387 
 
 y 1 
 
 EXCKRPTB 
 
 FROM 
 
 OPINIONS OF DISTINGUISHED MEDICAL 
 
 MEN IN THIS AND OTHER COUNTRIES 
 
 JUSTIFYING THE TREATMENT 
 
 OF THE LATE PRESIDENT 
 
 GARFIELD, 
 
 TOGETHER 
 
 With a letter in r<'i>l.V to tlu' resolution of the Sp<MMsil 
 
 Committee of the House of IJepresi'utatives 
 
 referring' to the expeiisos consequent 
 
 upon his illness and deatli. 
 
 WASHINGTON, D. C. 
 
 GIBSON BROTHERS, PRINTERS. 
 
 1882. 
 
r I>r. BlisB'B Authority. 
 
 ! following correspondenee will show ex- 
 ilic authority uuder ^vlilch Dr. Bliss went 
 he case, and that he assumed charge of the 
 nent of the late President at the express de- 
 )f Mrs. Garfield. The letters of Secretary 
 )la and ex-Secretarj-Hunt distinctly set forth 
 lets, and their clear and concise statements 
 iflii:ient to refute the misrepresentations and 
 !:s made Oy Senator Vest and others yester- 
 
 1329 F Steeet Nor.TinvEST, 
 W.\SHi.vGTON, D. C May 22, 1S82. 
 Robert T. Lincolx, Washington, D. C: 
 AR Sir : As one of ihc medical advisers of the 
 President Gartield, I take the liberty of ad- 
 ding you briefly upon a matver of both public 
 private interest. L'ertain stattmouts made by 
 cs of presumable credence in a portion of 
 )re3s of the country are calculated to ihspire 
 ) minds with doubt as to wliether the wishes 
 eneral Qarheld and his wife, together with 
 3 of their nearest friends, were re.-pected and 
 .wed in the selection of proiessienal gentle- , 
 who had charge of the case during his illness. | 
 ly I ask you to furnish me with an outline of . 
 :ircumstiinces connected with this part of the j 
 as far as they came under your own obscr. a- 
 . By so doing you will aid in setting ai re-.t j 
 e minor yet vexatious questions, the discus- 
 of which" tends to pervert and even distort the | 
 3ry of a labor which was by all regarded as a j 
 iotic duty. 
 
 ju will thus add greatly to the esteem in which ] 
 are held by myself and my associate counsel. , 
 Durs very truly, D. W. Bliss. 
 
 ' >'AR Dep.vbtmext, Washington-, May 23, 18S2. 
 liAR iriR : I have your note of yesterday asking 
 to furnish you with an outline of the circum- 
 ice-, so far as they came under my observa.io:i, 
 nectodwith the "FCloctioa of the professiuinl 
 tlemen who attended upon President Garfield, 
 i!:g his illness; in compliance with yuurre- ] 
 :st 1 give yoU such a statement, made as brief as 
 ■^■ble. 
 
 ,'hen the President was shot my carriage was 
 he door of the rulway stition and Within a 
 >eco.id3 thereafter I hurried it o3 to bring 
 i, the utmost speed being of course enjoined 
 m tlie driver. You were very soon at the 
 ;ion, the President having been, I think, borne 
 in upper room bef -re your arrival. I do not 
 all that anything which happened led me 
 ihiiik that any physician was present 
 
 .'ore your arrival; ceitainly there was 
 le whom I knew. You at once took cltarge of 
 jPresident, acting with othersurgeons whocame 
 x'kly to his help. Then followed his removal 
 the White Hnuse, and the anxious hours of the 
 eruoon, during wiiich a large number of sur- 
 );is (some of whom I knew personally, some 
 ly by name, and some being entirely nnkuovvn 
 
 ' uie) were in attendance. Uuring the night, as I 
 ■all it, this altoudanee largely cea-ed, and when j 
 eft the house at dawn I was informed by you j 
 
 '. It there woul.i pr^jably be no information to j 
 c a.s to the outlook, until after a gencial cou- 
 
 . Itation which had been appointed for 8 o'clock 
 liie morning. 1 rciurae'i about 9 o'clock, and 
 t l',;n.',peiiiap-; an hourai'ter tint, ail the mem- I 
 rs of t;.e Cabinc. being a.-somblcd m one of the 
 ambers, the lar.i;e numb'Tof medical gentle- 
 n in atrend;;r,ce u.on ilie President became 
 c subject of convcr-atlon, ail assenting to the 
 .■<-s^i'y orth/iinmb.-!! b;iug redueed a' once, f 'r 
 vi .us r.;u,so;.s. it apiKaied in t he c mversation 
 
 S the only surgeon known to those present in 
 ! room to have been summoned in the j 
 e was yourself, and also, that there , 
 re persons among the many anxious friends j 
 the President v/ho would not have probably 
 3sen you as one of his medical attendants. It 
 s therefore thought best to have the suggestion 
 .de to Mrs. Garfield of the propriety of ner se- 
 ling one or more surgeons to attend the Presi- 
 it and of the consequent cessation of the at- 
 idance of the others. For the pupose of com- 
 micatiug with her General Swain and Colonel 
 ckwell were sent for to the room and requested 
 make the suggestion I have made. Inasmuch 
 you were, so far as I know, the only surgeon 
 Hmoned directly by any one ncarthe President, 
 •sonally or olhcially, and had been in conse- 
 ince up to then in principal charge during what 
 i come to seem a very long time. I felt it my 
 :y to request General Swain and Colonel Rock- 
 11 at the same time to say to Mrs. Garfield that 
 ■he attendance of JJoctor Bliss was not agree- 
 e for any reason, and it was thought best to 
 ?e him retire, and any embarrassment should 
 felt in ellecting tliis, Ilnistcd that, as I h.ad 
 nmoned him, a mere suggestion might be made 
 ne, and that I woiUd see that his attendauce 
 jsed without emburras^me-ut Vj any one. _ 
 
 lahi now uncertain whether the -e two gentle- 
 men went on their mission and returned, or j 
 whether, without going, they were able to give u§!, 
 the information, which they at once did, that D.-. 
 Bliss had been selected to take charge of the Case 
 with such assistance as he should di-sire. '] 
 
 In pursuance of further convoi^atiou among all 
 thegentlemeii in the room, based on this inform- 
 ation, it was thought best that the .Secretary of the 
 Navy and myself should go to Dr. Bliss and ten- 
 der him the assistance of the Surgeon-Gen- 
 eral of the Navy and Surgeon-General of the 
 Army, with any other assistance which .he 
 might ask, and which it was in our power to afford 
 him, The Secretary of the Navy and myself at 
 once weut to your room and tendered you this as- 
 sistance. You replied that you would much like 
 to have t'lo aid and counsel of the Surgeon-Gcu- 
 eral of the Army ; that for reasoiis which 
 you mentioned you would not ask the assistance of 
 the Surgeon-General of the Navy; that further, for 
 reasons which you gave to us, you would like 
 the assistance of Snrgeon Woodward, of the 
 Array, and of Dr. Reybiiru, of this city. I there- 
 foie formally advi-ed the Surgeon-General of 
 the Army that you were the surgeon 
 in charge of the case, and directed him to 
 place himself in attendance with you, and to in- 
 struct Surgeon Woodward, of the Army, also to 
 place him.^elf in attendance. I do not now recall 
 the exact circumstances which resulted in the 
 summoning of Dr. Aguew and Dr. Hamilton, but 
 I remember that we were all anxiotis for their 
 presence, so that nothing should po.-,siblybe left 
 undone which might contribute to the recovery 
 of the President. 
 
 I believe the foregoing answers your inquiry as 
 completely as I am able to do from my own Knowl- 
 edge, Very truly yours, Robert X. Lincoln. 
 Dr. D. W. Bi.iss. 
 
 Washington, May 21, 1882. 
 Dear Sir: I was at the railroad station in this 
 city when President Gariield was shot. I saw him 
 in less than a minute afterward. He lay on the 
 floor of the reception room. In a few minutes ha 
 was removea to a room upstairs. I then saw Sec- 
 retary Lincoln. He toht mo he had sent imme- 
 diately after the shot for you. I expressed my 
 gratification at his having diiue so, for I had per- 
 fect confidence in your skill, jadg.neut, and ex- 
 perience. Soon after this, I saw you approach the 
 mattress where the President was lying. You un- 
 CuVered the wound, inserted a small probe into it, 
 spoke with the patient, gave him brandy, and ex- 
 ercised entire control of the ease. Afterward, 
 otiier surgeons came about the bed; but you 
 were in entire and unchallenged control of 
 the case. You remained so all that day; 
 and the friends of tire President and the 
 other surgeons acquiesced in your doing so. 
 Next morning something was said among the 
 Cabinet about the presence of so many peisous in 
 and about liie sickroom. It wms deemed expe- 
 dient to reduce the number of surgeous. This' 
 conclusion was comuiuiiicated to Mrs. Garfield, 
 and siie was l■eque.^ted, as I understood, to state 
 whether your direction and supervision of llie 
 case was undesirable to her. I was told she said 
 that this arrangement was entirely in accordance 
 with her wishes. Y'ou were then requested to 
 select such surgical assistance as you desired. 
 You mentioned the gcnilemen who acted with 
 you afterward. The Secretary of War and myself 
 conferred with membeis of the Cabinet after this 
 interview, and we proposed that the Surgeons- 
 General of the Army and Navy should be added 
 to your corps. The suggestion was approved by 
 our coile.igues. It was then commuuieatod to 
 you. You were pleased with the recommenda- 
 tion of Surgeon-General Barnes, but you objected 
 to the Surgeon-Geuerrl of the Navy on peisonal, 
 grounds. 1 did nut urge hiin further on you. 
 
 Afterward the members of the Cabinet sug- 
 gested that Drs. Agnew and Hamilton be added tc 
 the corps as consulting surgeons. This proposition 
 was conveyed to Mrs. Garfield and met her ap- 
 proval. It was alterward submitted to you auc 
 you approved it promptly ai;d cheerfully. 
 
 These facts occurred when things were fresh am 
 your control of the case was as-ured and exercise 
 in the presence of the President's family an 
 friends, with the knowledge of the world and wit 
 their acquiescence. 
 
 It isau iu^uli to .the truth to set up at this da' 
 the pretense that you in any manner intrud* 
 into the control of the case. It is at least a mei; . 
 reward for your skillful, unceasing, and herrjfc 
 devotion to your distinguished patient. f^ 
 
 I am, dear sir, with the highest consideratkw] 
 your obedient servant, William H. Iitn?T^ 
 
 Dr. D. W. Bliss, Washington, 
 
EUT 
 
 EXCERPTS. 
 
 " Tlu' (iistiiimiislu'd i):iticnt i-ouM not he uikUt lu'tter siirj^'i- 
 cal raiv tliaii is to he round in W:i>hiiit5ton. The v:i>t I'XjKM-i- 
 ence ij;jiiiu'tl iliuini;- the war of the j-ehellioii in the I'niled 
 States has iHffiisi'd an innnense amount of knowded^e coiKtern- 
 iii'T trunshot wounds anil their treatment auion^ army siu-<^e(»ns 
 in tliat eituntrv, and several of tin; most einlnent among them, 
 are connected loith the atce" vVrc 
 
 British Jfedicat Journa/, A uffust 20, 1881. 
 
 " The surgical treatment has l)een severely eritiirised in some 
 (piarters, very unfairly, as it seems to ns, inasmuch as the attacks 
 upon the course pursued have heen made without an oppor- 
 tunitv of personal ohservation of the ease, and without making 
 anv allowance for the difficulties in which the sm-geons in at- 
 tendance upon it have l)een placed." « * * " So far as the 
 facts ichic/i have been successi rely announced in the ojicial 
 bulletins are concerned, nothing has been mentioyied which has 
 been inconsistent icith what j/tlght beexpected to take place ni any 
 case of (t bullet loound, in which a bone has heen struck and 
 the bullet so diverted that it has been caused to pursue a deep 
 and tortuous coinse in nniscular tissues, and to pass out of reach 
 of ol)servation or detection by the surgeons." 
 
 Same Jourwil ^ December 17, 1881. 
 
 " After analyzing the statements of Drs. Hammond, Sinis, 
 Ashurst, and Ilodijen, in the North American Review for 
 l)ecend>er, 1881, we fully concur irith Dr. Sims in the pre- 
 vious assertion made by him that the woxmd if the late Prcsi- 
 
dent w IS as certtunly mortal as the imxnd of President Lni- 
 coln. The difference was onhj one of time.'''' 
 
 New Yorh Medical Journcd^ Novemher, 1881, 
 
 Sajs, recjardiiig English criticisras on the long and painful 
 conflict of sui-gery with the injury dealt to our lost President : 
 " Truly the modern art of surgery in all its fulness — not the 
 mere individual capabilities of the little knot of men who stood 
 as its representatives — w^as brought to bear upon tliis case," &c. 
 " Also, if any of Dr. Bliss' questions as appended hy him to 
 his nccotrnt of the case in the Medical Record of Octoher 8, 
 1881, ca)i he so answered as to show that in any respect the 
 conduct of the case could, w'dhout the light thrown upon it hy 
 the atdopsy, have heen hetter carried oat, toe trust that such an- 
 swer loill he hroxtght forward sp)eedily and holdly. We have 
 nothing hut praise for the surgeons as regards the'ir actual 
 management of the caseP 
 
 Boston Medical and Surgical Journal, Septonher 8, 1881. 
 
 " A lenient judgment must, liowever, be invoked for tlie phy- 
 sicians who have borne the task of an attendance, the trying 
 nature of which can be easily understood, and we ought to con- 
 ' grata late ourselves that no change has taken place in the per- 
 sonnel of the Bresident's mediccd staff.'''' 
 
 Same Journal, Septonher 22, 1881. 
 
 " No one, we believe, is in a position to say that the wound 
 7vas not from the heg'inning of a necessarily fatal character, or 
 that other measures than tliose taken could have averted the 
 result we all deplore." 
 
 Boston Medical and Surgical Journal, Septemher 22, 1881. 
 
 " It is plain, and is generally acknowledged, that no good and 
 much harm vnould have resulted from any serious attempt to 
 
3 
 
 cxtrjKtt the Kail, even hail it hccii possihh' to (h-tcriiiiiic its 
 exju't sitimtiitii." 
 
 ^^nr>r^l i:,,„rih AiKjnst l.'J, ISSl. 
 
 " In the Hj^ht of th(! fa«-ts that are fiinii.shcd the- piihlic it ih 
 easy to iiii»h'rstainl the extreme ejiiitiun of t/iie surgeons as to 
 pi'oI)iiii;; the wouikL" 
 
 Siiiiic 'founidl^ A iKjust ♦'), ISSl. 
 
 " \Vc t(i/,( p/(i/,'<i/rc in (ijfirniiixj (H/inii thnt t/ie tiynttiient of 
 thf Preaitlt'itt ?.v tinis far heyotid cr'itichm^ and it is fair to sup- 
 pose that so lotig aji the present metlieal staff remains in attend- 
 ance nothinji; will l»e left undone to insure the comfort, safety, 
 and recovery of the illustrious patient/' 
 
 Same JonnHil, Av</ifst 20, 1881. 
 
 " As iniu;ht have I teen expected, the manaj^ement of this ease 
 has heen open to much criticism hy the secular press. It is to 
 the credit of the profession, and especially of the gentlemen in 
 charge of the case, that so little can be said concerning what 
 might have been done and what was not done. Denjnte the 
 jourmd'mtic jyrescrihers in some of oar leadhifj dailies^ the peo- 
 ple have continued to maintain a confidence in the attending 
 and considtinf/sargeonsiohich in as gratifyhuj as it is necessary. 
 There seems to be^'pistly, hut one sentiinenf entertained hoth hy 
 the profession and the puhlic reyardiny the jiulicious manner 
 in irhi<-h this case has heen treated from the heyinninf/r 
 
 Same Jottrnal, Sejdemher 24, 1881. 
 
 "7^ is^ we helieve, the general verdict of the profession that the 
 late President received all the aid which medical science, intelli- 
 gently app)lied, cotdd fanxisJt. Looking back upon the case, 
 even with the light of the autopsy before us, it is imj>ossiblc 
 for any one to say that any ditTeii-nt mode of treatment would 
 
h;ive saved the President ; and fnrthennoi-e, we may claim that 
 medical art prolonged for months a life which might otherwise 
 have ended in a few days or weeks. We believe that tliis can 
 be truthfully said, and that it will be echoed and endorsed by 
 the medical profession." 
 
 Same Jouriutl^ Septemher 26, 1881. 
 
 " No meatis of more thorough exploration of the wound could 
 have been safely employed." 
 
 Drs. aS/ws, AsJiu.rst, and Ilochjen in the North American 
 Review '■'■ frankly acknowledged that the wound was ef<sentially 
 fatal; that the error of dia(/?iosis v)as, under the cit'cum- 
 sta?ices, unavoidahle ; that the treatment was in accordance 
 wdth accepted principles in surgery, and that in reality nothing 
 more could liave been done to prolong the life of the lamented 
 sufferer." 
 
 Cincinnati Lancet and Clinic, Septemhe) 24, 1881. 
 
 " No blame can be attached to the surgeons in attendance 
 upon the President for abstaining frou] instrumental interfer- 
 ence witli a view of locating the ball. * * * What skill 
 and science could do was done. The surgeons in attendance 
 merit the gratitude of ou7' people alone ; there is nothing 
 deserving of reproach." 
 
 Pacific Medical and' Surgical Journal, San Francisco. 
 
 " He was in able hands, well known to the profession in 
 Europe as well as in America." 
 
 Canada Lancet, September 1, 1881. 
 
 " Everything is being done for the patient that can be done. 
 Every confidence is very justly reposed in his medical advisers, 
 and, come what may, there can he no cause for hlame attached 
 to til em.'''' 
 
5 
 
 Mellcal \<'Wti ,in<l Al>.sii\t<(, J'hihn/iljt/ii.i^ (J,t,>hci\ 1881. 
 
 The publication in tliu current nunilior of the Ai/nrlra/i 
 JoHt'mtl of the Midicdl Science of the otHciul report of the 
 aiitoj)sy upon the lnnly of Pre.sjih-iit GarHeld will, we tniht, 
 whiK' >atisfyin^ the h'l^itiinate curiosity of the pmfe^.sjon and 
 of the hiity, at the same time elVeetually and j)ermanenfly (juiet 
 the Mufrieiidly criticism of the «ur<;ical treatment of the case in 
 which part of the (hiily press has so freely indulged and fi-om 
 which, we regret to oltserve, some medical journals, witimnt 
 full knowledge of the case, have not thonglit jiropcr to ahstain. 
 
 " The discoveries of the autopsy, taken in c(iiijim(;tioti with 
 what is known of the clinical history, will at ouca make ap- 
 parent to the profession the good common sense, H<lmiral)le 
 conservatism, and sonml surgical treatment and judgment 
 whitrh have characterized the m magemcnt of the case from 
 tii-st to last, and althi>ugh the non-mcdii-al mind may he slower 
 to compi-ehend the questions at issue, it will not he long hefore 
 the same conviction fon^es itself upon the people at large. 
 
 " 111' know heijoml the possihllltij of a ihniht that no hnnvui 
 skill amid have averted the fatal result ; hut we find, more- 
 over, that even in the searching light of the careful and 
 thorough post-mortem examination it is dilHcult, if not inipos- 
 sihle, to suggest any )iioiHf cation of the treatment, even in 
 minor points, which would have made it hetter adapted to the 
 
 exigencies of the case." 
 
 « « « » « » 
 
 From this general consideration of the history of the case, 
 viewed in the light thrown upon it l»y the details of the autopsy, 
 we may safely concludi- : 
 
 1st. That the treatment at the time of the reception of the 
 injury, immediately suhseipient to it, was that rendere<i j)roper 
 hy the condition of collapse which then existed. 
 
 •id. That on reaction taking place, a sufficient, tiioi-ough, and 
 careful examination was made with the tinger anii the prohe. 
 
 3d. That when the C(jnsulting surgeons were called in and 
 found that this had heen done, they very properly, and in ac- 
 
cordance with well-established and universally-recognized rnles 
 of surgery, refrained from repeating that examination. 
 
 4:th. That even if these rules had been disregarded and such 
 examination had been made, it would have determined nothing 
 of practical importance as regards the subsequent treatment. 
 
 5th. That wherever pus accumulations had taken place, 
 they were pi'operly opened by free incisions made at the most 
 dependent portions. 
 
 6th. That these incisions drained not only the course of the 
 aljscess, I:)ut communicated freely with that portion of the spine 
 which had been penetrated, and, therefore, with the track of 
 the ball ; and the completeness of the drainage is shown by the 
 absence of pus accumulations either in the locality traversed by 
 the ball or in the iliac or lumbar regions. 
 
 7th. That the damage done to the cancellated tissue of the 
 lumbar vertebra was sufficient in itself to explain the septic 
 state of t])e system, which in time, and independent of the Ijall, 
 (wliich proves to have become harmless,) would have destroyed 
 the life of the patient. 
 
 College and. Clinical Record, Philadelphia, October, 1881. 
 
 " The careful methods of exploration pursued h^ the attend- 
 ing surgeons will commend themselves to the attention of the 
 profession and the public as full commensurate with the impor- 
 tance of this celebrated case. The study of the autopsy will bring 
 to the mind of the most sceptical a thorough and persuasive vin- 
 dication of his careful, conscientious, and indefatigable medical 
 attendance — a vindication that was not deemed necessary by 
 those who had honestly placed their faith in their skill and dis- 
 cretion during the many wrecks of suffering through which their 
 distinguished patient so uncomplainingly struggled." 
 
 Medical Press and Circular, {London,) October, 1881. 
 
 " The general verdict of the profession is that the President 
 received all the aid lohich medical science, intelligently app)lied, 
 
conlij fiiriiia/i. It is licld tliiit, looking hack upon the oiHt' l»y 
 the liglit of the aiitojtsy, it is iiiijMtssilih' for aiiy one to Hiiy 
 that !i different line of tifatincnt than that |nirsne(l wouhl huvo 
 saved the Presiik'lit's life, itnil fui'th>u\ (hut iiudinil art pro- 
 liuii/iil t/i, lit', irlin/i ii/li, rii'is,' niiil/if Inn', , nil, il in ii few diltJH^^ 
 
 Virijiitiii Meliiiil. Minitldy,, SfjtUiuhti ^ IhSl. 
 
 " Tlie Presith'iit's eoiiditiitn is a siil»jeet of siicli deep inter- 
 est to every Atnericun that we are not surprised ut the ea«^er- 
 ness so j^onerally manifested l>y the ni('dic:d press to speenhite 
 as to tlie result. We Imre neen innmj riiliculoua di'^frripfinits 
 <i/ui sur/at'sett on tJn' ,snhji'i-t j)iit in print by ductors^ irhn^ in thix 
 in.'ifiince, manifi'st no (jrenter intelHtjence than the Initif, as to 
 the fiature of tlie wound. V>\ sueh a eourse the profession 
 lays itself liahle to have furtlier odious epithets atwl taunts 
 thrown at it. Not one of tlie six distiiiijuished medical men 
 now in attendance upon the Prc>i<ient has yet heen ahle to 
 trace the track of the hall, or to locate its present positi(»n witii 
 satisfa(^tory detiniteness to warrant them in unnounein«; an 
 opinion — although these gentlemen are the only surgeons who 
 have ever had an opportunity of examining tlie W(»nnd. * • • 
 Whatever may he the result noir^ even if fatal^ we would 
 feel resigned as we would live in the belief that everything 
 had been done for the restorittion if the President liinf human 
 skill could accomplish y 
 
 An/i'dts I >' Hygiene Publiiiue et de Medirin hyale, Paris, 
 
 F.h-rirr 1882, 
 
 Contains an a(H;ount of the ])ost-mortem and remarks " that 
 treatment was fully justified hy the results." 
 
 Philadelphia Medictd Times, October 8, ISSl, 
 
 In its jjondon letter, says: "When, hmvever, the suppuration 
 of the gland i-eased to form new points of j)us, then again hope 
 beeame Imovant tliat his magnificent constitution, his hii^hcour- 
 
8 
 
 age, judicious nursing, and consummate medical skill, all com- 
 bined, would bring him through ultimately. * * * The 
 medical management of the case has never been hostilelj criti- 
 cised, in my hearing at least — nothing, but whatever occurs 
 the public of Great Britain will ever feel that in a terrible 
 emergency the medical prof ession has acquitted itself loith dis- 
 tinguished skilly and has deserved, well of ally 
 
 Extracts from a Review of some of the more importard 
 Surgical Prohlerns of President GarfieWs Case, hy J. 
 William White, M. D., Demonstrator of Surgery and 
 Lecturer on Operative Surgery in the University of 
 Pennsylvania, Surgeon to the Philadelphia Hospital, 
 Fellow of the American Su7'gi,cal Association, etc. Phil- 
 adelphia, 1882. 
 
 Its motive is to be found in the fact that numerous articles 
 which liave from time to time appeared in both the medical 
 and the lay press, seem to indicate that in the minds of many in- 
 telligent people, within and without the profession, there is still 
 much misconception regarding several important points in the 
 case of the late President Garfield. 
 
 in bringing together the facts wliich I shall mention I have 
 especially consulted the official report, published in the Ameri- 
 can Journal of the Medical Sciences for October, 1881, and 
 have carefully perused the excellent articles of Drs. Ashhurst, 
 Hunt, Sims, Hodgen, Shradj, Weise, Kumar, Schiissler, Fi- 
 gueria, and others, as well as the editorials and criticisms of the 
 medical press of this and foreign countries. 
 
 The points which it seems worth while to consider, on ac- 
 count both of their general surgical interest, and of the mis- 
 conception alluded to, and which may be taken up seriatim, 
 are as follows : 
 
 1. Did the relative positions of the patient and assassin at 
 the time of the shooting afford any indication of the course of 
 the ball as revealed at the autopsy ? 
 
"1. Was it |»riili;ililc' tli.-il III :inv liint' tin- l»:ill could luivc 
 l)euii (Ictcctcil ()i- loc;it«'<l l»y tli(^ list! of prultcs ; :iiii| if Hu, hlititiM 
 such Mil ciuicaviir liusc liccn made ' 
 
 ;J. Did tlif subjective .sviiiptoiiis iiidic;ite aiivtliinj; more 
 serious tli;iii nerve injury or spiiiul concu^^ioIl ; or, in other 
 Words, did they riinii.>h rcliulijc iii;itcri;d for diiij^iiosis ^ 
 
 4. Was the siihse»iiu'nt tri-atiiieiit in any way whatever hurt- 
 ful ov defective, or could it have heeii modiH<'d with advanta;;e, 
 if the exact character of thi' injury had heen known i 
 
 5. What was tlic iiiiiiiediato cuuse of death '. 
 
 6. Was tlie wound necessarily a mortal one '. 
 
 ''Occasionally,* when the trunks of nerves are directly in- 
 jured (not divided, hut violently |)ii>hed aside,) the wound will 
 be accompanied with intense" |)ain, but none will Ite experienced 
 loeally ; the pain which is felt will be referred far away from 
 the tract of the ])i<)jectile to some distant part to which the 
 nerves are distributed. » * • I^oss rare cases are tiKtse in 
 which pain is not only felt in the wounded limii, but rcHex pain 
 is also felt in the o])posite uninjured limii," ^Vc. 
 
 " Nerve injuries may also caii>c jiain which, owin^; to ine.\- 
 pli(rable reflex transfers in the centres, may be felt in remote 
 tissues outside of the rei^ion which is tributary to the woiiikKmI 
 nerve.'' - 
 
 " In Case IN', iiulchinsoirs !Sei-ies, p. ;U;!, the median and 
 ulnar nerves bein*; injured, there was pain in the unhurt hand. 
 Piro(i;(jff, p. 3S4-, has similar instance from injury to the rii^lit 
 brachial plexus. 
 
 "In two (tases wounds of one leg seemed to the patient to 
 be truly in the other.""* 
 
 So far as 1 know all the diai^iioses (tf sj)inal injury which 
 were claimed to have JK-eii made in dilYcrcnt parts (d the coun- 
 try first appeared after the i»ubliciition of the autopsy, and this 
 is rather to the credit of their authttrs than otherwise, as cer- 
 tainly no one having merely those symptoms submitted to him 
 
 1 Gunshot Injuries, their History, Nature, and Treatment by Surgeon-Gen- 
 eral T. Loiigiuore, Loudou, 1877, p. 14r>. 
 
 » Injiirios of Nerves by S. Weir Mitchell, M. !».. Pliiladelphiii, 1H72, p. llKi. 
 3 Ibid., p. 14t;. 
 
10 
 
 in a similar case to-day would be justified in asserting the ex- 
 istence of a fractured vertebra or a grave injury of the cord. 
 
 Prof. Kumar, of Vienna, after a lengthy criticism of the case 
 in the light of the clinical history and the autopsy, wrote :^ 
 
 " Evidences of paralysis in the region of the lower extrem- 
 ities were never noticeable ; the only symptoms of distui'bance 
 of nerve function were those already mentioned — hypera^sthe- 
 sia of the skin of the feet and ankles and of the right half of 
 the scrotum — which at the end of the first week had entirely 
 disappeared. From all these symptoms no conclusion as to tlie 
 course of the ball could be drawn." 
 
 Lid ell says : ^ 
 
 " The general symptoms of gunshot fracture of the spine are 
 not essentially different from those which are present in othei" 
 forms of that injury, and they are referable mainly to paraly- 
 sis, either partial or complete, (l)ut commonly the latter,) of all 
 the muscular apparatus supplied with spinal nerves given off at 
 or below the seat of fracture." 
 
 Hamilton^ wrote in 1865 : 
 
 " In a few cases a ball has been known to pass through the 
 side of the body of one of the vertebrae, leaving a round hole 
 or a lateral furrow, without coming in c(jntact with the spinal 
 marrow or the blood-vessels. It is not proI)al)le that we shall 
 be able to diagnosticate such a case clearly during the life of a 
 patient, and if we were able to do so we do not see what bene- 
 fit could be derived from any surgical operation." 
 
 Legouest^ says : 
 
 " It is always very difiicult, if not impossible, to be assured 
 that the bodies of the vertebrge are injured when there are no 
 symptoms of a lesion of the spinal marrow. The sui-geon in 
 most of these cases is constrained to leave them to the efforts 
 of nature, watching for the appearance of those accidents which 
 may accompany the presence of foreign bodies, and which are 
 
 1 President Garfield's Verwundung, von Primararzt Dr. Kumar, Wieper 
 
 mediziuische BlStter, November 10, 1881. 
 
 ^ American Journal of the Medical Sciences, vol. xlviii, p. 311. 
 ^ Military Surgery, p. 338, quoted by Dr. Hunt. 
 * Treatise on Military Surgery. 
 
n 
 
 !ij;L,n-!iViito(l ill such cases by the iinpoiiiincc of the ..rirmis jti 
 the neij:;hh()rh()()(l of the wdimd." 
 
 Agnew^ says of fracturo i.f the veitel)ra- : 
 
 "Except ill fmctnres «»f tlio sj)iiioiis jiroct'sses, wheic the 
 rijunaijeti part is entirely aceessihh! t<» the touch, we ciiiitiot 
 atlii-iii the existeiUH^ of such an injury with any (U-j^rec of cer- 
 tainty. The presence of cerfain syinptoins fcdlowinj; a sutKcient 
 cause furnishes ground for supposing the existence of a fvnr- 
 ture, and yet these may all he present without any injury of 
 the kind. The prominent symptom is puralvsi>." 
 
 Autiiorities to this elVect might \>r nndti|)lic(l iudelinitcly, 
 but the (juestioii hanlly admits of dispute. 
 
 If, then, a study of the positions of the wounth-d man an<l 
 his assailant was without diagnostic value; if prol»ing to any 
 extent was stnmgly contraindicated, and could not possibly have 
 resulted in anything but harm ; and if tlu" subjective symptoms 
 were not distinctive, or were j)ositively mi>leading, it is evident 
 that the materials for definitely determining the character of 
 the injury were altogether wanting. Much has been written 
 in regard to "mistaken diagnosis," even by gentlemen who in- 
 tended to defend the maiuigement of the case; but it has al- 
 ways seemed to me that this did not fairl}' state the situation. 
 An " absence of diagnosis " on account of a total lack of neces- 
 sary eridence would have more nearly expressed it, and every 
 surgeon of experience knows how frequently and how unavoid- 
 ably this occurs. 
 
 The laceration of the cancellated structure of the first lum- 
 bar vertebra doubtless contributed largely to the j)roduction of 
 the septicaemic condition, which was in nowi>e due to lack of 
 proper or sutHcient drainage. More favorable circumstances 
 for its production than existed in the comminuted and softene<l 
 cancellous tissue, with its open venous sinuses, bathed in ichor- 
 ous pus, could hardly he imagined.^ 
 
 ' The Principles niul Practice of Surgery, Philadelphin, 1878, vol. i, )>. 825. 
 
 * " A loug, interrupted, and sinuous Hhot-wouud, with sevoral fractured 
 boues in its course and terniiimting in the neighborhood of the ahdoinintd 
 cavity, necessarily presents every facility for unhealthy Miij>j)uratii)u, the for- 
 mation of secondary abscesses, the retention of pua, and all their accompany- 
 ing inseparable and unavoidable evil conseqiieuceH." — Kniuar, op. cit. 
 
12 
 
 The fact that drainage was thorough and complete, and that 
 no portion of the unfavorable symptoms was due to neglect in 
 this respect, was fully established by the absence of purulent 
 collections either along the track of the ball or in the passage 
 caused l)y the burrowing of the pus. Tlfere was no time pre- 
 vious to the first operation at which the accumulated pus did 
 not pass out of the original wound, but its exist was favored 
 by gravitation after the two operations which brought the ex- 
 ternal openings on a lowel level, and enabled them not only to 
 drain completely the iliac and luml)ar regions, but also to can-y 
 away any discharge that may have come from the fractured 
 vertebi'a. 
 
 Prof. Max Schliller, of Berlin, after a careful review of all 
 these points, wrote :^ 
 
 " Even if a suspicion of tlie M'ound of the spine had arisen, 
 the problem of treatment, which tlie attending surgeons were 
 endeavoring with tlie greatest skill to solve, would have under- 
 gone no alteration." 
 
 The treatment was cautious, but thorough, and no indication 
 w^as overlooked or disregarded. Wherever collections of pus 
 took place, they were properly opened by free incisions made 
 at the most dependent portions. These incisions drained not 
 only tiie course of the aljscess, l)ut communicated freely with 
 that portion of the spiiie which had been penetrated, and, there- 
 fore, with the track of the ball, and the completeness of the 
 drainage was shown by the absence of pus accumulations either 
 in the locality traversed by the ball or in the iliac or lumbar 
 regions. The treatment also as regards the other complica- 
 tions, the parotitis, l)ronchitis, dyspepsia, etc., was in the most 
 marked degree careful and judicious, and, indeed, may be said 
 to have pi-olonged the life of the patient for many weeks. 
 
 As to the immediate cause of death, it was, as has been 
 stated, the rupture of an aneurism of the splenic artery. The 
 ball itself had become encysted, and had given rise to no 
 
 ^Deutsche medizinische Wochensehrift, No. 47, p. 634. 
 
13 
 
 dainjicijc wliatoviT, after the iiioiiiciit of its Ind^cnuirit, Init tin- 
 injury '<» IIh" caiiccllatcd tissue of the liiml>ar \ cilclira wmh siif- 
 fieieiit t<> explain all the M'|iti("eiuic >viin>I<iii>, :iri<i in tiirif 
 would doubtless of itself liave jti-oved fatal. 
 
 6. In atteniittiiiii,- fo reply to the sixth and last <juestioii, im 
 to whethei- or ii,.t the wound was necessarily a mortal «»ne, 
 nuicli time ;ind l;d)or li:is lieeii >pent in a review of mH the :iu- 
 thoi-ities henriiin- u]>on the subject. It may Im' sai<i at once 
 that in the whole r:iniio of surgical literature, civil und militarv, 
 no siinilai' case, i'ollowed liy i-ecovery, has ever lieen recorded, 
 and this statement is made with the full knowledjre that it ha- 
 been asserted that such recoveries are not infre(jtient. In some 
 instances these erroneous assertions may have been due t«» ne- 
 glect ju-operly to classif}- the eases, which are (d'ten verv im 
 properly reported. Of course, it is well known that fractures 
 of the vetebral processes are not esj)ecially fatal injuri«'s, and 
 that a large proportion of them recover. Many i>\' the>e an- 
 recorded under the general head of fracttui'es of vertebra', but 
 evidently have no liearing upon the case in (luestion. 
 
 What Lidell' does say, is that — 
 
 " In the British arn)y, during the Crimean war, there oc- 
 curred ten cases of gunshot wounds w'whfn/rturt of v<'/-ii/>rip, \t\it 
 without lesion of the s])iiial cord, of which six died ami four 
 recovered so far as to be invalided ; thei'e also occui'ird twenty- 
 two cases of gunshot wounds with fractures of tlie vertebra- 
 and lesion of the s])iiial cord, all of which died." 
 
 On the very same page Dr. Lidell, who is truly descrii)ed as 
 one of tiie most experienced of our miiitiw surgeons, says: 
 
 " Leaving out of the calculation sucii fractures as involve 
 the spinous process alone, the writer has never seen a case of 
 gunshot fracture of a vertebi-a get well, and he im'ght a<ld that 
 he has never seen life prolonged for a month after the in- 
 fliction of that injury." 
 
 " Attempts at extraction are dangerous and ofti-n useless," 
 and that " only when when paralysis exists will it be necessary 
 
 'American Journal of the Medical Sciences, vol. xlviii, p. HI 7. 
 
14 
 
 or prudent even to make incisions, or to search in the simplest 
 manner for the foreign body or for spicul?e of bone." 
 
 " In the Surgeon-General's Report, No. 6, one hundred and 
 eighty-seven examples of gunshot fracture of the vertebrae are 
 reported, of which one hundred and eighty died, and of seven 
 which recovered not one was a fracture of the ho<h/ of a ver- 
 tebra." ^ 
 
 Demme^ says : 
 
 " Extensive injuries or lodgment of balls in vertebra? or in 
 the cord give rise either to death or incurable paralysis," 
 
 Gross ^ says: 
 
 " Gunshot wounds of the vertebrae, with lesion of the spinal 
 cord, are nearly always, if not invariably, fatal. Of twenty- 
 two cases of this kind in the English army, in the Crimea, not 
 ©ne recovered. Even when the l)()nes ak»ne are affected the 
 danger is generally very imminent, most of the patients thus 
 affected dying in a short time." 
 
 No instance of complete recovery after the latter injury was 
 met v/ith, and in those here alluded to, the actual seat of the 
 fracture was in every case doubtful, ^o perforating wound 
 with recovery is mentioned at all. 
 
 Space will not permit a more extended consideration of this 
 sul)ject, but I may add that, in addition to tjie authorities 
 already quoted, the excellent writings of Alcock, Ballinger, 
 Bell, Bird, Chevalier, Clowes, Cole, Demme, Guthrie, Hall, 
 Hutchinson, Longmore, Hanby, Thompson, and Williamson 
 have been consulted, and with a similar result. 
 
 No undoubted instance of recovery after a coonpound com- 
 minuted or pel f orating gunshot fracture of the hody of a ver- 
 tebra has ever been recorded. 
 
 The explanation of this fact is apparent to every one wdio 
 carefully considers the nature of such an injury, the grave and 
 manifold dangers which encompass it, and the almost iniinitesi- 
 
 ^ Medical Record, 1867, vol. ii, p. 401. The italics here are Dr. Hamilton's. 
 
 ^ Military Surgery, edition of 1868. 
 ^ Treatise on Surgery, vol. ii, p. 82. 
 
15 
 
 inul c'liiinct' which the p.-iliciit h:i>, if he ocipc uiic i»r two i»r 
 tht'iu, of .'ixoitliiii^f them ;ill. 
 
 In sii|)j)i>|-t of the forc-xiiiii^ statciiiciil^, Ixith :i> t<» thr ikh-.- 
 essary fatality of the wound and as to the ahsohitc i;orr<'«-.tut!8H 
 of the ti-eatiucnt in the I'rcsidcnt's cmko, it woiiKl \>v easy to 
 ucUhiee ahiiost unliinilol contiiniatorv evidence. The load ilij^ 
 medical journal.-- of the world have >troii«xly and iineijuivocally 
 iij)iield these views, and, indeed, it may he said that thev have 
 heen maintained i>y every wiitci- who has discn.»sod the Kid»iect 
 and who is entitled, iiy sjx-cial stutjy or c\|.crience, to .-.jicak 
 with authoi'ity. 
 
 r shall conline myself now, however, to t|Motini^ the testi- 
 mony of thi't'e eminent meniliers of the jirofession in this 
 country : 
 
 •'Looking- at the whole case from heirinninj:; to end, 1 do not 
 see that the treatment could have htuMi altered in any wav to 
 the advantage of the illusti'ious patient ; nothing was (hme that 
 should have heen omitted, and nothing was left iindoni' that 
 could possihly ha\e heen of henetit."'' 
 
 "The President's surgeons did all tliat men could do ; all 
 that the present state of science would permit ; and all that 
 could have heen done even if they had at first ascertained the 
 (n)urse and direction of the l>all. Our whole medical literature 
 does not contain a single \vell-authenticate<l case of recovery 
 fr<»m such a wound.'" " lie had not the least chance of rec()v- 
 ery under any circnmst;inces or any treatment. "- 
 
 " In reviewing the history of the case of President Garfield 
 I can find no reason for adverse (criticism of any part of the 
 management."^ 
 
 In con(dusion, it may he asserted that, aftei- careful consider- 
 ation a.n<l thorough seach through the i-ecor<ls (d' this and sim- 
 ilar cases, and after tiie ojipnrtniiity of deliltei'ate comparison 
 thus affor<led, the ftdlowing facts apj)ear to he iiicontrover- 
 tihlc : 
 
 1. It was never possihle at any time or I*}- any method to ju>- 
 
 ^ Dr. John Ashburst, Jr., in North .\merican Review, December, 1881, p. 
 
 ,594. 
 
 '^ Dr. J. Marion SiuiR, Ibid., p. (;()ii. 
 ^ Dr. John T. Hodgcu. Ibid., p. •.lo. 
 
16 
 
 certain definitely and safely the precise character and extent of 
 the President's wound. 
 
 2. Any. attempt in this direction further than was made l)y 
 the attending surgeons would in all probability iiave resulted 
 fatally at once, and their steadfast resistance to extraordinai-y 
 influence in favor of operative interference entitles tliem to 
 great credit. 
 
 3. The treatment, which was directed to meeting the indica- 
 tions as they arose, was in every respect that which it would 
 have been necessary to adopt had it been possible fully to de- 
 termine the exact nature of his injuries. 
 
 4. Life was prolonged for an unusually protracted period by 
 the careful and skilful attention which the distinguished patient 
 received. 
 
 5. Death resulted from the secondary effects of the wound 
 upon structures far l)eyond the reach of surgical interference. 
 
 6. No undoubted instance of recovery from such a wound 
 is to be found recorded in surgical literature. 
 
 Cojy'ial from the New York Medical Gazette of January 21, 
 
 1882. 
 
 EDITORIAL THE TREATMENT OF THE LATE PRESIDENT'S WOUND. 
 
 In the Wien Medicin Wochen, No. 47, 1881, Prof. Max 
 Schuller, after giving a complete history of the late President's 
 case, concludes as follows : 
 
 " Takino; into consideration all tlie circumstances connected 
 with tliis gunshot wound, it is evident that the determination 
 of the direction taken by the missile by probing would have 
 been extremely diflicult, and, if it had been possible, would have 
 been accompanied b}^ great danger to the patient. It is prob- 
 able that the track of the bullet thi-ough the muscular tissue it 
 traversed was so irregular, and the tissue itself so torn by the 
 projectile flred at so close range, that an immediate attempt to 
 follow hi the direction of the ball would have been futile. 
 
17 
 
 AiMoiii^ the syiaptoiiis w liicli pi-fx-iitrd tlirnisclvcs inimr»liiit«*lv 
 after the receipt <»1" the injury, (dily the j)!iiii :iii<l <li>tiii'ltjiiic(' of 
 sensihility in the lower extreinilies <^avf an indicafiun df the 
 true course of the liuUet." 
 
 "Tins (listurhaiice of seiisiliiHty in l)oth lower cxtrmiitii's 
 woulil scarcely ha\ i- occuri-fd without a lc>ion of the cord (either 
 hy exti-avasation and ])ressure upon the dura or a direct injiirv 
 of a li»;;ht <ifradc of the sui»stan(te of the cord) alntve the point 
 of origin of the nerves distributed to these inenjhers. If, iiow- 
 ever, the supposition has heen entertained that the vertebral 
 colunui was wounded, the (juestion of indication foi- treatment 
 would not have been different from tiiat institute*! by the at- 
 tending surgeons." 
 
 "To prevent sepsis in gunshot injuries and to bring to a suc- 
 cessful issue such a wound as that received by Pnttidc'if (ritr- 
 Jieldy is one of the mosf (/Ijficult achievements, and cannot alirmjs 
 he accomplished, even with the viost careful and assidnonn ap- 
 plication of antiseptic surgery.'''' 
 
 Dr. Schnller has fallen into the error of suj»|)o^ing that ni-r- 
 vous sensation or pains can always be traced to some specitic 
 lesion of the nervous system ; while nothing is better estab- 
 lished than that such sensations are often wholly unreliable as a 
 means of exact diagnosis. The literature f)f nei've injuries is 
 replete with exani])les which illustrate the truth of this state, 
 ment. Lesions of the (jaiKjIionic system, where there is no lesion 
 of the nerves of connnon sensation or of motion, often cause 
 reflex pains and paralysis in (»ne or both extremities or in other 
 parts of the body. Ordinary colic, or distent i<»n of the stomach 
 by gas, may cause pains in various parts of the l)0(ly ; and if 
 the disturbance or lesion of the ganglionic nerve is persistent, 
 (as it would l)e in case of its l)eing traversed by a ball,) the re- 
 flex pains would necessarily be ])ersistent. There was nt) posi- 
 tive evidence, therefore, furnished by the pains, lir^t in the right 
 foot and then in tlu^ left, that they were not causetl by such an 
 injury, and especially since these pains only lasted a short time. 
 
 "It is true, also, as shown by Mitchell, that an injury of the 
 spinal nerve is not always expresseil by pains in that part of the 
 
18 
 
 body which corresponds to its disti'il)ntion. The author relates 
 the case of a man who, being wounded by a ball in his right 
 thigh, felt pain only in the left thigh ; and in another case 
 cited by him an injury of the right sciatic nerve caused paraly- 
 sis of the right arm and only paresis of the right thigh. But 
 in a matter so well known to medical men it is unnecessary to 
 cite examples. We do not deny that tlie rule is otherwise, so 
 far as lesions of nerves of common sensation are concerned, but 
 the exceptions are so frequent as, in the total absence of other 
 evidence but a temporary, symmetrical pain in tlie lower ex- 
 tremities, to justify the inferences made by the surgeons in the 
 case of the late President. 
 
 " It is certain, also, that in case it were to have been neces- 
 sarily inferred from the pains in the feet that the spine had 
 been injured, it could not indicate whether it was simply a con- 
 cussion, the ball iiaving glanced off in some other direction, or 
 an actual penetration of the spine, the ball remaining embedded 
 in that structure, or a complete perforation the ball be lodged 
 at some point remote from the spine. It would determine, in 
 short, nothing of any practical importance ; as Dr. Schnller 
 justly says, it would nut hav*' changed tJie indications of treat- 
 ment^ or to use his exact language, ' the treatment would not 
 have been different from, that instituted hy the attendants^ " 
 
 "While we were writing, the British Medical Journal for 
 Decend)er 27, 1881, came to hand, and we iind in it a very 
 full expression of opinion on this subject by its editoi-. He 
 thinks that during the first 24: or 48 hours after the receipt of 
 the injury some further exploration might properly have been 
 made, but it is evident from Ids statements that lie was not 
 well informed as to the extent of the explorations which were 
 actually made by Drs. Wales, Bliss, ajid Woodtoard. He 
 does not doubt that the splenic artery was injured, nor does he 
 think that any exploration, however thoroughly made, could 
 have averted the fatal result ; a)id in this conclusion he declares 
 himself in. accord with the opinions of Drs. Sims, Ashurst, 
 and Ilodgen, as expressed in their several papers published in 
 the Decem.l)er number of the North American Review. 
 
19 
 
 " When, tlicrcforo," says flic editor uf (Ih- iiforciiHMitioiicd 
 jiuinial, " the iiijiiiN faiiK' in the I'di-iu ol' a M-vcre i^iiiisliot 
 Tract 11 rc( of two y\\», ami tlic |)rri'<'ral i<>ii of tlic vcrtclu-al folimiM, 
 Hot ti) uic'iitidM tlic Ktlicr accuiiijtaiiyiiii; Icsjoiis, tlio i-liiiiiccs 
 of oscapf Itocaiiu' iiitiiiitcsiiiial that flic wound ini^lit l)C 
 strictly rci:,ar(lc(l as a iatal oiic. No jiarti<Mdar iiiodu of Kiirgl- 
 (tal trcatiut'iit, no anioiuit of skilled inii-sini; and attention to 
 hold out a rc'HSoniiblc hope of being al>le to avert the fatal re- 
 sult. Pi'ofeasiimal aklll, devotion^ and extreme v^ittc/ifulnesH^ 
 iiiujht pivloiuj life, as we helieve tliey did toils utiaost tether 
 in the Presidents case, hvt either in the for) a of hlood-pinsnuinij, 
 or if not in that, in the form of exhaustion, or in some other 
 7nanifestation o/ the kimi, the fatal ind was sare to follun\ 
 We have expressed retrret that the early explorati<»n of the 
 wound was not more complete, in the belief that the diagnosis 
 and prognosis would have been rendered elearer, had it been, 
 and that some of the passing complications which ensued might 
 probably have been evaded ; but it never occurred to us, when 
 once the true nature and extent of the lesions were fully ex- 
 posed at the examination after death, that the exploration 
 could have exerted such an influence as tostop the final result.'' 
 
 As the editor of the British Medical doarnal alludes to the 
 matter of placing the patient in the same {tosition in which he 
 was when the ball was received before proceeding to probe, 
 but naively remarks that, owing to the shock liiis may not 
 have been possible in the President's case, we take the liberty 
 of suggesting to him that this rule, given in the writings of 
 certain surgical authors, was never intended to apply to any- 
 thing but muscular wounds, and especially wounds of the ex- 
 tremities, in which a restoration of posture does occasion- 
 ally cause a restoration of the channel made by the ball, and 
 which would otherwise l>e obliterated by the atrtion of the 
 muscles as sliding valves ; but even in these cases it is seldom, 
 as all army surgeons know, of any value. No surgeon of ex- 
 perience, of reputation, nor who has ever given the subject a 
 moment of thought, has ever advised this to be done in the 
 case of a gunshot wound of the belly or any of the large 
 
20 
 
 cavities; for the reason that it could he of no possihle use — 
 the channel through the viscera could not thus be restored. 
 This is' especially true in case the ball has entered the abdomen. 
 The intestines, especially after being wounded, are in constant 
 motion ; and to think of restoring the channel of the ball by 
 this method is simply puerile, and its mention is unworthy a 
 medical student. 
 
 If the ball had passed through the liver, whose position is 
 changed by every degree of inflection of the body, the diffi- 
 culties would be the same. Tiiere are other reasons, also, why 
 surgeons have never taught that, in case of an abdominal 
 wound, such as that suffered by the President, the patient 
 should be put again upon his feet; namely, first, that if the 
 intestines have been perforated the effect of this would be to 
 hasten and make certain the escape of their contents into the 
 peritoneal cavity, and thus vastly increase the dangei* of a 
 fatal result; second, there may be, for aught we can know, a 
 concealed hemorrhage, which would be necessarily increased by 
 such a change of position; and, tliii'd, that the patient is almost 
 invariably suffering under such extreme prostration from the 
 shock that to maintain him in an erect position until the prob- 
 ing was completed and the ball extracted would be simply im- 
 possible or promptly fatal. 
 
 Surgeons have, therefore, always enjoined perfect rest in the 
 horizontal posture from the first moment after the accident, 
 and they are not likely hereafter to teach any other doctrine, 
 or to disturb the viscera with probes after belly wounds, in any 
 position of the body. No one has yet followed these absurd 
 and dangerous suggestions, or if he has, he has taken good care 
 to conceal his ]'esults. 
 
 The London. Lancet for September 24, 1881, concludes a 
 somewhat lengthy review of the President's case, as follows : 
 " The fact that life had been so long preserved is the best evi- 
 dence in favor of the surgeons." 
 
 We wish to add to these rather desultory remarks a word or 
 two more in reference to the question of the practicability of in- 
 troducing probes or drainage tubes into the track of the wound. 
 
21 
 
 It is ii Miiitti'i" "1 fa<-t, cait.iltlc of" tlic t'ii>i('.Nt (irriioMHtnitioti, 
 tliiit tlio coiii-sc of the Icill \v:i> Hot strai^^lit. Tlicsc iirt? tlic 
 known lacts (Icnicil liy no one. 'I'lir Itall >tnick tlic rlcvcntli 
 ril) al)oiit tliivc incla's Ironi its anterior cxtrcniit y ; tln-n tlir 
 twelfth ril) near its postcrioi* extremity ; then the tiliro -ejirti- 
 lage hetweeii the la>t tjorsal ainl tirst lunihar vertehra, near the 
 root of the ti"!insverse pi'oeess, from which point it passed for- 
 ward and dowiiwanl, cinei-i^ini:' fi-oni the front of the first Inm- 
 bar vertehi'a otdy a little to the lef'i oi' the centre; ami here 
 was au'ain (Iclleclcd to the Idt. until it liecanie lodj^ed mider 
 and l»elow the pancreas, two oi- three inches to the left <d the 
 spine. In this conrse it had suffered, as any onemay demonstrate 
 on the skeleton, four marked detli'ction> ; tir>t, on the eleventh 
 rih; second, on the twelfth rih ; third, as it entcreil the sjiiiie; 
 fourth, as it emei"i;e(l from the spine. Such heintj the actual 
 fact, to have carried a pi-ohe or drainage tnlte througii its chan- 
 nel would have heen impossible. But adnnltin<^ that the chan- 
 nel had been straii^ht, every sin-i^eon knows that such channels 
 in the cavity of the belly do not remain open for the conven- 
 ience (jf the sui-<;'eon, and, as we have already >fated, they can- 
 not be re-established. It is, to <tur mind, evidenci' of the lack 
 of knowledge and experience in surgery for any man to say 
 that he could can-y a prol)e safely among the vital tissues to 
 the depth of seven or ten inches ; and (as in the President's 
 case it must have been carried) behind the kidney, between the 
 liver and colon, or behind both to the spine, and through the 
 spine to the seat of the ball. 
 
 Mr. Garfield had a very broad chest, and ii is ijuite j^rohahlc 
 that the distance of the hall as found in a straight line was 
 twelve inches. Whoever talks of catting or probing far the 
 ball, or of satisftctorihj draining it thrimgh drainage tubes, 
 seems to us to talh nonsense; and we arc md surprised there- 
 fore that the almost unanimous e.i'pressiott of the medical pro- 
 fession at home and abroad is that the sargtons pursued the 
 only course which presented any ehmir,' nf s,n-ing or <f pro- 
 longinq the life of the patient. 
 
Washington, D. C, February^, 1882. 
 
 Hon. E. B. Taylor, 
 
 Chairman of the Committee for AiidUhig Claims for Ser- 
 vices and Expenses Growing out of the Illness and 
 Burial of the late President of the United States, 
 Jaynes A. Garfield: 
 
 Sir : Attention having been called to the expressed wish of 
 jour Committee, as set forth in the resolution, requesting of 
 those persons whose services to the late President Gariield are 
 to come before you for consideration an estimate of the value 
 of those services, I have the honor to state that, after a full 
 conference with the medical gentlemen associated with mo in 
 attendance upon the President, 1 am requested by them to ex- 
 press their earnest desire to meet the wishes of the Honorable 
 Committee, while yet, as a matter of delicacy, they beg to be 
 relieved from presenting bills to Congress for services ren- 
 dered. 
 
 It is believed that it would be more satisfactory to the Com- 
 mittee, to Congress, and to the American people, to present to 
 your Committee a statement of tlie services rendered in their 
 endeavor to promote the comfort and preserve the life of the 
 President, leaving the matter of compensation to your Com- 
 mittee, than to present an itemized bill. 
 
 This opinion is one of most earnest conviction, in view of the 
 fact that the physicians have no claim against the United 
 States, and that the action of Congress in the matter of com- 
 pensation for their services is a recognition that they were ren- 
 dered to the President of the United States, and not simply to 
 the man, James A. Gariield. 
 
 My permanent counsel consisted of Surgeon-General J. K. 
 Barnes, U. S. A., Surgeon J. J. Woodward, U. S. A., and Dr. 
 Robert Peyburn, all of Washington, D. C. 
 
 It is proper to state that all these gentlemen gave daily per- 
 
23 
 
 sonul attention to the l*re.si«leiit, and I)i-s. W Isvard atiil iujy- 
 
 l)ni'ii ultcrnatctl iiii^lit service, niir ..I tlieni Ikmiilt ininifiliuti'ly 
 with ine each iiiulil until Si'|.tcnil)rr 17. 1^*>1. 
 
 After the Pi'csiileiit arriveil at Kllx-roii, at his riMjuesf the 
 ninuher of })hysifiaMs atteii<lin;j; iijxiii him was reihiccd, and 
 these gentlemen retii-ed fmm the ease. They were, however, 
 called to Elheron inmuMliately after the death nf the President 
 to assist in eondueting the auto|)sy. 
 
 The distiniji;uishcd counsel from Philadeljdiia and New ^'..rk 
 city, Prs. I). Hayes A^ncw ami Frank 11. 1 laiiiilton. were 
 summoned to Washington on the nii:;ht of. duly lid, issl, .-md 
 ai rived tlie followin^L;- morning, remainiiii; in (•••nsnltation durinj^ 
 that day. They were apain >unnn<'ne<l Jidy ^IM, .and fi-oni 
 that date <;"ave alternate personal service of frt»ni three to four 
 days each, until the death of the President. 
 
 It is perhaps unnecessary foi* me to state that all the physi- 
 cians in attendance during the periods ahove-named virtu- 
 ally gave their entire time and attention to the case of the 
 President, and I am glad to he ahle to say that the whole his- 
 tory of surgery shows no such sti-iking instance <d' harmonious 
 and self-sacriticing devotion to the c.ire and comfort of a j)atient 
 as was displayed hy the medical gentlemen in consultation with 
 me. 
 
 As surgeon in charge of the case, I was for eighty (SO) con- 
 secutive days constantly on duty, from the time the Presiilent 
 was wounded until his death. This service inclu<led day aJid 
 night attendance, which recjuired the ahandonment of my pri- 
 vate practice, and so seriously impaired my health as to prevent 
 me from resuming my full professional duties until ahout the 
 1st of January, 1883. Dr. D. S. Lamh. of Washington, ac- 
 com])lished as an anat(»mist and pathologist, was selected to 
 perform the autojisy, and called to Elhei-oii foi- that j>m-pose. 
 The skilful manner in which he perfoiMne<l thi> delicate service 
 fully justified the. selection made. 
 
 1 desii-e in this connection to pay a just trihute to the untir- 
 hig and devoted services of those who performed the immedia^" 
 
24 
 
 duty of nursing tlie President during his illness, viz : General 
 Swaiin, Colonel Rockwell, Dr. Boynton, Mrs. Dr. Edson, Mr. 
 O. C. Rockwell, and Steward Wm. T. Crump, whose health 
 was seriously, and it is believed pernrianentlj, impaired by his 
 continuous and exhausting duties. 
 
 Last, but not least, I desire to specially mention the faithful 
 services of President Garfield's family servant, Daniel Scroggs, 
 (colored.) 
 
 Therefore, tlie compensation for services rendered in the case 
 of the lamented Garfield, which so keenly touched the sympa- 
 thy of all and engaged their anxious solicitude, is respectfully 
 sul)mitted to your deliberate judgment. 
 
 I have tlie honor to be, very respectfully, your obedient ser- 
 vant, 
 
 D. W. BLISS. 
 
YA 91! 
 
 f 007 456 722 8 ^