GAEFIELD, JAMES A. 



321 



The most important points revealed by the autopsy, 

 and which are to be considered by the profession, are : 



1. Would the condition of the President, immedi- 

 ately after his injury, have justified a more thorough 

 exploration of the wound, or would such a procedure 

 have been safe at any time before primary reaction 

 was established ? 



2. Was his transfer to the Executive Mansion time- 

 ly and properly made ? 



3. Were the best and mpt judicious means insti- 

 tuted to secure prompt reaction '*. 



4. After reaction was comparatively complete on 

 the 3d of July, and when there had occurred sponta- 

 neous evacuations of normal urine and alvine evacua- 

 tions, and an absence of any evidence of internal haem- 

 orrhage or peritonitis, would further exploration have 

 been necessary, especially when it is considered that 

 the probable reopening of the lacerated vessels would 

 induce haemorrhage ? 



5. Were the surgeons then in attendance justified 

 in deferring any further exploration until the arrival 

 of the distinguished counsel on the morning of July 

 4th? 



6. At the consultation, July 4th, and after it was 

 proved to be impossible to follow the track of the ball 

 any considerable distance beyond the fractured rib, 

 would an operation have been justifiable, necessitating 

 an incision through the soft parts, and a removal of a 

 portion of the rib, so as to develop the track ? 



7. In the light of modern military surgeiy, which 

 teaches the readiness with which leaden balls become 

 encysted, would an operation at any tune for removal 

 of the missile have been justified unless there was some 

 evidence of the missile being a source of irritation ? 



8. Considering carefully the condition of the Presi- 

 dent during the entire period of his illness, and the 

 facts revealed by the autopsy, would not any operation 

 for the purposes before mentioned have placed the 

 President's life in great jeopardy, and, at oest, have 

 hastened the time of his death without atfording any 

 signal relief ? 



9. Was the treatment of the case as presented prop- 

 er, and did it or not prolong his lite to the utmost 

 limit ? 



10. Was the mistaken diagnosis a natural result of 

 the conditions present, and, to have developed a cor- 

 rect diagnosis, would not operative procedures have 

 ensued ? 



11. If we had known the exact course and locality 

 of the ball, and the organs injured in its passage, 



i should the treatment have been modified in any par- 

 ticular ? 



I desire to say, in a brief review of the leading facts 

 as to the general conduct of the case, that it has been 

 apparent to the medical reader that my prognosis was 

 favorable, and, notwithstanding the mutations, I au- 

 gured a successful termination. It is but justice to 

 myself to state that my prognosis was based on a le- 

 sion of minor importance. Had our diagnosis been 

 correct, modern surgery should have conducted the 

 case to a successful termination. T believe the medi- 

 cal profession, whom I address, will bear me out that 

 the prognosis was correct, if the diagnosis had been 

 also correct. I was not always able, during the prog- 

 ress of the case, to account for many of the more pro- 

 found symptoms, and yet could not succeed in learn- 

 ing of any more extensive or complicated lesions than 

 were first suspected. I desire to make the inquiry 

 whether more extensive explorations could have oeen 

 safely made, or whether the condition presented a 

 knowledge of the relative position of the patient to 

 the assassin, the character ot the missile, and the con- 

 dition of the lesion and symptoms which follow 

 would have directed the investigation toward the actual 

 track and lodgment of the ball, the track of the ball 

 presenting a course of entrance downward and for- 

 ward to the point of impingement upon the eleventh 

 rib. and being then deflected to the left at almost a 

 right angle, passing behind the kidney, perforating 

 the intervertebral cartilage and first lumbar vertebra 

 VOL. xxi. 21 A 



anterior and to the left of the kidney, and finding its 

 lodgment below the left extremity of the pancreas, 

 wounding in its track the splenic artery. I would ask 

 if any known instrument or means of exploration has 

 ever been presented to the profession capable of trac- 

 ing before the death of said patient the course of this 

 bullet ? Also whether the conditions could have been 

 improved or mitigated, or his life preserved longer by 

 any other line ot treatment ; whether, in view of the 

 facts, modern conservative surgery could offer any- 

 thing more for the comfort or recovery of the illus- 

 trious patient ? 



It is proper to state, in conclusion, that the most 

 approved antiseptic dressings were used during the 

 entire progress of the case. 



There was considerable lay and professional 

 discussion of the medical treatment, the gen- 

 eral conclusion being that, aside from the mis- 

 taken diagnosis, the wound was necessarily 

 mortal, and it is doubtful if anything more 

 could have been done to mitigate the suffer- 

 ings of the patient. 



The remains lay at the Francklyn Cottage, 

 Elberon, until Wednesday, September 2 1st, and 

 the public was admitted to view the face of 

 the dead President. After brief religious cere- 

 monies at ten o'clock, on the 21st, the body was 

 borne by special train from Long Branch, and, 

 passing silent and reverent crowds at every 

 station, reached Washington at about 4.30, 

 where it was received by an imposing funeral 

 escort and taken to the Capitol. It was laid in 

 state under the great dome, previous to being 

 taken to Cleveland, Ohio, for burial. It was 

 exposed to view during the 22d, and crowds of 

 people passed through the rotunda to look 

 upon the face of the deceased. Meantime, 

 preparations were made in Cleveland for re- 

 ceiving the remains, and there the principal 

 obsequies were to take place. On the after- 

 noon of the 23d, after impressive ceremonies 

 in the rotunda of the Capitol, the coffin was 

 borne to the station of the Baltimore and Po- 

 tomac Railroad, and the funeral train started a 

 little after five o'clock. Official representatives 

 of the various departments of the Government, 

 of most of the States, and many municipal cor- 

 porations, accompanied or followed the re- 

 mains. The train, heavily draped with mourn- 

 ing emblems, entered Cleveland at 1.20 o'clock 

 p. M., on the 24th, and the body was placed in 

 state on a catafalque beneath a pavilion erected 

 for the purpose in the center of Monumental 

 Park. All day on Sunday, the 25th, a great 

 concourse of people passed the pavilion, and 

 on the following day an impressive funeral 

 took place, and the remains were deposited iu 

 a tomb in Lake View Cemetery, to await the 

 preparation of the place of final sepulture 

 which had been set apart for the purpose by 

 the trustees of the cemetery. The procession 

 included a military and civic pageant of un- 

 usual proportions. The day of the funeral, 

 September 20th, was observed throughout the 

 country as an occasion of general mourning, in 

 response to a proclamation of President Arthur, 

 which had been supplemented in many of the 

 States by the recommendations of their Gov- 



