“Yes, I Shot the President, but His Physicians Killed Him.” The Assassination of President James A. Garfield

2018 ◽  
Vol 84 (11) ◽  
pp. 1711-1716 ◽  
Author(s):  
John D. Ehrhardt ◽  
J. Patrick O'Leary ◽  
Don K. Nakayama

President James A. Garfield suffered two gunshots on July 2, 1881, but did not die until 80 days later of complications from sepsis. He might have survived had his injuries not been contaminated, either by the gunshots themselves or the interventions that followed. “Yes, I shot the president,” said Charles Guiteau, Garfield's assassin, “but his physicians killed him.” The drama of Garfield's struggle to survive his injuries evoked enormous national interest, a harbinger of the medical dramas and documentaries of today. D. Willard Bliss, a former Civil War surgeon, and his handpicked consultants underwent daily scrutiny by the professional community and lay press. As the President died because of his injuries, the surgeons’ reputations suffered. A primary criticism was the supposed lack of antiseptic interventions in Garfield's care, especially when probing the wound with unwashed hands. Inserting a finger into the wound, however, was a basic part of examination of a gunshot wound at the time. Many American surgeons had not accepted Listerian antisepsis at the time of the event, and aseptic techniques, such as scrupulous handwashing and surgical gloves, had not yet been developed. In the context of surgical practice of the era, his surgeons followed the standards of care of the time.

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Mamun ◽  
E Charles

Abstract Aim Informed consent requires all material risks to be discussed, as per Montgomery vs Lanarkshire 2015. This audit was based on the latest RCS England guidelines on consenting patients. We aimed to assess our adherence and to introduce standardised procedure-specific consent stickers to ensure the highest standards of care, which were reproducible. Method We undertook two retrospective case note reviews of patients undergoing emergency and elective general surgery procedures from 01/01-15/06 and 01/10-30/11 in 2020. RCS Good Surgical Practice 3.5.1 “Consent” details the standards for this audit. We included patients undergoing appendicectomy, cholecystectomy, incision and drainage and hernia repair (inguinal, umbilical, and incisional). We did not audit laparotomy due to variability in procedural risks precluding a specific sticker and we excluded patients unable to give consent. Results Our initial audit of 82 patients highlighted the variability between practitioners in the material risk discussion. Different patients undergoing the same procedures were being consented differently with significant omissions. We designed procedure specific-consent stickers to be used when consenting to address this imbalance and made these stickers available on surgical wards. A re-audit of 50 patients showed increase from 41% to 88% in documentation of material risks. While only 34% of the audited consent forms featured the stickers, those forms that did have the stickers on had 100% material risk documentation. Conclusions We saw an improvement in material risk discussion by implementing procedure-specific consent stickers. This supports the growing need for standardising consent across General Surgery to reduce variability. We will next aim to design laparotomy stickers.


2018 ◽  
pp. 57-77
Author(s):  
Stephen M. Rutherford

This chapter examines the medical challenges posed by the increased number of gunshot wounds during the civil wars, and sets out the changes in the way these wounds were treated. The treatment of battlefield wounds expounded in surgeons’ manuals, is placed in context with what we now understand about the biology, pathology and effective treatment methods for wounds. The techniques used by the civil-war surgeon are compared with those of later periods. Despite a lack of understanding of microbiology, physiology and, in many cases, anatomy, many methods employed by civil-war military surgeons reflect good contemporary surgical practice. Despite the lack of antibiotics, anaesthetics, hygienic environments and high-quality surgical implements, survival rates from injuries on the field arrear to have been considerable, if treated. In developing treatments for the problems posed by gunshot wounds, some civil-war surgeons used an evidence-based approach, and laid the foundations for much modern surgical practice.


2005 ◽  
Vol 23 (34) ◽  
pp. 8802-8811 ◽  
Author(s):  
Simon C. Crawford ◽  
Paul A. Vasey ◽  
Jim Paul ◽  
Andrea Hay ◽  
Jo A. Davis ◽  
...  

Purpose Studies indicate that ovarian cancer patients who have been optimally debulked survive longer. Although chemotherapy has been variable, they have defined standards of care. Additionally, it is suggested that patients from the United Kingdom (UK) have inferior survival compared with some other countries. We explored this within the context of a large, international, prospective, randomized trial of first-line chemotherapy in advanced ovarian cancer (docetaxel-carboplatin v paclitaxel-carboplatin; SCOTROC-1). The Scottish Randomised Trial in Ovarian Cancer surgical study is a prospective observational study examining the impact on progression-free survival (PFS) of cytoreductive surgery and international variations in surgical practice. Patients and Methods One thousand seventy-seven patients were recruited (UK, n = 689; Europe, United States, and Australasia, n = 388). Surgical data were available for 889 patients. These data were analyzed within a Cox model. Results There were three main observations. First, more extensive surgery was performed in non-UK patients, who were more likely to be optimally debulked (≤ 2 cm residual disease) than UK patients (71.3% v 58.4%, respectively; P < .001). Second, optimal debulking was associated with increased PFS mainly for patients with less extensive disease at the outset (test for interaction, P = .003). Third, UK patients with no visible residual disease had a less favorable PFS compared with patients recruited from non-UK centers who were similarly debulked (hazard ratio = 1.85; 95% CI, 1.16 to 2.97; P = .010). This observation seems to be related to surgical practice, primarily lymphadenectomy. Conclusion Increased PFS associated with optimal surgery is limited to patients with less advanced disease, arguing for case selection rather than aggressive debulking in all patients irrespective of disease extent. Lymphadenectomy may have beneficial effects on PFS in optimally debulked patients.


Author(s):  
Mitch Kachun

By 1850 Crispus Attucks began playing a significant role in African Americans’ affirmation of their essential Americanness. Black abolitionists muted his mixed racial background in favor of a fully African American one, and his possible reasons for being part of the Boston mob were left unscrutinized. Attucks emerged as a black patriot and Founder. During and immediately after the Civil War, for African Americans, Attucks remained a symbol of black patriotism and military valor. But some whites began to emphasize his Native American background and to question his status as a hero. And as the nation slowly distanced itself from the Civil War, it became clear that the national interest did not include racial justice for black Americans.


2020 ◽  
pp. 226-231
Author(s):  
V. V. Petkau ◽  
V. V. Breder ◽  
E. N. Bessonova ◽  
K. K. Laktionov ◽  
I. S. Stilidi

On April 27, 2020, COVID-19 pandemic affected more than 2,5 million of people in more than 200 countries and caused 185 000 deaths. Healthcare systems have come under enormous stress. In COVID-19 pandemic oncological patients face two serious challenges: the risk of severe infectious disease course and the risk of malignant tumor progression. Forced correction of existing oncological standards of care is based on expert and professional community opinions, and daily gaining experience. The issue resumes the data on COVID-19 influence on liver function among the patients with chronic liver diseases and hepatocellular carcinoma. The guidance on HCC management in COVID-19 pandemic are provided. More than 1,5 million of people suffers from the liver pathology caused by chronic virus hepatitis, alcohol consumption, nonalcoholic fatty liver disease. Mild COVID-19 is often followed by transient liver function disorder which do not need specific treatment. Severe COVID-19 lids to the increase of aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT), to the decrease of serum albumin in most cases. Regarding the HCC treatment preference should be given to telemedicine, limitation of contacts in health-care facilities, outpatient treatment, including oral medication (tyrosine kinase inhibitors), and if possible delay of invasive procedures with the help of bridge-therapy and active monitoring. Selecting the patients for surgery, ablation or transarterial chemoembolization (TACE) patients with minimal risk of decompensation, with maximum treatment benefit (on the base of prognostic scales), with lack of comorbid should be preferred. Selective and super selective TACE with drug-eluting beads or radioembolization should be used to reduce the risk of immunosuppression and postembolic syndrome. Live organ transplantation should be considered to be postponed. Targeted therapy could be a temporarily alternative to invasive procedures.


Author(s):  
Dmitry V. Khaminov ◽  
◽  
Alexander N. Sorokin ◽  
◽  

The history of higher education, science, and academia in the Asian part of Russia has been extensively covered in historiography. Historians have focused on various aspects of these phenomena in connection with social, cultural, economic, as well as political and ideological processes. In most cases, these processes have been approached from two different perspectives. The first one focuses on the center-periphery relations and entails a comparison of the provincial processes with what was happening in the center of Russia. The second concentrates on regional and local processes, including at the micro level. However, the period of the Revolution of 1917 and the Civil War (1918–1920) in the history of Asiatic Russia is of particular importance for the scientific and educational complex of the region in general and for its social sciences and humanities segment, in particular. The authors’ focus is history. Historical research itself, education, science, and the corporation of historians in the paradigm of that period played the most important structure-forming roles. The political, ideological, and sociocultural implications of historical research (the formation of the historical consciousness, civic and political identity and culture, ideological attitudes, moral values, patriotism) are difficult to overestimate. In the period of uncertainty of the development of both the country as a whole and its Asiatic periphery (when the outcome of the armed confrontation was not obvious to anyone), the role of historians in different spheres of the state and society grows, they become important actors of key processes, epitomized by the so-called “third the role of universities”. The study of these aspects of historians’ activities, the mechanisms of their interaction, the influence on the system of social interactions and other aspects, foregrounds this new trend in historical research. The work is written on the basis of a wide range of historical sources: official documents and materials (laws and regulations on the organization of higher education and science); archival materials (most of them are first introduced into academic discourse) – organizational, administrative records that reflect daily activities of universities and research institutions; materials of regional and local periodicals; sources of personal origin; historiography of the Asiatic periphery. In the course of the study, the authors come to the conclusion that the initiative to develop historical research, academic institutions, strengthen the “third role” of universities and scientific communities was generated both “bottom-up” and “top-down”. Both historians and public legal entities, that is authorities at all levels, benefited in these relations.


2020 ◽  
Author(s):  
Caroline A. Hartzell ◽  
Matthew Hoddie
Keyword(s):  

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