Clearfield Republican. [volume] (Clearfield, Pa.) 1851-1937, 1881-10-05
THE FATAL WOUND.


field, to follow and explain the vary
ing symptoms, and to determine no
only the immediate cause of deaf
: but the ultimate causes that lead I,
that event. In attempting this, how
, ever, II must be said that the informa
tion thus far supplied is still yer,
scanty, and that any conclusion reach
ed now may be entirely overturned By
more complete description of tn
pathology and the history of the case
Mr.. Garfield was shot on the morning
Of July I'd. The ball entered the bach
about four inches to the right of tn,
spine, and between the tenth anC
eleventh ribs, fracturing the latter
Its direction was from the right sidt
toward the left, but slightly forward
and downward, and passing on its way
IL crushed through the body of tht
first lumbar vertebra, and finally lodged
in the deep muscles Of the back Of
loins about two inches and half tC
the left Of the spine, below the pan
creas. This organ, it may be explained
is an oblong gland, very similar il
structure to the salivary glands, which
lies across the back part of the abdo
men behind the stomach, its larger
end being somewhat to the right o.
the centre of the body and its smaller
end extending to the spleen, upon the
left side, above the left kidney. The
pancreas was not affected by the
wound, but the reader should under.
stand its position, as well as that OF the
vertebra above mentioned. Ii will be
remembered that the spinal column
or backbone" is made up Of series
Of bones or vertebrR, piled one upon
the other. Theupper vertebre, called
cervioal, form the neck to the twelve
dOrsal vertebrR the twelve ribs are at.
tached, and below these come the lum.
bar vertebra, the largest Of them all
Each vertebrR consists Of body, o
circular mass OF bone, with flat sur.
faces above and below, which rest
upon those adjoining, aud ofa curiously
formed ring of bone behind this, with
a projection or spinous process at the
back, The series Of rings, lnterloclling
together forms the flexible canal that
contains the spinal cord from which
nerves pass out to supply the different
parts OF the body. 1t was the injury
of one of these nerves, either by the
ball or by spinters of bone, that caus-
cd the pain in the legs of which the
President complained in the carly
stages of the case, and il is possible
that the spinal cord itself had sustained
some harm from the fracture
When the patient was taken to the
White House he was in a state OF col.
lapse from the schock of the injury,
and throughoutthe day it was believed
that ho must die. In the course OF
the night, however, he rallied little,
the panic subsided and the case was
given in charge of a selected group of
surgeons. The latter knew from ex-
perience that the less a penetrating
wound of the abdomen was meddled
with the better, and they determined
upon a strictly conservative and ex-
pectant course of treatment, which
consisted simply in careful dressing
Of the wound and attention to the
patients general condition. On July
4th, DIR, Agnew and DR.. Hamilton
were summonedin consultation. They
saw the patient, who had quite recov-
cred from the shock and had no dis.
quieting symptoms they learned what
treatment had been adopted, and were
convinced that the surgeons in charge
were doing what was right and were
competent to the care Of the case. IL
does otappear that either DR.. Agnew
or DR.. Hamilton made a personal ex-
animation of the wound at this time,
and after signing q bulletin or two
they went homo and did not sec the
patient again until the 23d. Up to
this time everything had apparently
been going well. This tissues had closed
in around the ball, which gradually
became encysted, or enclosed in hard.
ened tissue, and hencefortb ceased to
be an element in the case. Between
the spine and the outer wound also the
process of repair had gone on, so that
the track Of the ball was no longer
open. But around the fractured rib
active inflammation had set up and an
abscess formed, the presence OF which
was indicated by chill and a sudden
rise in temperature and pulse at noon
OF the day named. The consulting
surgeons were summoned in haste and
on Sunday, July oath, DR., Agnew
made an incision into this pus cavity.
There was an abundant discharge
and subsequently II number of
splnters Of bone were removed. Mean.
while, however, the imprisoned pus
had already begun to burrow along
the vertical muscles of the loin, so that
the operating surgeons found deep
channel reaching downwards on the
right side, in a different direction from
the track of the ball, which by this
time was nearly closed. The treatment
applied to what was thus enormously
supposed to be the wound would have
been the same in any case. 1t was
simply to keep il clean aud facilitate
tho discharges. Nevertheless II did
not diminish, and to promote the latter
object a second incislon was made, two
weeks later, below the last rib and the
original orifco was allowed to heal.
This would probably have accomplish.
cd its purpose had not other causes
brought about such condition of the
patients system as TO stop altogether
the process of repair. The discovery
made later OF the unexpected depth Of
this suppurating channel was not as
important as it appeared, because it
was by this time evident that the pa.
tient was suffering from some other
trouble than was caused by any then
visible or within reach.
This trouble came from the fractured
vertebr@, There is no complication
so dangerous in q wound as broken
or diseased bone. The growth and
nutrition Of bone are slow, and in.
nammation and degeneration and the
death OF the bone tissue are CORES.
pondingly evil IN their effects. The
body of the first lumbar vertobrp is
mass of light, spongy bone, especially
liable to destructive inflammation 1t
had been shattered by the ball and its
fragments scattered and driven into
tho soft tissues. Tho decay of the
bone gradually ensued, and, while the
ball was safely out Of the way and the
external wound was becoming less i'm.
portant, there had been developing,
out OF sight and out of reach, condi.
tion Of disease that could not but con.