Sacramento daily record-union. [volume] (Sacramento [Calif.]) 1875-1891, 1881-10-03

the American JOtt77IGA OF 9iedtcas ostssS
thefolowing official record OF the post norton exam
nation iIthe body OF President James a Garfield,
made,septsmber 20, 1881, Commencing at 4:S0 P. IL,
eighteen hours after death, at Francklyn Cottage,
FIberon. N. j.: Present and assisting, D. W. Bliss,
Surgeon General J. K. Barnes. U. S n, Surgeon J.
J. woodward, L. S. a., DR.. Robert Reyburn, DR..
Frank H. Hamilton, DR.. D. Hayes Agnew, DR..
Andrew e. Smith, Of EIberon and New York, and
Acting Assistant Surgeon D. S. Lamb, OF the Army
Medical Museum, Washington. Before commencing
the exarni alton consultation was he'd by those
PHYSICIANS in 4 room adjoining that in which the
body lay, and it WIS unanimously agreed that the
dissection should be made by DIR. Lamb, and that
Surgeon Woodward should record the observstIons
made II was further unanimously agreed that the
Uranium should not be opened. Surgeon Wood
ward then proposed that the examination
SHOULD BE CONDUCTED
AS follows: That the body should be viewed exter-
nay, and any morbid Appearances existing record
ed That catheeer should then be passed into the
wound, as was done during life to wash it out for
the purpose OF assisting to find possible track OF
the bullet that along it an ncision should next be
made from the superior extremity of the sternum
to the pubs and this crossed by transverse one
Just below the umbiicus; that the abdominal flaps
thus made should then be turned back and the
ipal c1vity opened, the position OF the bullet
should BE- ascertained, il possible, before making
any further Incision, and that the thoracic yscera
should be examined. This order Of procedure
was unanimously agreed to, and the examination
was then proceeded with and the following external
appearances observed The body was con
siderably emaclated, but the face was much less
wasted than the limbs. preserving fluid had
beea injected by the enbalmer few hours before
into the left feorll artery aud the pipes used for
the purpose were still In position. The under sur
face Of the body presented
NO ABNORMAL APPEARANCES,
And there was no ecchymoss or other discolorstioa
Of any part of the front of the abdomen. Just be-
low the rigat ear and little behind it, there was
an oval liberated opening about half an inch in
dianater, from which some rancorous pus was pass
ing, but no tumefcation could be observed in the
parotid opening. considerable number of pur-
gura-lke spots scattered thckly over the left
scapula, and thence forward as far as the axilla
They ranged from oDeeighth to onefour.n Of an
inch in diameter, slightly elevated and furfur
ace)u the surface. and many of them were con-
fluent In groups Of two 20 four moro. Similar,
but much less abundant eruption, was observed
sparsely scattered the corresponding region
the right side. An oval, excavsted ucer, about an
inch long, the result OF small carbuncle, seated
the spinous process OF the tenth dorsal YER
Zebra Over the sacrum there were four small bed
sores, tie largest about inch in diameter Five
pustiles and a number of irregular spots OF post
norton hypostatic congestion were scattered over
the shoulders back and buttocks. The decreased
ccatrix of the wound made By the pistol bullst was
recognized the tenth interco5:al space three
and half inches 70 the right OF the vertebTa spine
deep line or ncision made in part by
THE OPERATION OF JULY 24rH
And extended by that of August sth occupied
position closely corresponding to the upper border
OF the right TO the twelfth rib 1t commenced pos
teriously about two inches from the vertebral spine,
and extended forward little than three inches
At the interior extremity of this incson there was
deep, nearly square, abraded surface about an
inch across. well-o flexible eatheter, fourteen
inches long, was then passed into this wound, as
had been done to wash it out during life. More
resistance at first encountered than had usually
been the case but after several trials the catheter
entered without ary violence to its full length. Ii
was then left in position, and the b dy disposed
supinely for examination of the viscera The era
MUM was not opened. A long incision was made
from the superior extremity of the sternum to the
pubs, followed by transverse incison crossing the
abdomen just below the umbillicus. The four flaps
thus formed were turned back and the abdominal
viscera exposed
MASS OF BLACK CALCULATED BLOOD
Covered and concealed the spleen and the left mar
gin of the greater omeutum. On raising the omen
tum it was found that this blood mass extended
through the left lumbar and lilac regions and
dropped down into the pelvis, in which there was
some cotted fluid q foot-note here says: "a large
injection material of embalmer.") The coagulated
blood having been turned out and collected, it
measured very nearly pint. 1t evident
that secondary hemorrhage had been the immediate
cause of death. But the point from which the blood
had csc lped, was not at apparent. The
omeatun not adherent to the ntestines which
were moderately distsnded with gas no intestinal
adhesions were found other than those between the
transverse colon and the liver already mentioned.
The abdominal cavity being now washed out as
thoroughly as possible. fruitless attempt made
70 obtain some indications of the position Of the bull
let before making any further incisions. By push
ing the testineS asde the extremity Of the cathe-
ter, which had passed INTO the wound could be
felt between the peritoneum and right lilac fascia,
but it had evidently doubled upon ITSELF and al
though prolonged search was made, nothing could
be seen or felt to indicate
THE PRESENCE OF THE BULLET
Either in that region or elsewhere. The abdominal
vscera were then carefully removed from the body,
placed in suitable vessel and examined seriatim,
with the following result Admissions between the
liver and transverse colon proved to be bound in an
abscess cavity between and under the surface of the
liver. The transverse colon, which involved the
gall and bladder, aud extended to about the same
distance on either side OF it, me lsuring six inches
transversely, and four inches from and before the
backward cavity, was lined with thick pyogenic
membrane, which completely replaced the capsule
OF that part OF the under surface of the liver
pied by the abscess It contained about two ounces
of greenish-yeow fluid, of the texture off pus mat
ter The abscess d MT involve any portion of the
substance OF the liver except the surface, with
which it was in contact, and communication
could be detected between il and any part of the
wound. Some recent peritoneal adhesion existed
between the upper surface of the right lobe of the
liver and the diaphragm. The liver was larger than
normal, weighing eighty four ounces. Its substance
was firm, but of
PALE, YELLowIsH COLOR
On its surface and throughout the interior of the
organ from fatty degeneration. No evidence that
it had been puncured by the bullet could be found
nor were there any assesses in any part of its
tissue. The spleen connected with diaphragm
adhesions. There were several rather deep con-
genial hssures in its margin, giving il lobnlated
appearance. 1t abnormally large. weighing
eighteen ounces. of very dark red color both on
the surface aud on the section. Its parenehyma
was soft and habby, but contained no assesses or
InIraetiops There were some recent peritoneal adj
hesions between the Posterior wall Of the stomach
and the posteFior abdominal particles. With this
exception abnormRlities were discovered in the
stomach or mtestines, nor any other evidences
GENERAL OR LOCAL PRRTToNITIs
Found besides those already specified The right
kidney weighed six ounces; the left kidney seven
Just beneath the capsule of the left kidney atabout
the middle of its convex border, there was little
abecess onethird of an inch in diameter There
three small Serious eysts on the convex border
OF the Iput kinney, Just DeDSatn capsule. In
other respects the tissue Of both kidneys was normal
IN appearance and in texture. Behind the right
kidney, after the removal OF that organ from the
body the dilated track of the bullet was dssected
into. II was found that from the point at which it
had fractured the right eleventh rib three inches
and half to the right OF the vertebral spine the
missile bad gone to the left ohquely forward pass
ing through the body OF the first lumbar vertebrse
and lodging in the adipose connective tissue imme
diatey below the lower border OF the pancreas.
about two inches and half TO the left of the spinal
column, and behind the per;toneum, where il had
become
COMPLETELY ENCYSTED
The track of the bullet between the point at which
it had fractured the eleventh rib and that at which
it entered the first lumbar vertebrs was consider
ably dilsted and pus had burrowed downwards
through the adipose tissue behind the right kidney
and thence had found its way between the perito.
channel, which extended almost to the groin. The
neum and the right lilac fascia making de- cepdinp
adipose tissue behind the kidney in the vicinity Of
this descending channel, mu:h thiekened and
condensed by Inflammation. In the channel, which
was found almost free from pus, lay the flexible
catheter, introduced into the wound at the COM
mencement of the autopy Y. Is extremity was
found doubled up ITSELF Immediately beneath
the perltoneuIE, reposing upon the lilac fascia,
where the channel dilated into pouch of con-
siderable size. This long descending channel, now
clearly seen to have been caused by the burrowirg
of pus from the wound, supposed during life to