Evening star., 1901-09-19

ways very many qualifying conditions in
every operation in surgery which cannot be
explained intelligently to the public. The
pancreas might or might not have been ex-
posed during this operation. In any event
the wound In the substance of that organ
was not discovered. Even now some of the
surgeons doubt that it was injured by the
bullet at all.
In the absence of any proofs to the con-
trary DR.. Parkes explanation of the gam
grenous condition of the bullet track seems
to be the most reasonable theory as to the
actual cause of death. This theory is sup
ported by the statement Of the physicians
after the autopsy, to the effect that the ball
had been lost in the necrotic tissues pos
terror to or behind the pancreas
In such a case and under such circum-
stances 1t is quite easy to infer that the
juices Of the pancreas more easily gravi-
tated toward the postertor encystment while
the patient was In a recumbent position
after the operation and produced destruc-
tive sloughing condition. An evidence that
the pancreas had been penetrated would be
the escape Of the juices of the gland
through the wound along the canal cut by
the bullet. OF course, with the bullet track
closed as was the case after the opera
tion, discovery OF these juices was impos-
sible, and, theoretically, the possibility of
injury to the pancreas might have been
eliminated, as In the supposed direction OF
the ball there seemed greater likelihood of
damage to the splenic artery, which is on
higher horizontal plane.
Should Have Found Bullet.
In an article in the Medical Record quoted
by the Herald called attention to the pos
sbilities Of the pancreas and kidney being
wounded, as both were In the assumed
course OF the ball. In the light Of subse-
quent events 1t Is to be regretted that the
Roentgen rays could not have been used to
locate the bullet. Even now no one knows
where it is lodged. 1t will forever be
scientific secret, and one Of the most his
torical Of surgical operations will, there
fore, lose one Of it's main points OF inter-
est.
Some CT the surgeons say that the gan
grenous spot in the pancreas was the re-
suit Of the extension of the decomposing
process backward from the wounds of the
stomach, and that this condition was In
dependent of the bullet injury. The only
way to disprove that theory would be to
know the exact location of the ball and to
connect it In straight line with the wound
of entrance. Alas! as the bullet was not
found this point will ever remain mys-
terry.
II 1 can interpret the sentiment Of the
medical profession / would venture the
opinion that there will be surprise that
means so close at hand and so readily ap-
piled as the Roentgen ray was not made
use of by President McKinley's physicians.
Since the discovery Of this penetrative
force by Prof. Roentgen almost every one
who has spoken of it's benefits to mankind
has referred to the use to which 1t might
have been put In the case OF President
Garfield 1t seems too bad that the most
conspicuous opportunity for It's application
should have been lost when another chief
magistrate of the United States lay stricken
from an assassin's bullet.
Attempting to account Tor the gangre-
nous condition of the bullet track by as
suming that the bullet was poisoned 10
hardly in line with the probabilities when
viewed in connection with other pathologi-
al az in 10 was
poisoned by the bullet there should nave
been a uniform gangrenous condltlon from
the point OF entrance OF the missile missile a!ong asns
condition, however. is not admitted to
have existed. In fact, It was stated In the
bulletins when some stitches were removed
from the operation wound in the skin that
the infection was caused by fragment
of clothing which accompanied the bullet
for a short distance, that 1t was superficial
in character, and that after being dressed
the wound was in satisfactory condition.
II the bullet had been poisoned death
would undoubtedly have occurred more
quickly th.n 1t did as the result OF an
overpowering systemic affection due to the
rapid absorption of the toxic agent in the
blood
Pancreas Juices.
After weighing the testimony of the diff
ferent gentlemen I am impressed by the
statement of DR.. Roswell Park to the eff
feet that the pancreas was penetrated by
the bullet in its backward course, and that
the pancreauc juices leaked into the bullet
track and poisoned and partially, digested
the various tissues with which these juices
came in direct contact This may also ex-
plain the existence Of the gangrenous con-
dition Of the internal surfaces OF the sto1n-
ach wound, for the latter were evidently
in more or less contact with the pam
creatic juices up to the time the operation
was performed.
The sloughing Of the breast wound was
evidently an entirely different pathological
affair. This wound was under the sur
face of the skin, which latter was merely
hrst shot fired by the assassin did not
touch the skin at all. but was detected by
q button, causing only indirect confusion