Evening star. [volume] (Washington, D.C.) 1854-1972, 1881-09-27
KINDLY ENGLISH SENTIMENTS.
OPINIONS OF ENGLISH EXPERTS-pR HAMILTON
DEFENDS THE SIRGICAI. IRE ATMENT


OPINIONS OF ENGLISH EXPERTs-DR. HAMILTON
DEPENDS THE SURGICAL TREATMENT.
a London dispatch says: II had converse
| ton the other day with two eminent surgeons
on the official report of the autopsy President
Garfeld's body. While they seemed disposed to
critcise certain details Of the medical treatment
they are thoroughly of opinion that from the
first moment of the case death was inevitable.
This appears to be the opinion of the whole
faculty in England but it is noticed with
surprise and modification i'm many quarters
that the entire diagnosis of the case seems TO
have been wrong from beginning to end.
The Lancet, whose articles on the case We're
written by, or at least submitted TO- the cor
rection of two very able surgeons seems to
have known more of the case 5000 miles off
than DR.. Bliss. When the latter was proclaim
ing that the patient was on the high road to re-
covery, the Lancet suggested that after all, per-
haps the channel believed to have been made by
the bullet was only mine made by the burrow-
ing of pus, and that in that case septic cond-
ton of the blood would supervene and probably
result fatally. The case has not tended to in
crease popular respect for medicine and surgery.
Beaconsfield died while the doctors were wrang-
ling over point of medical etiquette and it was
not until President Garfield's life slipped away
from him that the surgeons really knew or un-
derstOOd the nature of his wound. I am told
that from the first Sir William Gull held that DIR.
Bliss location of the ball was all wrong, and
that he denounced the experiment with Prof
Bells instrument as rank piece of quackery,
absurd and ridiculous from its nature"
WHAT DR.. HAMILTON SAYS.
DR.. Frank III. Hamilton has written for the
Medical Gazette an article giving a brief history
of the Presidents case. After summing up the
various events in the progress Of the case he
says:-'1t may be necessary, however, torepeat
inasmuch as contrary statements have been
made, that the lungs contained not even the
most minute abscess, and that there was no
az c<ofin nfcnn I'm ,F
lures examined, except one less than half an
inch in diameter, near the surface of the left
kidney. There were three small Serious cysts
under the peritoneal covering on the vortex
edge Of the right kidney, each about the
size of the vertical section of large pea
The abscess found between the trans
verse colon and liver was evidently not metasta-
tic, but probably was caused by the original in
jury. There was no cycatriX or wound Of the
liver, nor anything to indicate that it had suf-
fered injury in slightest degree. Since it has
been thought by some that it was the duty of the
surgeons to have ascertained positively the course
and location of the ball, it is proper to consider
whether one or the other were practicable. AS
to determining the course of the ball by PROBE
every anatOmist will see that it was impossible,
which the ball must have taken to reach its
final destination; that it passed through
the solid structure of the vertebra and
that no metallic instrument sufficiently firm to
give indications Of the course and the direction
which it took within the body could ever have
reached the ball. Nor would any surgeon Of
experience familiar with gunshOt wounds of the
belly, IN the absence Of any satisfactory or con-
elusive evidence as to what course the ball had
taken. venture to introduce q probe into the
abdominal cavity for the purpose Of exploring
the supposed track; nor, indeed, if he had evil
dence as to the course and situation Of the ball
could he have been justified in such exploration.
No point is better settled in surgery than that
interference of this sort in gunshOt wounds of
the belly is meddlesome useless and dangerous,
and had it been done and fatal peritOnitis in
consequence been set up the surgeon doing it
would have been justly held responsible for the
fatal result"
After showing the difficulties that lay in the
way Of reaching the ball, even If its location had
been known, Dr. Hamilton concludes BY saying:
Il am reminded now to say, in reply to some
suggestions made from time to time that We
ought to have made a counter opening i'm the
lower portion of the long sinus which terminated
in the right lilac fOssa, that there was no period
of time during the progress OF the case in which
we felt absolutely certain that what we recOg-
nized in the fOssa or point Of induration was the
ball, nor were We entirely certain at any time
where the lower end of the sinus was actually situ
ated. Nothing but very flexible instrument
could ever be introduced, and ina smuch as when
introduced its presence in the track could not
be recognized by the sense of touch, We were
left without any means Of determining, with
sufficient degree Of accuracy to justify an oper-
alton, where the lower end of the channel was.
Indeed, it is probable that the flexible catheter
employed never reached the lower end OF the
channel, but doubled upon itself near the crest
of the ilium. To have cut through or between
the great mass of muscles in the lower portion
of the lumbar region for the purpose of making
a counter incsion into the small channel. the
course of which we did not and could not know,
even approximately. would have been, under
any circumstances, an unjustifablc procedure,
and especially so in the case OF the President,
whose hold upon life during all this long period
seemed to depend upon q thread.
The PENNSYLVANIA democratic convention to |