Trauma Surgery - History

History

Dr. George E. Goodfellow is credited as the United States' first civilian trauma surgeon. He opened a medical practice in the silver boom town of Tombstone, Arizona Territory in November 1880 where he practiced for the next 11 years.

On July 4, 1881, two days after U.S. President Garfield was shot in the abdomen by Charles J. Guiteau, a miner outside Tombstone was shot in the abdomen. On July 13, 1881, Goodfellow performed the first recorded laparotomy to treat the miner's gunshot wound. The man had a perforated small intestine, large intestine and bowel. Goodfellow sutured six holes in the man's organs. Similarly, President Garfield was thought later to have a bullet possibly lodged near his liver but it could not be found. Sixteen doctors attended to Garfield and most probed the wound with their fingers or dirty instruments. Unlike the President, the miner survived.

Goodfellow treated a number of notorious outlaw Cowboys in Tombstone, Arizona during the 1880s, including Curly Bill Brocius. During the Gunfight at the O.K. Corral on October 26, 1881, Deputy U.S. Marshal Virgil Earp his brother Assistant Deputy U.S. Marshal Morgan Earp were both seriously wounded. Goodfellow treated both men's injuries. Goodfellow treated Virgil Earp again two months later on December 28, 1881 after he was ambushed, removing 3 inches (76 mm) of bone from his humerus and attended to Morgan Earp on March 18, 1882, when he was shot while playing a round of billiards at the Campbell & Hatch Billiard Parlor. Morgan died of his wounds.

Goodfellow once traveled to Bisbee, 30 miles (48 km) from Tombstone, to treat an abdominal gunshot wound. He operated on the patient stretched out a billiard table. Goodfellow removed a .45-calibre bullet, washed out the cavity with hot water, folded the intestines back into position, stitched the wound closed with silk thread, and ordered the patient to take to a hard bed for recovery. He wrote about the operation: "I was entirely alone having no skilled assistant of any sort, therefore was compelled to depend for aid upon willing friends who were present—these consisting mostly of hard-handed miners just from their work on account of the fight. The anesthetic was administered by a barber, lamps held, hot water brought and other assistance rendered by others."

Goodfellow pioneered the use of sterile techniques in treat gunshot wounds, washing the patient's wound and his hands with lye soap or whisky. He became America's leading authority on gunshot wounds and was widely recognized for his skill as a surgeon.

By the late 1950s, mandatory laparotomy had become the standard of care for managing patients with abdominal penetrating trauma. A laparotomy is still the standard procedure for treating abdominal gunshot wounds today.