c~esslull treatment. 1t is the basis of ali
treatment, But We may diagnose accu-
rately, and yet u patient dies when the
wound is mortal. We may fail to dag
nose correctly, and u patient dies for
the same reason that the wound is NOR
tai. In a mortal wound the diagnosis.
true or false, is powerless to ave life.
And SO it was with the President. His
wound wa mortal whether diagnosed
correctly or not. And it is uncharitable
and ungracious to blame the in
the Presidents case for its fatal termin-
alton. They did all that men could do;
all that the presentstate of science would
permit, and all that could have been
done, even if they had at first ascertained
the course and direction of the ball.
Medical science is not yet an exact one.
It is in a transition state. Although it is
progressing with wonderful rapidity, the
time will, [ fear, never arrive when such
cases as the Presidents may be treated
with any more success that atthe present
day.
DR.. Ashhlrst reviews the history ofthe
case from the day the wound was in
iicted. He does not think the attend
ing surgeons should have made an effort
to remove the ball, either when first
called in or at any subsequent time, and
his conclusion, Cooking at the whole
case from beginning to end" is this: II
do not see that the treatment could have
tage of the illustrious patient; nothing
was done that should have been omit
ted, and nothing was left undone that
| Sould ffoSCibfy iIofC SSh vi DCICii
On the question of a necessarily fatal
| ending, his answers somewhat qualified,
| but "given a case precisely like the Pres
ident's and it must, no doubt, end IN
| DEATH still, the case might be different
while the wound was SIMILARLY
which he means that, had the President
been a youth of 20, entirely free from
care, and able to me in his illness
an ample supply of food, "the case might
possibly, though not probably, have ter
minated differently"
DIR. Hodgen can find no reason for
adverse criticism of any part of the man.
agement," and does not see that any
thing was done, either at the examina.
ton or, in the treatment, tended to hast
en- death or IN any way ~unfavorably in.
fiuence the progress Of the case" Any
probing beyond the inner surface of the
ribs, he believes, would have been "of
no value" His conclusion is this: Had
the site of the ball been known, it could
not have been removed. Had the site,
| character and relation of the aneurism
been known, the vessel could not have
ligated. Had the presence o. the pus
cavity been recognized, it could not have
been evacuated without fastening the
fatal termination. Finally, if the pus
cavity had disappeared harmlessly, if the
aneurism had been spontaneously cured
if the bullet had remained ~encysted, the
injury to the spine, with the carious con.
dition of the bones and the ulceratina
inter vertebral cartilages, must have lief,
the President a deformed invalid"
DIR. Hammond, among numerous other
points that he raises against the treat,
ment the President received, makes
these, which he calls alleged "circum'
Stances" believed by him to be true
"There never was any adequate reason
why athorough exploration ofthe wound
with finger and probe, could not have
been made within "a hours after the
shooting. Had this been done the track
of the bullet would certainly have been
discovered, as it had pursued a perfectly
straight course, undef1ected by any tiS
sue through which it had passed; the
injury to the ribs and the first lumbar
vertebrae would have been ascertained
pieces of bone and clothing would have
been extracted, le~ssening the suppura.
ton and consequent danger of pypmia
and though the ball would not probably
have been reached, its approximate sit
uation would not have been-as it was
a matter of guess.work. The failure to
discover the real track of the bali, and
to treat the fractured ribs, led to the
burrowing of pus in,,the right inguinal re.
gion, and the formation ola sinus which
during life was supposed to awe been
made by the bullet" DIR. Hammond's
concluding paragraph is this: "And fl
nal1y to sum up the main conclusions, il
is denied that the wound was necessarily
a mortal one; it is denied that the science
of art and surgery are in such an imper.
feet state of development as to afford nc
~~-a ~..lon En- tho 4raattnant Of q caca