The Washington times., 1901-09-08
DANGER FROM PERITONITIS
Views of Local Physicians on the
Presidents Condition.
DR.. II. T.. Reyburn Compares Mr.. Nc
hinley's Cnse with That of Gar
held-HOw the Complication Sets
In Chances of Recovery Equal.

In - Chances of Recovery Equal.
As bulletin followed bulletin last night
| 1t became apparent to Washington ply
| sicians. who are watching the case at the
Miiburn home through the medium of the
telegraph that peritonitis was the compli-
| cation most to he feared.
Gradual but persistent rise of tempera-
| ture and an increase of pulse rate are
common symptoms of that disease. At
| $50 O'Clock last night the temperature of
the President was announced as 1925. the
highest point reached during the day.
The pulse was i30, twenty faster than at
3 o'clock yesterday morning.
This condition was deemed grave by
local members of the medical fraternity.
Several prominent surgeons stated that
| If the case was progressing favorab4y the
operation on Friday would have been fol-
| lowed by fever for period of about
twelve hours and then a drop to point
almost normal.
This. coupled with the fact that the
bulletins issued early iii the evening con-
tanned the ominous sentence, The Presi-
dents condition remains unchanged -
accentuated the grave apprehension which
has existed in Washington ever since the
news was received.
The popular conception of peritonitis is
rather muddled. 1t is disease which af-
fects the peritoneum or lining of the alb
dominal cavity and which covers the in
testines and stomach. Peritonitis is
caused when this lining Is infamed by
contact with septic organisms which
would in the Presidents case probably be
bits of food escaping through the fissures
of the wounds in the stomach. The COM
plication is a most serious one. 1t seldom
lasts long In fatal cases death usually
results In three or four days. Death is
generally caused by Inflammation of the
intestines so pronounced that their proper
functions are not performed. The mus
cles of the intestines become paralyzed,
the contents ferment, and the poisonous
gases affect the lungs, the heart. or the
nerves to such an extent the system is
overwhelmed and the disease terminates
fatally.
DR.. Robert r. Reyburn, one of the physi-
clans who attended President Garfield
during his long illness. was yesterday
disposed to regard the condition of Presi-
dent Mckinley as most grave He point
ed out that the case was developing much
more rapidly than had that of the Exec
utive who fell by the hand of Guiteau.
President Mckinley has shown much
higher fever in the period since the at
tempt to kill him than President Garfield
did for three days after he was shot
This too. despite the fact that the wound
of President Garfield was more complex
than that of President Mckinley.
In the opinion Of DR.. Reyburn, the case
which is now attracting the attention of
the world will be shorter than the one
with which he was connected. He ex-
poets that there will be a decided turn
for better or for worse, within forty
eight hours Like nearly all other medi-
cal mer who are followingfhe case Dr.
keyburn thought the great immediate
danger was from peritonitis.
The greatest element OF danger" he
said late last night, lis the gradual rise
In temperature. If it falls before morning
it can. of course. be taken as favorable
symptom. In fact, drop at any time,
that is, drop to about normal, can be
considered advantageous. There are three
dangers. First, the shock produced by the
wound: then the danger of septic poison
ing. and then the danger of peritonitis 1
deem the chances of recovery about equal.
THE treatment for peritonitis is some
what limited The. old-fashioned use of
opiates has been discarded Coal tar pre-
parations, such as phenacitine, are to be
avoided on account of their weakening
effect on the heart. The most usual and
safest treatment is the wet sheet pack.
The patient is wrapped in a wet sheet.
This reduces the fever and has no bad
after effects. 1t is possible that food will
have to be given for the present by injec-
tions.
President Garfield was nourished for
ten days in this manner alone Beef ex-
tract. milk. and eggs were his diet The
wound which caused his death was long.
crooked, and deep one. extremely difficult
to drain. The bullet entered the right side
of the back, four inches from the spinal
column. 1t struck the first dorsaI verte-
bra, passed forward. fractured the elev-
enth and twelfth ribs, and was DETECTED
to the left. 1t passed through the body
of the first lumbar vertebra and lodged
beneath the pancreas. In its course it
grazed the splenic artery. The part
grazed afterward swelled, and bursting
was the immediate cause of death Peri
tonitis set in and would have terminated
fatally had not the artery burst. Gar
helds system was thoroughly poisoned.
Peritonitis would have eventually caused
his death.
During the entire course of his illness
there was but once or twice that Presi-
dent Garheld's temperature was higher
than was that of President McKinley last
night at $3.50 o'clock, when the bulletins
announced it to be 1929"
DIR. J. Wesley Bovee last night gave a
Times reporter the following general out
line of the Presidents case: IF the in
crease in temperature and pulse rate con-
tinues for twenty-four hours after an
operation. and especially If it is continu-
ally increasing. there are strong indica-
tions of peritonitis; If such symptoms as
distension of the abdomen and considera-
bic local pain be present, the probability
of peritonitis is greater. The peritoneum
is a serous membrane lining the abdomi-
nal and pelvic cavities and covering the |
organs therein contained.
I'm this case peritonitis will result from |
the leakage of the septic contents of the |
stomach through the holes made by the |
into the body by the bullet. The ball |
would gather impure organisms from the |
barrel of the revolver, the clothing which |
it pierced, and even the perspiration on !
the skin. The infection might be so mild |
that the strength of the Individual will |
overcome it. But in this case the tenn
perature and the pulse rate would not |
be so high nor the other symptoms so |
pronounced.
''If the Infection is more virulent the |
strength of the individual is less apt to |
marked with more or less rapid progress |
sion to fatal termination.
"One symptom of peritonitis is intes-
tinal obstruction. The peritoneum or |
covering of the inteStines becomes SO in |
famed that the muscles that contract and |
expand are practically paralyzed. There
Is then no passage of the contents of the
intestinal canal. Fermentation sets in.
Gases arise. They affect the respiration.
They may affect the nerve centres. The
functions of the heart may be interfered |
with The lungs are filed with impure
gases and the blood is consequently
charged with them. In such instances
the heart will beat tumulIuously but the |
pulse will be very high. but quite weak
This is caused by the fact that the heart