Akron daily Democrat. [volume] (Akron, Ohio) 1892-1902, 1901-09-28

best to choose the anterior or posterior
route. A laminectomy Is compara-
lively simple operation In thin SUBJ
ject; but to reach the body of q verte-
bra, much less go anterior to 1t, as
would have been necessary to have
recovered the ball and removed the
spiculae of bone driven forward by
it, in patient Of President Garfield's
build, would have taxed both the
anatomical knowledge and surgical
daring of the greatest of his sur
geons, the gifted Agnew. If the an
terror route were chosen, one has only
to think Of the important vessels and
nerves superimposed on the bullet,
aud were almost in contact with it.
BY either, anterior Oh posterior route,
the danger from hemorrhage would
of necessity have been great.
Again, can we say that pyemia has
been banished from surgery? Certain
ly not; rare it is, to be sure, at pre-
sent; but President Garfield had just
the kind of a wound that Is today,
with all our much-vaunted asep-
tic and antiseptic surgery, diff
cult to treat and uncertain In
its results. Compound fractures,
especially of soft bones, such as
vertebrae and ribs in inaccessible
situations, constitute the most fertile
cause of pyemia today. Moreover,
pyemia following bone injuries is ad-
mittedly more fatal than pyemia fol-
lowing injury to soft parts. There
fore, there should not have been at
the time SO much criticism of those
brave and skilful men who labored
necessarily for nearly three months
to save their distinguished patient.
Now, that the matter is up again for
discussion, it should be the duty of
medical men, particularly, to set mat
ters and history right, and not en-
courage the belief, so very general,
that President Garfield's wound, fatal
in 1881, would be trivial today. 1t
was fatal in 1881 and would prob
ably be fatal in 1901. Mistakes may
have been made; but even if they had
not been, there is little likelihood that
the Nation would have been spared
the poignant grief at the brilliant Gar.
fields untimely taking off and the dis
grace of a second murdered president.
President Mckinley was shot from
the front with a 32-caliber ball enter
ing five inches. below the left nipple
and one and one-half inches to the
left of the median line. 1t traversed
the abdominal cavity, perforating
both anterior and posterior walls of
the stomach, the opening in the
former being small, the one in the lat
ter large and ragged-just the charac-
ter of wound usually made by pistol
ball at very close range. After
thorough closure Of the gastric
wounds, from which there had been
some extravasation, careful search
was made of other possible injuries
None were discovered and the surgeons
were reasonably certain that the bull
let had found lodgnYent in the muscles
of the back. The abdominal cavity
was freely irrigated with normal salt
solution, and closed without drainage
by through and through sutures OF
silkworn gut. A small piece of cloth
ng-presumably from the undershirt
had been carried in by the bullet
but was we understand from
the statements given out. found
in the abdominal portion Of the wound.
In exploring the abdomen, DR.. Mann
acted wisely in enlarging the original
wound, rather than performing mediar
section. Irrigation of the cavity is tt
be distinctly commended; likewise the
use of interrupted sutures, saving as
they do the loss of time, and facilirat
ing to no inconsiderable degree, when
rightly placed, drainage-two very i'm
portant elements In the Presidents
condition.
Whether or not provision should
have been made for further drainage
depends entirely upon the existing
conditions, and they were best judged
by the distinguished surgeons charged
with the responsibility of saving, II
possible, the most precious life in the
world. The profession has had the
utmost confidence in each of them
the Nation has shown Its graft
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