Savannah morning news. [volume] (Savannah) 1868-1887, 1881-09-30
AFTER THE AUTOPSY.
GENERAL GARFIELD'S WOUND
An Analysis of the Case by Doctor
Hamilton The Treatment Re-
viewed In DetaIl-The Folly of any
Attempt TO Find or Extract the
Ball - Outside Criticism Fully
Answered.

Attempt to Find or Extract the
Ball = Outside Criticism Fully
Answered.
In the next number Of the Medical Gazette,
Of which Doctor Edward J. Birmingham is
editor, and which is to great extent the
organ Of the rising generation of physi-
clans and of the American Academy Of
Medicine, which has approved the treat
ment adopted, will appear an exhaustive
review of the Presidents case, obtained by
that valuable journal from Doctor Frank
Hamilton. 1t was dictated by Doctor
Hamilton, and is as follows:
So far as am informed the testimony is
conflicting as to the relative positions of the
President and the assassin when the pistol
was fired. 1t is now rendered probable that
the assassin stood well to the right and
slightly in the rear of the President. The
ball entered about four inches to the right
OF the spine, penetrating and comminuting
the eleventh rib, entering the intervertebral
substance between the last dorsal and first
lumbar vertebr8, and passing oblieuelY for
ward, emerged at point near the centre of
the first lumbar vertebre in front, and was
found some distance to the left of the YER
tebTp, at the lower margin Of the pancreas,
being situated nearer it's posterior than its
anterior surface-wholly without the perito-
neal cavity. 1t is unnecessary to say that
the course of the ball, after penetrating the
rib, was not determined until after death. |
saw the patient on the morning of July in
consultation. We were then informed of the
manner of the accident, and that on the re-
ceipt of the injury the President had fallen to
the floor, sinking down to the right side; that
being interrogated he complained of pain
in his right ankle, and subsequently, in the
course of the day, of a similar pain in his
left ankle, which pains had been promptly
relieved by the hypodermic injection of
morphine. He vomited Immediately after
the receipt of the injury, and in the course
OF the day his urine had to be drawn once
by the catneter. There was not when first
seen by myself, nor has there been at any
time subsequently, any apparent loss of
power in his lower eXtremities, or diminu-
tion Of the natural sensibility at any point.
The pains In his ankles, however, were &C
companied with hypeT3sthesia of the inte-
gument, and a few days later it was OBJ
served that there was hypeI3sthesia of the
integument OF the right side of the scro-
tum. All OF these symptoms--the pain and
the hyper@sthesia-disa wholly in
the course Of the first week or two and
never returned. On the morning of the 4th
of July, the patient being partially under
the influence of the morphine, was not suf-
fertng pain, the bowels were tympanitic,
and the pulse was feeble.
SURGEON GENERAL WALES EXAMINATION.
At the first consultation, the question
having arisen as to the probable course of
the ball, 1t was stated that Surgeon General
Wales, of the navy, had on the day of the
receipt OF the injury introduced his finger
to its full extent, and that he had declared
that 1t penetrated the substance of the
liver, the structure of which he recognized
by its granular feel and DIR. Bliss stated that
he had introduced a probe about three
inches, which seemed to have passed in the
same direction. This testimony was re-
garded sufficient to determine that the ball
was at least beyond our reach, and beyond
the reach of safe exploration. DR.. Wood
ward had introduced his finger sufficiently
deep in the wound to determine that the
rib was broken. Finding upon personal ex
animation and inspection that the track of
the wound was completely closed by firm
clot l refused to make any further explora-
ton. From this time forward great uncer-
tainty existed in the minds of the medical
attendants as to the actual course and pres
ent situation of the ball. On the oath of
July, and after the complete subsidence
OF the tympanites, a circumscribed
point of induration was discover
ed in the right lilac fossa, which at
once led to a suspicion that the ball
had been DETECTED, coursing along the
anterior surface of the lumbar muscles, and
that this induratfon indicated It's present
seat. This suspicion was sustained by the
hYper@thesia of the right side of the scro-
tum, which, as Professor Weisse had
already shown in his anatomical observa-
tions, would be the natural result OF an
fr,Sf1 ys1ff fha Tr,nrr ,a1
trio nerves, which lie in the course of the
then supposed track Of the ball. Still fur
ther confirmation was added when, on the
9th Of July, we found that flexible cathe-
ter could be carried downward in the direc-
tiOn OF the supposed situation of the ball
to a distance of seven inches. The point of
induration in the right lilac fossa gradually
moved dOwnwards, and became more hard
and defined, conveying the impression that
it was the ball, and that it was eucysted.
At the autopsy, 1t having been determined
that this was not the ball, further examina-
tion of the channel in this direction was not
prosecuted. Indeed, this induration had
entirely disappeared after death, and It is
now presumed that it only indicated the
lower end of the long sinus already de-
scribed.
About this period small pouch of pus
was formed in connection with the main
channel, extending underneath the integu-
ments of the back, causing rigors, which
were at once relieved by free incision;
and a little later rlgors followed in cOnse-
quence of the temporary obstruction of the
channel, caused by the floating of a small
fragment of the rib into the orifce, which
were relieved on the removal of the frag-
ment.
THE STOMACH AND THE PAROTID GLAND.
On the 8Ih of August, great difficulty
having been experienced in the introduc-
ton of the drainage tube into this long sup
purating canal, an iucision was made below
the twelfth rib, the patient being under the
influence of ether. About a week later the
stomach of the President became exceed
inglY irritable, aud it was found necessary
to suspend 2limentation by the mouth, and
for three or four days he was nourished
only by enemata. On the fourth day after
the suspension Of slimentation by the |
mouth the right parotid gland began to en-
large august ~, and on August "a sup
purated, and was incised, the first incision
giving exit only to few drops OF pus.
Subsequently it opened into the mouth and
meatus auditorius eXternus, and three or
four incisiOns were made at different points
on the surface for the exit of matter. At
the time of death the suppuration and
swelling of the parotid gland had almost
entirely disappeared.
BRONCHITIS OF THE RIGHT LUNG.
Following the parotitis there was gradual
development Of bronchitis in the right lung,
and finally broncho pneumonia of the lower
portion of the right lung, indicated by we'll
defined dullness and a total absence of the
respiratory murmur In that region. From
this time until the period of his removal
from Washington there are no events of
striking interest worthy of being related in
this brief summary, except the alarming
weakness and great somnolency of the pa
tient, which occurred on the oath, 25th and
26th of August, and which led to an appre-
hension that fatal issue was at hand. The
patient was evidently suffering from atmos-
pheric influences, the heat being intense and
oppressive, and most of the time the air be-
ing motionless, so that leaf could not be
seen to stir upon the trees surrounding the
White House. There was no evidence, how
ever, at any time that the patient suffered
from malaria having its source In the
house drainage or the marshes in the