Very respectfully, your obedient servant,
J. A. Garfield,
Brigadier-General, Chief of Staff.
Major-General Rosecrans,
Commanding Dept. of Cumberland.
II.
The following is the official record of the post-mortem examination of the body of President James A. Garfield, made Sept. 20, 1881, commencing at 4:30 P. M. eighteen hours after death, at Francklyn Cottage, Elberon, N. J.
There were present and assisting, Dr. D. W. Bliss; Surgeon-General J. K. Barnes, U. S. A.; Surgeon J. J. Woodward, U. S. A.; Dr. Robert Reyburn; Dr. Frank H. Hamilton; Dr. D. Hayes Agnew; Dr. Andrew H. Smith, of Elberon and New York, and acting as the assistant surgeon, and D. S. Lamb, of the Army Medical Museum, Washington, D. C.
Before commencing the examination a consultation was held by the physicians in the room adjoining that in which the body lay, and it was unanimously agreed that the dissection should be made by Dr. Lamb, and that Surgeon Woodward should record the observations made. It was further unanimously agreed that the cranium should not be opened. Surgeon Woodward then proposed that the examination should be conducted as follows: That the body should be viewed externally, and any morbid appearances existing recorded; that a catheter should then be passed into the wound, as was done during life to wash it out, for the purpose of assisting to find the position of the bullet; that a long incision should next be made from the superior extremity of the sternum to the pubis, and this crossed by a transverse one just below the umbilicus; that the abdominal flaps thus made should then be turned back and the abdominal viscera examined; that after the abdominal cavity was opened, the position of the bullet should be ascertained, if possible, before making any further incision, and that, finally, the thoracic viscera should be examined. This order of procedure was unanimously agreed to, and the examination was proceeded with.
Dr. Woodward. Dr. Reyburn. Dr. Barnes. Dr. Bliss. Dr. Hamilton. Dr. Agnew.
The following external appearances were first observed: The body was considerably emaciated, but the face was much less wasted than the limbs. A preservative fluid had been injected by the embalmer a few hours before into the left femoral artery. The pipes used for the purpose were still in position. The anterior surface of the body presented no abnormal appearances, and there was no ecchymosis or other discoloration of any part of the front of the abdomen. Just below the right ear, and a little behind it, there was an oval ulcerated opening about half an inch in diameter, from which some sanious pus was escaping, but no tumefaction could be observed in the parotid region. A considerable number of purpura-like spots were scattered thickly over the left scapula, and thence forward as far as the axilla. They ranged from one-eighth to one-fourth of an inch in diameter, were slightly elevated and furfuraceous on the surface, and many of them were confluent in groups of two to four or more. A similar, but much less abundant, eruption was observed sparsely scattered over the corresponding region on the right side. An oval excavated ulcer, about an inch long, the result of a small carbuncle, was seated over the spinous process of the tenth dorsal vertebra. Over the sacrum there were four small bed sores, the largest about half an inch in diameter. A few acute pustules and a number of irregular spots of post-mortem hypostatic congestion were scattered over the shoulders, back and buttocks. The inferior part of the scrotum was much discolored by hypostatic congestion. A group of hemorrhoidal tumors rather larger than a walnut protruded from the anus. The depressed cicatrix of the wound made by the pistol bullet was recognized over the tenth intercostal space at three and a half inches to the right of the vertebral spines. A deep linear incision made in part by the operation of July 24, and extended by that of August 8, occupied a position closely corresponding to the upper border of the right twelfth rib. It commenced posteriorly about two inches from the vertebral spines and extended forward a little more than three inches. At the anterior extremity of this incision there was a deep, nearly square, abraded surface, about an inch across. A flexible catheter, fourteen inches long, was then passed into this wound, as had been done to wash it out during life. More resistance was at first encountered than had usually been the case, but after several trials the catheter entered, without any violence, its full length. It was then left in position, and the body disposed supinely for the examination of the viscera. The cranium was not opened. A long incision was made from the superior extremity of the sternum to the pubis, followed by a transverse incision crossing the abdomen, just below the umbilicus. The four flaps thus formed were turned back, and the abdominal viscera exposed. The subcutaneous adipose tissue, divided by the incision, was little more than one-eighth of an inch thick over the thorax, but was thicker over the abdomen, being about a quarter of an inch thick along the linear alba and as much as half an inch thick towards the outer extremity of the transverse incision. On inspection of the abdominal viscera in situ, the transverse colon was observed to lie a little above the line of the umbilicus. It was firmly adherent to the anterior edge of the liver. The greater omentum covered the intestines pretty thoroughly from the transverse colon almost to the pubis. It was still quite fat and was very much blackened by venous congestion. On both sides its lateral margins were adherent to the abdominal parietes opposite the eleventh and twelfth ribs. On the left side the adhesions were numerous, firm, well organized, and probably old. [A foot-note here says: These adhesions and the firm ones on the right side, as well as those of the spleen, possibly date back to an attack of chronic dysentery, from which the patient is said to have suffered during the civil war.] On the right side there were a few similar adhesions and a number of more delicate and probably recent ones. A mass of black, coagulated blood covered and concealed the spleen and the left margin of the greater omentum. On raising the omentum it was found that a blood mass extended through the left lumbar and iliac regions, and dipped down into the pelvis, in which there was some clotted blood and rather more than a pint of bloody fluid. [A foot-note here says: A large part of this fluid had probably transuded from the injection material of the embalmer.] The blood coagula, having been turned out and collected, measured very nearly a pint. It was now evident that secondary hemorrhage had been the immediate cause of death, but the point from which the blood had escaped was not at once apparent. The omentum was not adherent to the intestines, which were moderately distended with gas. No intestinal adhesions were found other than those between the transverse colon and the liver, already mentioned.