A Case of Gunshot Wound of the Stomach in Which the Patient Recovered

     Apropos of the fateful shot that ended the life of our lamented President, I wish to call attention to a case occurring in the practice of my father, Dr. J. W. Penn, now dead.

     The accompanying cut (from photograph taken September 18th) is that of Alex. Mullins, the patient in question. [603][604] He is now 52 years old and still an active farmer. I quote from my father’s scattered case records: He was shot at 7 A. M., May 22d, 1878, by his own pistol, his opponent having taken it from him, and hence shooting at close range. The similarity to the President’s wound is apparent, since the revolver used was of 32 calibre, and the wound of entrance, as seen from the cut, only about an inch lower than the shot that killed President McKinley, or to be accurate, it is one and one fourth inches to the left of the median line, and one and one half inches above a line drawn across the navel. The patient had just eaten a hearty breakfast. My father saw him about two hours after the shooting. He vomited freely as soon as shot, the matter consisting of the meal just eaten and copious quantities of clotted blood; he continued to vomit blood during the first day. Patient rested well after a hypodermic of morphine. For 14 days he was fed exclusively on the mucilage of the cactus or prickly pear, which was allowed from the first, and was permitted other forms of liquid nourishment after this time, gradually returning to a full diet. He was in bed just five weeks, and I am sorry the records are so meagre regarding the temperature and pulse, but there was never a decided rise of fever, and no evidence of peritonitis, his long continuance in bed being rather a precaution than a necessity.

     I wish to add this case to the list mentioned in an editorial of the Journal of Sept. 14th, in which Alcock is quoted as giving one case of recovery from gunshot of the stomach, out of 3000, before the days of modern surgery, and while it is not reported to substantiate the “masterly inactivity” plan of Senn and other authorities on military surgery, it incidentaly [sic] illustrates the ability of nature to cope with grave conditions, the more that being an inch lower than the President’s wound it would seem that both pancreas and kidney were in greater danger of injury. My father believed that the full stomach was a favorable factor in that fewer fibers of the stomach wall were cut by the ball, and hence a closer approximation of the wound edges following the contraction after emesis. As one of the lessons of the President’s case, would it not be well in such wounds to first excise the necessarily contused, and possibly infected edges elliptically, much as an ulcer might be excised, before uniting with suture? Would gangrene of the stomach wall have been so likely had this been done? The above is not said in criticism of the technique of the execellent [sic] surgeons in the case, but as stated, a possible advantage to be gained from this sad experience.