Morris tribune., 1881-07-14

animation We may fudge by tho absence of
certain symptoms that most of the important
organs of the abdomen have escaped from
being wounded in this case"
For example," he continued, explaining his
Positlon with great care, Gas general rhle,
II the intestinal tube is wounded by bullet
most probably there would ensue what is called
extraVasatlon of it's contents. Such an occur
renee IN all probability would be followed
by speedy peritonitis, a continuation Of the
collapse and death within two or three days or
less II any of the large arterjal or venous
trunks were wounded; so as to induce eoplous
Internal hemorrhage, reaction would not take
place, but death would occur within twenty
four hours. If the kidney or ureter
injury would also be attended by extravasation
into the cavity of the pertoneum, DR. urinal ex-
travasatlon and of bloody discoloration of the
contents of the bladder. This lesion would also
be attended with serious collapse, ending,
most probably, in early dissolution. If the
gall bladder had been wounded extravasation of
bile into the cavity of the peritoneum would be
speed.ly followed by collapse and death. Gun
shot wounds of the stomach may be recovered
from, but are as general rule fatal, and are
associated with unmistakable symptoms of a
very grave character. Extensive wounds of
the liver are followed generally by internal
hemorrhage into the cavity Of the peritoneum,
which is almost invariably Gf the hemorrhage
beprofuse) followed by extravasation, collapse
and speedy death.
'As the condition Of the president up to the
grave symptoms have enumerated it might be
reasonably hoped that, if the liver is the organ
reached bv the ball. the part of that organ
struck has been but slightly impinged upon,
and that it is outside the cavity of the peritone-
um, and that a salutary reaction may take
place."
Suppose the injury to the liver to be but
slight-the tissues of the liver to be but slight
ly lacerated-so you suppose the danger to be
over?" asked the reporter.
"No. Even after reaction has taken place
suppuration in such wound as the one we are
or less extent, and purulent absorption or sep
ticnmia may take place and produce fatal re-
suit"
'sIs this a possible or probable danger?"
IL should say it might be possible intercur-
rent complication in this case. The reports
1t would not be SO probable In the case of a
healthy. constitution as in person of ante
eedent broken down physique"
"When would such. secondary symptoms be
likely to show themselves?"
s'From the fifth tn the twelfth day"
"Then would he be out of danger in two
weeks if the symptoms all remained favorable
''Not even then, for prolonged suppuration
might be attended by purulent absorption at
any time during the progress of suppurative
wound'
''When will he be out of danger, then?"
"With the presence of foreign body in the
system until suppuration had entirely ceased it
could scarcely be said that all danger was over,
uuL III SunsnoJ wounds IT inc aDaomlnal organs
resume their normal functions the prognosis
then becomes almost absolutely favorable"
els it possible that the bullet wounded mono
of the organs you have mentioned?"
by bare possibility, the mesentery or tho
omentum might be pierced without very dan
gerous symptoms occurring, but such thing
would be almost like that which l saw in the
case of Poole, the pugilist, who received bull
let in the heart, which was not followed by
hemorrhage simply because the bullet slipped
incidentally under the coronary artery"
'sWhat course is the most proper to be pur-
sued in regard to the extraction of the bullet
in President Garfeld's case.
''After twentv-four or thirty-six hours in
fammaton sets in along the track of the gun
shot wound. and generally renders search for
the bullet futile at that time A suggestion Of
Dr. Wales to search for the bullet by the
gentle insinuation of the finger soon after the
wound was received was most jndicious, and
if properly followed up, might have at that
time discovered the seat of the ball. Until
Inflammation has subsidized along the track of
the wound and suppuration shall have freely
set in, interference in regard to the search for
the ball would be contrary to established
rule"
''Might the ball remain in the system and be
harmless?"
eyes. Bullets remain encysted among the
tissues and at times remain harmless, as oc-
Cured in the case of Poole to which just re-
ferred He lived eleven days after he wae
shot, and the ball was found to be entirely en-
velored in a cyst without the slightest degree
of suppuration."
''Then what killed Poole?"
"Poole died of Inflammation of the pericar-
dium, with etfuson of serum into the cavity OF
the pericardum."
swell, DOCTOR" said the reporter, eff yor
balance the chances, is it more likely that Gen
Garfield will live or die?"
81 should say to that" replied Dr. Car.
nochan that having escaped so far the grave
symptoms which 1 have just enumerated the
chances IN favor of his recovery have greatly
increased"
DR.. AGNEw's OPINION.
Dr. A. Hayes Agnew was found at his coun
try seat at Haverford station, on the Pennsyl
vania railroad, this evening, and courteousl,
interviewed by the Herald correspondent The
bulletin sent him during the day by the fou
physicians in attendance at the White Hous
was read over by DR.. A2now with great care
| and he pronounced the symptoms as hourl,
more favorable. The official bulletins printel
in the evening papers up to o'clock, he said
confirmed the hopes expressed in the Garlic
message to him.
''The absence of any further dstension O
the abdomen, the disappearance of the pain
| in the legs, the many other signs that the pres
| idents strong system is reassertng itself ar
| all too gratifying to be passed over withou
comment" " said the humane physician. 81 an
| avorse to limiting at the new dangers tina
| threaten the patient, because the newspaper
find their way into that sick chamber witt
alarming ease. Everybody reads the newspa
| actually, in the sick room. Therefore, thin
| it wise not to talk about the dangerous way
marks that stand at intervals along tn
road to recovery. Consideration for the pa
| tient stands before everything. It is by striv
ing to see the effects of the future stages O
| the wound tall of which are natural and likel
to arise) that the progress of the patient can b
constantly assisted. For instance, the favor
able bodily condition of the president prove
far more clearly than the natural action of til
| bowels that the intestines have not been sey
cred, because had the stomach or an intestis
been cut death from blood poisoning woul
have occurred ere this. I do not regard til
search for the ball as wise at this stage, and d
| not think for moment that it will be attempt
ed DR.. Degrass, of Georgia, was the first t
propose the heroic treatment suggested by Dl
simms in the Herald; but I doubt very muc
cumstances. Nobody knows or ca
know exactly where that ball is lodged. il
serted my finger to its full length into th
| W0und, lar past the broken RIB; still cann(
say where it is can surmise; but who woul
dare to cut patient open on a mere guess
Wherever the ball is there exists q clot {
blood which nature or science must eliminat,
had great number of cases during the wa
quite similar to President Garfed's. some
whom recovered. Therefore, his case is NJ
hopeless, although in the great majority of il
stances a fatal result follows. The tingiing
the legs is not serious symptom as might i
inferred, especially since Mr.. Garfield move
his legs readily. He turned over on his fac
readily to permit us to examine his wound"
/ ''What is the exact location Of the wound?
was asked.
"It is on the right side, four inches fro,
the spine," replied DR.. Agnew. "The miss
entered between the tenth and eleventh rib
the latter being broken. From he exterit
appearance of the wound the presumption ce
tainly would be that the liver has been ira,
ersed and that the ball is somewhere in Il
lower par! of the abdomen. Either case woul
be equally dangerous"
"What are the great symptoms in his favor!
'sFirst of all, the evidences that are concl,
sive to q phvsician's mind that none of Il
small intestines are cut and that the bladder
uninjured. The growing desire of the patie
for more nourishing food (Which he has evinct
especially to-day. am informed) indicates Il
return of q normal action on the pars of III