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his fellows, yes. If by this is meant that he is so constituted by birth or development that he is physically abnormal and therefore not responsible, no. This idea of calling degenerats all those whose views of affairs become perverted by association with those who glory in pulling down everything that exists because it does exist, by reading only firebrandish literature of anarchism, and by devoting their time to concocting arguments against the fundamental principles of law and order and good government, is absurd. No, Czolgosz is an anarchist, that is all.

So let us leave him and turn to the other side. President McKinley is living today, thanks to the skill of the surgeons. This prospect of a fortunate result in this case of National and world-wide interest is due to the prompt surgical intervention and the application of the best technic and surgical sciences of today. But for these, the anarchist's bullet would have been successful or a practical miracle would have had to have occurred. Those who were called on to save the President deserve all the praise and honor that will be theirs for having proved themselves equal to the occasion.

Surgeons are being called on daily to do more delicate and more difficult operations than was this on the President, but in a patient so illustrious, it required courage in any one who should attempt it. A critical world watcht, and the hopes of a nation were centered on this operation, and a false step, or faulty technic in the slightest degree would mean a mighty disaster. Had there been lack of prompt decision to operate, irretrievable damage would have been done, and the tragedy would have been complete.

This prompt decision to operate gave evidence of courage as well as rare surgical judgment. Perforation of the gastro-intestinal tract into the peritoneal cavity is a most serious condition in any case, and those who attempt to meet it know that condition may be revealed when the abdominal cavity is opened that might defy even the surgical skill of the day to overcome. It is for this reason that courage in this case was necessary. When the cavity was opened and the stomach and the intestins had been examined and two openings in the stomach was the sum of the pathological lesions found, the surgeons certainly breathed more freely, for modern surgery was equal to the emergency. If conditions passing surgical skill had been discovered, who can tell what imprecations would have been heapt on those who operated, when death should end the scene?

We repeat: Under the circumstances, it required courage for the surgeons to do their duty, but they did it. The medical profession of America is proud of and congratulates the surgeons who workt so faithfully to save the chief magistrate of the Nation. They only did their duty, it is true, and thousands of others might have done as well, but nevertheless praise is theirs and we accord it.

Medicins administered by the rectum or vagina should be given in twice the dose by the mouth.

A monthly magazine cannot be a newspaper, and it should not try to be. For medical news we must look to our weekly medical journals. However, the sad case of our President is of such absorbing interest that we will be pardoned if we deviate from our usual custom and give some of the facts concerning this case that come under the head of news rather than science.

The Shooting of the President. [From our Correspondent.]

BUFFALO, N. Y., September 12. Within an hour of the infliction of the wounds received by President McKinley he was operated upon at the Exposition Emergency Hospital. The surgeons present were Drs Matthew D. Mann, Professor of Obstetrics and Gynecology, University of Buffalo; Dr. Herman Mynter, Professor of Operativ Surgery, University of Buffalo; Dr. John Parmerter. Professor of Anatomy and Clinical Surgery, University of Buffalo; Dr. E. Wallace Lee, of St. Louis, Mo., who bappened to be on the Exposition grounds; Dr. Eugene Wasdin, of the Marine Hospital Service, and Dr. Presley M. Rixey, physician to the President.

The operation was performed by Dr. Mann; first assistant. Dr. Herman Mynter; second assistant, Dr. John Parmenter; third assistant, Dr. Lee. Dr. Eugene Wasdin gave the anesthetic, which was ether. The operation lasted 45 minutes. Dr. Rixey arrived at the latter part of the operation. There were two wounds, one about the center of the sternum. the other two and one-half inches below the free costal border on the left side and in the semilunar space. It was this latter wound which necessitated the speedy operation. A five-inch incision was made and the course of the bullet followed up. It was found to have penetrated the anterior wall of the stomach. The opening was small and was sutured with silk. After closing this a search was made of the intestines; the stomach was lifted from its position ard a larger perforation was found in its posterior wall. It was over an inch in diameter, jagged and irregular. This wound was sutured with black silk also. Continuous catgut was used for the fascia. The skin was coaptated with six thruand-thru silkworm stitches, and interrupted catgut was past between the silkwormgut. The abdominal cavity was thoroly irrigated with normal salt solution. There was very little food in the stomach at the time of the shooting; because of the dexterity of the operators and this happy incident no foreign matter entered the perineal cavity from the stomach. The wound was closed with catgut, without drainage, and bandages were applied. The bandages were removed at 8.30 a. m. Saturday and showed but little staining.

Before anesthesia had past off, the President was conveyed by ambulance to the residence of Mr. John G. Milburn, president of the Pan-American Exposition, the emergency hospital being for temporary use only.

There are three nurses and three orderlies in attendance on the President. Dr. Rixey and one of the surgeons are with the President each night, and consultations of all the surgeons are held three times a day, Dr. Roswell Park was at Niagara Falls and came on a special train, and assisted during the latter part of the operation. He is surgeon in charge. Dr. Charles McBurney, of New York, was called in consultation on Saturday, and is still here. He is the guest of Dr. Mann.

The surgeons are much inconvenienced by the incessant inquiries from reporters and are very guarded in their remarks.


The male nurses in attendance on the President are from the United States Army Hospital Corps, who were detailed for this duty immediately after the shooting of the President, from the detachment of Hospital Corps men on duty with the Field Hospital Exhibit of the Army Medical Department at the Pan-American Exposition. The men selected for this responsible duty were Acting Hospital Steward Palmer A. Eliot, and Privates Ernst Vollmeyer and John Hodgins. All of these men completed the excellent courses of instruction at the School for Hospital Corps men at the Army General Hospital at Washington Barracks, D C.; besides which Steward Eliot is a graduate of the Bellevue Hospital Training School for Nurses, and Private Vollmeyer is a graduate nurse of the Presbyterian Hospital of New York City. Private Hodgins is a soldier of nine years' army service and long experienced in military hospitals. Much of the attention required in the President's case is of such nature as cannot well be performed by

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female nurses in attendance, and the efficiency of these men is such as to have elicited much favorable comment from the staff of attending surgeons. Army medical officers are highly gratified that the hospital corps should be officially connected with the President's case and have the opportunity of so publicly demonstrating its professional efficiency and the excellence of its personnel.

The female nurses in attendance on the President are Miss Helen Mohan, a graduate of the Buffalo General Hospital Training School; Miss Conley, a graduate of the Buf falo General Hospital Training School, and lately clinic nurse at the German Hospital; Miss Hunter, nurse of Mrs. McKinley and Miss Grace McCullough, of Baltimore, has been summoned.

As the President continues to improve, the excellent judgment and great wisdom in the surgeons who first saw him in treating the President as a citizen and in not being concerned with too much formality or red tape become more and more apparent. The operation from the course of symptons is to be regarded as an aseptic one. The heat resulting from the discharge of the revolver made the bullet practically aseptic, and the perforations of the stomach wall will heal soon because the sutures past thru normal tissue, and not, as in the case of tumor and ulcer, thru diseased tissue. The wonderful dexterity of the operators, Drs. Mann and Mynter, prevented any discharge of stomach contents into the peritoneal cavity; hence no symptoms of peritonitis have or are expected to occur.

It is impossible at the present time to get a more detailed technical description of what was done at the operation than that which I have already given.

One of the surgeons in attendance was askt by a press representativ to compare Garfield's case and its treatment with that of President McKinley, and in reply stated that to do so would be to give the history of the progress of twenty years of surgery. Besides, he said, the two cases are entirely different. Garfield's wound was an extremely unfortunate one in every way, hard to get at and difficult to handle. The wound of President McKinley, on the other hand. is in many respects a fortunate one. No comparison is possible.

During Tuesday night two stitches were removed on account of some perceptible irritation. The wound was cleansed and again closed. It is the belief of all the surgeons in attendance on the President that his recovery is certain. If peritonitis were to have appeared its symptoms would have been manifest long before the time of this writing, and the fact that the kidneys and bowels have been functionating normally since Tuesday, showed that the surgeons have good reason to be hopeful. Until early Tuesday morning the President received stimulants only hypodermically, but at that time was given a nutritiv enema. In the afternoon beef juice was given by mouth. It is not necessary to give sedativs, for the patient gets four or five hours' sleep.-Jour. Amer. Med. Ass'n.

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At that time there were present around the operating table Dr. P. M. Rixey, the President's personal physician; Dr. M. B. Mann, and Dr. H. Mynter.

"As soon as I saw the President I was struck with his condition. There was a pallor in his face, and on examination it was found that his pulse was abnormally high. There was every indication that the man was dangerousiy wounded, and that an immediate operation was imperativ.

"There was a consultation of the physicians as to whether it was expedient to wait longer for Dr. Parke or to begin at once. It was finally decided to go ahead with the operation. All the while I was greatly imprest with the President's fortitude. He wore a faint smile on his face, and yet all the while his expression indicated that he knew the seriousness of the wound, that it had been inflicted by a man who had planned to kill him, and that the ultimate success of the treatment was as yet problematical.

"Having decided to perform the operation, one of us said:


'Mr. President, your condition demands an operation.'

"Gentlemen,' was the answer, uttered in a low, quiet tone, as if spoken to some little child, I want you to do whatever in your judgment you think is necessary."

"That is the last thing he said at the hospital. We did not encourage him to talk, for we knew that the more quiet he was, and the more free from excitement, the more likelihood of success would attend the operation.

"Dr. Mann then took charge, and the flesh was cleaned by shaving and by antiseptic solutions. The President was then put under the influence of anesthetics, which acted promptly and satisfactorily. An incision was then made in the abdomen, thru the aperture made by the bullet, about four and one-half inches long. Thru this opening the stomach was drawn, and on examination it was found that the bullet had past straight thru this organ. As the President had had a hearty luncheon between 1 and 2 o'clock, the stomach was partly filled with undigested food This had oozed thru the holes in the stomach to a certain extent and had run down into the abdominal cavity. Since the abdomen is inclosed in a lining known as the peritoneum, this lining had also been perforated by the bullet.

"The bullet could not be found. Accordingly, the abdominal cavity was washt clean with antiseptic solutions, and all possible care taken to destroy any infectious germs.

"The holes in the stomach were ugly ones, and the posterior hole was much more jagged and torn than the one in front, thru which the bullet past first. This I consider a most serious matter, altho to be expected, since the bullet had spent some of its force by the time it had reacht the further side of the stomach, and thus tore rather than pierced its way thru.

"After repeated bathing of the wounded parts with antiseptic lotions the apertures in the stomach were sewed up with silk sutures, and the abdominal cut was sewed together with silkwormgut sutures.

The external wound was then carefully drest with an antiseptic bath, and a wide abdominal binding was applied. The body was then wrapt in sheets, around which blankets were folded, and the President was placed in the ambulance.

"The President was still unconscious when the operation was completed and the ambulance had been summoned to carry the wounded man to the home of President Milburn. This was fortunate, for it was much better for him to be carried away in an unconscious condition than for him to awaken and to be conscious of the jolting of the vehicle."

"The Medical News, in its issue of September 21, will review the President's case From information received editorially. in advance of publication, we give the following quotations:

"The gangrene, extensiv as it was, seems to us not so different from others observed under analogous circumstances as to require the assumption of exceptional causes for its explanation. Necrosis of tissue in a thinner or thicker cylinder along the track of a bullet is thought to be the rule, and ordinarily it is easily taken care of by liquefaction and absorption. And necrosis, even of a considerable extent, in feeble. patients, about a sutured wound is certainly not. unknown, even if rare, and is explained by interference with the local circulation, either by tension or by the spread of coagulation within the blood vessels.

"The spread of the process in a patient of low reparativ power would not be so very exceptional or surprising. Was the President such a patient? Apparently he was. According to Dr. Wasdin, when the incision was reopened, toward the end of the fifth day, 'no effort was required to open it thruout its entire length, altho only the track of the bullet was affected. That expression would hardly have been used unless he had intended to indicate

that the amount of repair usual after that lapse of time had not taken place. Then, the President was 58 years of age, had led a sedentary, laborious and anxious life, and had a complexion and appearance which, for some years, had been commented upon as indicativ of impaired vitality.

"It is evident that the surgeons, notably Drs. Mann and Mynter, with whom the first decision lay, acted with commendable promptitude and courage in undertaking the operation, and showed excellent judgment in its course and skill in its execution. They did all that could properly have been done, and nothing that should have been left undone. The usual causes of death after such injury and operation were escaped or removed or prevented, and their patient succumbed to a complication which is so rare that it could not reasonably have been anticipated, and could not have been averted.



"The President died because he could not

carry on the processes of repair, and because the

effort to do so was more than the vitality of the tissues involved could support. This, of course, excluded the possible presence of poison brought by the bullet, or of destructiv action by the pancreatic juices. If either of those was a factor, it needs only to substitute it in the statement for the assumed defectiv vitality of the patient. Whatever cause acted, it was unrecognizable at the operation and uncontrolable then or subsequently.

"There has been some criticism of the confident assurance of recovery made by those in attendance after the fifth day. To us the progress of the case up to that time appears fully to have justified those assurances, and the public anxiety to have required them.”

The review of the case closes with the following reference to the doctors:

"They did their work skillfully and judiciously, their behavior was dignified, restrained and worthy of the best traditions of the profession, and they had the misfortune, when success seemed to have been secured, of seeing it overthrown by a complication which could not have been foreseen or avoided. They deserve our admiration and sympathy, not our criticism.”

Medical Equilibrium.

Few men can endure the pressure of sudden and unexpected popularity. All literature teems with the annals of deplorable collapse under such circumstances. Skilled workmen, experienced financiers, brave soldier heroes, and astute statesmen have won such laurels that their heart is broken when new idols appear and claim attention, and their sunset is more melancholy than their sunrise was glorious. History would furnish enuf

such instances to pack many volumes; current literature produces quite enuf for our consideration. Bill Anthony, lauded to the skies for doing his plain duty, died of a broken heart and at his own hand, because the fickle public had tired of its clay idol. Dewey breasted bravely the Spanish fleet in pursuance of duty, and bore his laurels bravely till one unfortunate act condemned him forever. Hobson sternly sought to win entrance to the jaws of death itself, because of duty; and soon fell from his high pedestal of fame because of a little foolish sentimentalism. We know the prestige and reputation that will follow the already prominent and famous physicians and surgeons who attended President McKinley, and we venture to predict that not one of them will "lose his head" thru the popularity which must necessarily follow attendance

upon such a distinguisht personage.

Medical men who know so well the use of the knife, suture, and cathartic, are in general too well balanced to be swept into foolishness by the flowing and ebbing tide of temporary popularity, and we expect each to wear his well won laurels with professional modesty and dignity.

[The above was written when "everything was favorable," and when it was expected that the President would recover. Now that the worst and the then unexpected has happened, we will not take back the above, for no blame attaches in any way to the medical attendants. However, success would have given the attendants a much greater reputation among the laity than failure, however blameless.]

The Use of Quinin in Parturition. The conflicting opinions on the use of quinin in labor leads us to note what the recognized authorities have to say on the matter. Many practitioners fail to gain benefit from the drug in labor because it has been accused of causing predisposition to post-partum hemorrhage, and also because, if given in sufficient dosage, it is

prone to induce vomiting. It has never been proven that quinin tends to induce post-partum hemorrhage, and all our knowledge of the drug teaches that it is a preventativ of that complication. Vomiting is often a thing to be wisht for in the case of a rigid and slowly dilating os uteri; but if one does not wish the troublesome vomiting for the sake of the markt relaxation accompanying it, he may administer full dosage of scale pepsin with the quinin and thus prevent vomiting, while gaining the therapeutic effect of the drug in increasing the expulsiv power of the uterin contractions. We append quotations.

King's American Dispensatory says: "In obstetrical practise, quinin is frequently serviceable. It may be employed to remedy irregular and ineffectiv pains, and in cases where complications of a periodic nature arise. As with its anti. periodic virtues, small doses of opium associated with it increases its oxytocic power. By its tonic and contractil action, it minimizes the danger of post partum hemorrhage. * * * Quinin is occa. sionally of value in puerperal fever and septicemia."

As regarding the danger of administering quinin in pregnancy lest abortion ensue, The International Medical Annual (E. B. Treat & Co.) says: "Chambrelent and Bruyere report as the result of careful study, that only in a small percentage of pregnants is quinin possest of oxytocic properties." [It will be noted that this refers only to the pregnant, and not to the parturient female. -ED.]

The American Text Book of Obstetrics, referring to this feature, says: "Many medicaments have been recommended for this purpose, but of them all alcohol, quinin and ergot alone deserve consideration. The last was extensivly employed at one time, but clinical experience for bids its use to-day. Owing to the recommendations of Albert H. Smith and of Fordyce Barker, quinin has had, and still has, a great reputation as a stimulant

to the uterus in labor. Quinin has the positiv disadvantage, moreover, that it will occassionally in certain susceptible individuals produce post-partum hemorrhage."

Ellingwood's Materia Medica, Therapeutics, and Pharmacognosy says: "Quinin has a direct power in inducing contraction of the parturient womb, especially if from inefficient strength the labor has been prolonged until the nervous force of the patient is well nigh exhausted. Fifteen grains may be given at one dose. The contractions become normal in frequency and of regular character and force. It thus overcomes inertia and will prevent post-partum hemorrhage. It is a good remedy for this latter condition when it has occurred. It is a dangerous remedy in large doses during pregnancy, as it may bring on premature labor."

Professor Barton Cook Hirst says: "If there is defect of expulsiv power in the first stage, administer fifteen grains of quinin in capsule with scale pepsin to prevent vomiting."

Grandin & Jarman's Obstetrics says "The administration of quinin in large doses, say twenty grains by the mouth or thirty grains by the rectum, occasionally appears to evoke contractions."

The wise physician guards every prognosis with qualifications as to any prob able or possible change in the features of the case. Never give an absolute prognosis of life or death; and, above all, never name the hour of probable dissolution.

"Keep your shop, and your shop will keep you," is yet applicable. No young practitioner has any time to loaf; let him perfect himself in his weak points. The doctor who is seen loafing may as well move. The laity only want the services of a busy man, yet they do not distinguish between a man busy with practise and a Better be man busy at other things. always doing something.

Be cautious in giving atropia to flaxen-haired, light-complexioned, nervous women.

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Another Test Case.

Editor MEDICAL WORLD:-On page 343 of August WORLD Dr. S. C. Chapman gives the history of a case and asks the readers of THE WORLD to prescribe. It occurs to

me that this case is not the most suitable one on which to test the different schools of practise. This man may die under any treatment, or he may recover in spite of the doctors. Let us select a case on which we can test a line of treatment and see certain results; a case in which if one line of treatment fails, another, and even a third plan may be tried.

A man who has had good health for a year past now has a chill every day at 10 a. m.; he has high fever (say 104 degrees temperature) for several hours; then he perspires freely, gets up, eats a hearty meal, takes his gun, and goes to the swamp to kill squirrels. He is all right until next day when he has the cold, hot and sweating stage again. His bowels act well, his appetite is good in the morning and in the afternoon when the fever leaves him; his tongue has a white coat, or a coat the color of ashes; it is large and indented by the teeth on the sides.

Let us have a treatment that will, in twenty-four or forty-eight hours, arrest the daily paroxysms. In this case we can try several plans of treatment before we kill the patient. Here we can see with certainty what treatment cures the patient at once.

Would like also a treatment for this case: A man who previously had good health has a slight chill at 2 o'clock p. m., fever for one hour or two, sweats freely, and at night is all right, eats a hearty meal, sleeps well, bowels and kidneys act well; but four hours earlier next day he

has a severe chill, high fever, is very restless, delirious, pulse 120 or 125, bowels do not act, kidneys act very scantily, urin is high colored. He vomits almost everything he swallows. At night he is somewhat better, but temperature is still one or two degrees above normal.

We who live in a malarial district know that if this man has another paroxysm he will be in great danger. Tell us how to prevent it.

This is not written in a spirit of criticism. If homeopathic doses will stop the chills in the first case or prevent dangerous symptoms in the second case when the next paroxysm comes, no one is more anxious to know it than I am.

Kindrick, Miss. C. KINDRICK, M.D.

[This is a much fairer test than Dr. Chapman's, for obvious reasons. Will our homeopathic friends be as ready to reply to the first, or to both these test cases, as they were to Dr. Chapman's test case? Will their prescriptions be as uniform? Possibly there may be no "keynote" symptom, like the "sputum flying to pieces like batter." Was Dr. Chapman's test case prepared with this "keynote," in order to display a uniformity that does not usually obtain? We are seekers after truth. We have frankly shown our hands in the test proposed by you; now be as frank with us. Let us have your treatment for the first, or both these test cases proposed by Dr. Kindrick. Let us hear from our own and other schools, too. ED.]

The Telephone as an Aid to the Country Doctor.

Editor MEDICAL WORLD: Some time ago an inquirer in THE WORLD askt how to make a cheap telephone. The answers were all that could be desired, and showed "Yankee ingenuity" to perfection. I was somewhat disappointed in not seeing a reply where the lines had been constructed, and used by the doctor as an aid to his practise.

The utility, convenience and luxury of a telephone line to a country doctor can only be realized by possession. A brief description of a short line that I constructed a few years ago, I hope will be of interest.

My line extends from my office to a little village which we will call “A," about 2 miles away. Here I have a "phone" in the blacksmith's house. This being at

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