320 



GARFIELD, JAMES A. 



ingeniously arranged bed, designed by Mr. T. N. Ely, 

 the fatigue incident to the transportation was reduced 

 to a minimum. Nevertheless, as was anticipated, 

 some signs of the disturbance produced by the jour- 

 ney have been exhibited since his arrival, by rise of 

 temperature and increased frequency of pulse. At 

 present his pulse is 124; temperature, 101 '60 ; respi- 

 ration, 18. D. HAYES AGNEW, 



FRANK H. HAMILTON, 



D. W. BLISS, 



J. K. BARNES, 



J. J. WOODWARD, 



ROBERT REYBURN. 



The President showed signs of gratification 

 at the change, but there was no immediate 

 evidence of improvement. On the 8th the 

 symptoms were regarded as promising again, 

 and at the patient's request Drs. Barnes, Wood- 

 ward, and Reyburn withdrew from the case, 

 leaving it in the hands of Drs. Bliss, Agnew, 

 and Hamilton. The same week a day of prayer 

 for the recovery of the President was observed 

 in several of the States. For two or three 

 days the reports were hopeful, but bronchial 

 trouble was developing, and threatening the 

 lungs. From the llth to the 15th the reports 

 were fluctuating and rather dispiriting. The 

 patient was placed for a few hours each day 

 in a reclining chair where he could gaze from 

 the window of the cottage npon the sea. On 

 the 16th there was a serious relapse, with 

 marked symptoms of blood-poisoning, includ- 

 ing severe chills, fever, and inability to retain 

 anything in the stomach. The last day is thus 

 briefly described by Dr. Bliss : 



At 8 A.M., September 19th, the pulse \vas 106 and 

 feeble ; temperature, 108'S, and all the conditions un- 

 favorable. In half an hour afterward there was still 

 another chill, followed by febrile rise and sweating, 

 and also with pain as before. During the periods of 

 chill and fever he was more or less unconscious. He 

 passed all day in comparative comfort, and at 8.30 in 

 the evening his pulse was 108, respiration 20, and tem- 

 perature evidently a little lower than normal. At 10.10 

 p. jr. I was summoned hastily to the bedside, and 

 found the President in an unconscious and dying con- 

 dition, pulseless at the wrist, with extreme pallor, the 

 eyes opened and turned upward, and respiration 8 

 per minute, and gasping. Placing my finger upon 

 the carotid, I could not recognize pulsation ; applying 

 mv ear over the heart, I detected an indistinct nutter, 

 which continued until 10.35, when he expired. The 

 brave and heroic sufferer, the nation's patient, for 

 whom all had labored so cheerfully and unceasingly, 

 had passed away. 



Besides the physicians there were present at 

 the moment of death Mrs. Garfield and her 

 daughter, Colonel Rockwell, Mr. O. C. Rock- 

 well, General Swaim, Dr. Boynton, J. Stanley 

 Browne and "Warren Young, the President's 

 private secretaries, and four attendants of the 

 sick-chamber. Death was preceded by a se- 

 vere pain at the heart, and the President's last 

 words were, "0 Swaim!" The announce- 

 ment of his demise evoked expressions of uni- 

 versal grief, not only throughout this country 

 but from the principal cities of the Old World. 

 Messages of condolence came from representa- 

 tives of authority abroad as well as at home, 

 and from many private and unofficial sources. 



The following personal message was sent to Mrs. 

 Garfield by Queen Victoria : 



BALMORAL GOUKT. 



MRS. GARFIELD, LONG BRANCH : Words can not ex- 



terri- 



uiort you as 

 THE QUEEN. 



press the deep sympathy I feel with you at this 

 ble moment. May Goa support ana comfort 



he alone can ! 



An autopsy of the body was made on the 

 afternoon of September 20th, Dr. D. S. Lamb, 

 of the Medical Museum at Washington, hand- 

 ling the knife, and all the physicians who had 

 taken part in the case, as well as Dr. Andrew 

 H. Smith, of Elberon, being present. The re- 

 sult showed that the diagnosis of the wound, 

 so far as it concerned the course of the bullet, 

 had been mistaken from the start. The fol- 

 lowing is the official announcement of the re- 

 sult of the autopsy : 



By previous arrangement a post-mortem examina- 

 tion of the body of President Garfield was made this 

 afternoon, in the presence and with the assistance of 

 Drs. Hamilton, Agnew, Bliss, Barnes, Woodward, 

 Reyburn, Andrew H. Smith, of Elberon, and acting 

 Assistant Surgeon D. S. Lamb, of the Army Medical 

 Museum, Washington. The operation was performed 

 by Dr. Lamb. It was found that the ball, after fract- 

 uring the right eleventh rib, had passed through the 

 fipinal column in front of the spinal canalj fracturing 

 tee body of the first lumbar vertebra, driving a num- 

 ber of small fragments of bone into the adjacent soft 

 parts, and lodging below the pancreas, about two 

 inches and a half to the left of the spine, and behind 

 the peritonaeum, where it had become completely en- 

 cysted. The immediate cause of death was secondary 

 haemorrhage from one of the mesenteric arteries ad- 

 joining the track of the ball, the blood rupturing the 

 peritonaeum, and nearly a pint escaping into the ab- 

 dominal cavity. This haemorrhage is believed to have 

 been the cause of the severe pain in the lower part of 

 the chest complained of just before death. An ab- 

 scess cavity, six inches by four in dimensions, was 

 found in the vicinity of the gall-bladder, between the 

 liver and the transverse colon, which were strongly 

 adherent. It did not involve the substance of the 

 liver, and no communication was found between it 

 and the wound. A long, suppurating channel ex- 

 tended from the external wound between the loin- 

 muscles and the right kidney almost to the right 

 groin. This channel, now known to be due to the 

 burrowing of pus from the wound, was supposed dur- 

 ing life to have been the track of the ball. On an 

 examination of the organs of the chest evidences of 

 severe ' bronchitis were found on both sides, with 

 broncho-pneumonia of the jower portions of the right 

 lung, and, though to a much less extent, of the left. 

 The lungs contained no abscesses and the heart no 

 clots. The liver was enlarged and fatty, but free 

 from abscesses. Nor were any found on any other 

 organ, except the left kidney, which contained near 

 its surface a small abscess about one third of an inch 

 in diameter. In reviewing the history of the case in 

 connection with the autopsy, it is quite evident that 

 the different suppurating surfaces, and especially the 

 fractured, spongy tissue of the vertebrae, furnish a suf- 

 ficient explanation of the septic condition which ex- 

 isted. D. W. BLISS, 

 J. K. BARNES, 

 J. J. WOODWARD, 

 ROBERT REYBURN, 

 FRANK H. HAMILTON, 

 D. HAYES AGNEW, 

 ANDREW H. SMITH, 

 D. S. LAMB. 



Dr. Bliss concluded a review of the case, 

 published in the " Medical Record," in Octo- 

 ber, as follows : 





