Professional Opinions of Prominent Surgeons Regarding the President’s Wounds

     In view of the absorbing interest, to both the profession and the public, of the President’s case, we have obtained the following opinions from well known surgeons on its strictly scientific aspect. It is gratifying to note that there is practical unanimity of opinion on all the grave questions involved:

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     Dr. John B. Deaver stated that from the nature of the bulletins by which only he could be guided, he believed that the President will recover. He expressed his opinion as follows: “I think that more cases similar to the President’s would be followed by recovery, if prompt surgical treatment at the hands of men with the capability of the President’s surgeons were instituted. The greatest risk to which the President was exposed, barring hemorrhage, was that of infection of the peritoneal cavity. It is in these cases where procrastination, dilly dallying, the fear of assuming too much responsibility, in short, not having the courage of one’s convictions, are responsible too often, I regret to say, when the surgeon finally prepares to repair the damaged tissue. If it is ever indicated to apply the expression ‘he who hesitates is lost,’ it is in cases of wound of the abdomen. We are not justified in questioning whether the wound is of a penetrating or of a non-penetrating character. In this day of aseptic clean surgery the immediate action to mechanically correct the damage done is the ‘sine qua non.’ The promptness with which incision into the abdominal cavity was made, revealing the injured viscus and the extent of the injury, the repair of the same followed by a flushing with sterile salt solution, and the immediate closure of the abdominal cavity, is putting into practice modern surgical art. The results in the President’s case demonstrate the value of asepsis and not anti-sepsis.”
     Dr. J. B. Roberts stated: “From the information given by the newspapers, I believe that the President received a wound which would have been followed by rapidly fatal septic peritonitis, had early operation not been performed. It has been a source of much satisfaction that he has had the services of such well known and justly distinguished surgeons.”
     Dr. Joseph Price stated, “It is fortunate that a hospital in readiness and with the best modern appointments should have been in the immediate vicinity of the accident, and that prompt abdominal surgery was employed by from two to three of the best men in the country, all of whom have had excellent results in a prolonged practice, and all of whom have performed very complicated and successful work. It is also fortunate that the surgical ability of Buffalo was at home. Most of these operations result disasterously [sic] on account of the delay in waiting until the next morning. In this case the surgeons promptly sought perforation, cleansed and closed it, and determined the fact that other important viscera were not injured. There having been no hemorrhage from wounded vessels, probably settled the fact that the ball was innocent and buried in muscle, and therefore no attempt was made to seek or to remove it. As there is no evidence of splenic, renal or spinal injury, we could expect but one result in the hands of such men. The pulse of the President was rapid and the temperature a little high, which would, however, be explained by the extent and nature of the injury in a man of the President’s age. The delay caused by sending to adjoining cities or educational centres for surgeons, commonly results disastrously. Promptitude was of paramount importance in this case as it is in similar ones. Again, the surgeons were prompted by their large and varied experiences and were not in the slightest degree influenced by the opinions of Sir William McCormac and Mr. Treves, as to the non-interference in gun shot wounds in the abdomen. Drainage was not necessary in this case. There had been no vomiting, the stomach was empty at the time [438][439] of perforation, and if the peritoneum was contaminated at all, the toilet was perfect. In the great work of Dr. Dalton, of St. Louis, about all the operations were performed in general hospitals, but were as prompt as possible. Early interference exceptionally results in death unless some injury be overlooked. Overlooking a perforation of the bladder, bowel or some other important organ is quite common. A few years ago my brother, Dr. M. Price, removed the right kidney for a gunshot wound involving both kidney and liver, hemorrhage having been quite copious from both organs. The kidney was removed and the liver wound carefully drained. In this case drainage was important; had it not been practiced, the results would probably have been disastrous and fatal. Drainage in the President’s case was not indicated and would have delayed his convalescence had it been instituted. Large numbers of old soldiers carry large musket or rifle bullets in their muscles or in their bones. I know of three soldiers who are carrying bullets in the mastoid portions of their temporal bones or in the deep structures of their ears, all useful men. In Garfield’s case their was an injury to his spinal cord and column as well as injury to large vessels resulting in aneurysmal complications. The injuries in the two President’s cases are not at all similar. One could and was repaired by skilled hands, the other could not be repaired.”
     Dr. R. C. Norris stated, “Following with interest the course of the President’s convalescence, the anxiety on account of his pulse particularly has largely disappeared now in view of the fact that symptoms of peritonitis have not developed, and at this day we can feel practically assured that it will not develop. Ability to take food by the mouth, free action of the bowels, his returning strength, cheerful disposition, ability to sleep, together with a steady improvement in his pulse and temperature warrant us to believe that his convalescence is assured. The medical profession should feel especially proud of this triumph of modern surgery, and while the greatest praise should be awarded to all the physicians associated in the management of the President’s illness, the prompt and skillful work of Dr. Mann should not be lost sight of as the important factor in rescuing the President from certain death. It is of interest to note the rare good judgment displayed by Dr. Mann in not employing the gauze drain.”
     Dr. Orville Horwitz stated, “The promptness with which the President was treated saved his life. The fact that the surgeons treated him like any other patient with a similar wound and the skill employed speaks well for American surgery. That there has been no peritonitis shows the value of aseptic closure of the wound. I believe that the surgeons displayed excellent judgment in not continuing their search for the other bullet as no viscera other than the stomach were injured.”
     Dr. Henry R. Wharton stated, “Following the history of the President’s case from the bulletins published by his physicians, I am led to believe that a favorable termination is likely. At present the moderate elevation of the temperature and pulse rate might point to the development of a superficial abscess but does not point to the development of peritonitis. It is probable, by this time, that the perforating wounds in the walls of the stomach, which were promptly closed by sutures, are healed and will cause no further disturbance. The bullet which is supposed to be buried in the muscles of the back is not likely to give rise to serious trouble. The favorable outlook of the case up to the present time seems to be largely due to the modern methods of surgical treatment carried out by the very competent staff of surgeons under whose care the President has been.”
     Dr. William B. Coley, of New York, stated, “The President’s case furnishes new and striking proof of the soundness of the American method of treatment of gun-shot wounds of the abdomen. The brilliant successes of Kocher and Bull in 1883 and 1884 first brought the operation into prominence. American surgeons were the first to accept their teachings, while as late as 1890 two of the leading French surgeons made a vigorous attack upon what they termed the American method of treating shot wounds of the abdomen, and still advocate the old laissez faire policy. The same year, I made an analysis of one hundred and sixty-five cases treated by operation, the majority by American surgeons. This analysis showed a mortality of only sixty-seven and two-tenths per cent., in place of the mortality of about ninety per cent. by the old methods. Of twenty-four cases of wounds of the stomach, there were six recoveries. In forty-eight fatal cases, death was due to peritonitis. In twenty-five cases the average time of death in the fatal cases was twenty-six hours after operation. In only one case did death occur after five days, and this was a case of wounds of stomach, liver and kidney. The enormous importantance [sic] of early operation is shown by the fact that, of the cases operated upon during the first twelve hours, forty-three and six-tenths recovered, while only twenty-two and seven-tenths recovered of those operated upon during the second twelve hours. The fact that the President was operated upon almost immediately after the injury by a very skillful surgeon, combined with the most important fact that the stomach was practically empty, renders the prognosis most hopeful. The fact that he has already progressed favorably for five days, makes the hope of recovery almost a certainty. The further experiences of the last decade, based upon a much larger number of cases treated by operation, confirms the conclusions that I drew in 1890. These were, first, exploratory incision in the region of the wound to see if it be penetrating; second, if penetrating, immediate median laparotomy; third, signs of peritonitis, if present, while lessening the chances of recovery, do not contraindicate operation.”
     Dr. Christian Fenger, of Chicago, stated, “It is a satisfaction that this life, so precious to us and to the whole civilized world, has been saved by a foundation laid by two of our own immortals. It was the labors of Senn and the late Charles T. Parker that revolutionized the treatment of internal wounds. A perfectly typical and I might say, ideal handling of the President’s case was made possible by the exposition hospital facilities and by the mental superiority of the august patient who put himself unreservedly into the hands of able men who did not hesitate an instant to assume the responsibility of prompt action on the lines of most advanced knowledge of rational, intelligent surgery. The masterly technique of Mann, the efficient assistance and counsel of Mynter and Roswell Park, also masters in abdominal surgery, the splendid handling of the anesthetic by Wasdin, the after treatment, so ably conducted by these gentlemen and Rixey, contributed to a result for which not only the nation, but the whole world, is at this moment profoundly thankful. The enormous burden of responsibility that had to be borne was much lightened by the wise counsel and assistance of McBurney. Of inestimable value to all concerned was the clearheadedness of Secretary Cortelyou, who, without hesitation, which in this case would have been fatal, made it possible to save the President’s life by prompt decisive action. Irrespective of this happy result, we have to congratulate ourselves that this celebrated case has been handled throughout in so masterly a way, that it will stand forever as an example of perfect, scientific surgery.”
     Dr. Arpad G. Gerster, of New York City, stated, “The President will recover. His recovery will be due to the prompt assent he gave to the energetic proposal of his medical advisers, and last, but not least, to the excellent surgery practiced on him. The surgeons that are saving the life of President McKinley could probably have done the same for Garfield, because they knew and practiced the same methods in 1881 they are employing so successfully to-day, but they were young men then and the gray hairs at the head of the profession did not practice modern surgery.”