Barbour County index. [volume] (Medicine Lodge, Kan.) 1880-current, 1881-10-27
eUN-sHoT WOUNDS.


Medicine been so thronoed with dis.
tinguished members of the medical
profession as they were Last evening
when DIR. J. Marion Sims read his me-
mor on the surgery of "Gun-shot
wounds OF the Abdomen" Among
those present were DIR. Austin Flint,
DR. James X. Wood, DIR. Lewis a.
Sayre, Prof. Faneuil ID. Weisae Dra
Gardner and Muzzey, of the United
States Army; DR.. Cushing. DIR. Newell
OF New Brunswick, N. j.: DIR. W.T.
White, DIR John p. Gairish. and MANY
others. Or. Fordyce Barker presided
10 introducing his paper, DR.. Sims re-
ierred 70 the great progress of ovariot-
omy as an operation during the last
Few years, and to its contributions TO
the important department of peritoneal
surgery. The honor of having first
performed the operation belonged. he
said, TO an American surgeon. DR.. Nc
Dowell, and 1t was, therefore. in its
origin especially an American opera
ton. He traced the later progress of
the operation in the hands of Alley.
Peasley, Battey, and other surgical mas
teIs in the United States, and of Spen-
Ger Wells and his co-workers in Eng.
land. The question whether the incis-
ION in the peritoneum should be COM
pletely closed or not was an omen one
with earlier surgery until experience
and experiment alike evinced the pro
priety Of bringing the cut edges of the
membrane together, and permitting
them to unite. DIR. Sims cited cases
in which the edges Of the peritoneum
only had united, while those of the alb
dominal wall had failed to knit toQeth-
er, and with the discussion of this point
brought the subject down to the work
OF the recent international medical
congress in London, where a large
number Of papers were read ON peri
toneal surgery, in all its aspects. by
Spencer Wells, Lawton TAFT, and other
distinguished Europeans.
He next proceeded, with the dis
closures Of these papers fresh in his
memory to discuss the advances in
peritoneal surgery of late years, since
Listerism and the drainage tube came
to avert the danger from septicmmia
that was once so intimately associated
with all operations involving incision
OF the peritoneum, and the exsection of
any OF the viscera situated within its
cavity. AS between the two, if one OF
the other must be given up, DR.. Sims
declared that he should prefer to give
up the antiseptic method of Lister and
retain the privilege of using the tube
which could be inserted near the bot,
tom OF the cavity, and thus serve 70
carry of all septic fluid. He recalled
a case in which he was associated
with the late DR.. Nelaton, Of Paris,
physician to Napoleon Ill, in the per.
Torrance of the autopsy. A large
quantity Of serious fluid mingled with
blood was discovered in the peritoneal
cavity, and there being no doubt that
the patient had died Of septic fever, he
remarked to the distinguished Paris
surgeon that the septic influences
might have been avoided by using a
drainage tube. EYES," replied Nela-
ton, 'and there would have been no
objection to that"
After speaking of the various forms
OF peritoneal surgery, DIR. Sims
passed to gun-shot wounds of the alb
domen of that peculiar case involving
penetration of the peritoneal cavity,
and OF one or more Of the viscera con-
tanned within it. One of the Oldest
cases cited was that of DIR. Newell, Of
New Brunswick, in which the patient
accidentally shot himself, the bullet
penetrating the peritoneum, perforat-
ing the intestines. and passing COM
pletely through the body. DR.. Newell
made an incisiOn of the abdomen and
peritoneum. removed the tow and 9TH
er matter, closed the wound and the
man recovered. But the most promi-
nent cases cited were those of Albert
ID. Richardson, who lived five days af-
ter being shot, and of James Fiske,
Jr. In the former the liver and the
gastric cavity were penetrated; in the
latter the bullet entered little above
the umbilical mark, penetrating the
omentum, and perforating the viscera.
In the light Of modern surgery, DR..
Sims held that In both these ca es an
operation should have been attempted
by incision Of the abdominal wall and
the peritoneum, extraction Of the bull
let, closure Of any perforatlon of the
viscera that existed, thorough cleans
ing of the peritoneal cavity, and the in
sertion of a drainage tube He next
alluded to his experience as an ambu-
lance surgeon in the Franco russian
war, and the lessons in peritoneal sur
gerry gathered from it, showing, as
general law, that in wounds received
below the rim of the pelvis the patient
usually recovered, while in those in
which the bullet entered above that
point the termination was uniformly
fatal.
In conclusion, DIR. Sims adverted
briefly to the presidents case and to
the telegram sent by him to an Ameri-
can physician three days after the
event occurred. 1t was then believed
that the bullet had penetrated the peri
toneum and injured the liver. He had
prepared the paper he had just read to
show that his advice was based upon
enlightened surgical principles. had the
first diagnosis of the case proved to be
correct. The later disclosures of the
case had, however, taken 1t out Of the
category of peritoneal surgery, and
shown the wound to have been one in
volving bone and muscle only. Had it
been a wound involving the peri
toneum, however, the only hope Of saw
ing life would have rested in an opera
ton such as he advocated.
The paper was ably discussed by DR..
Sayre. DIR. James R. Wood, DIR. Cush-
ing, DIR. Muzzey, and others.