Medical contribution

Thesis on abdominal wounds

Goodfellow was the first physician known to operate successfully on abdominal gunshot wounds, which had been previously considered an all-but-certain death sentence. During his career, he published 13 articles about abdominal bullet wounds based on treatments and techniques he developed while practicing medicine in Tombstone.

His articles were laced with colorful commentary describing his medical practice in the primitive west. He wrote, "In the spring of 1881 I was a few feet distant from a couple of individuals [Luke Short and Charlie Storms] who were quarreling. They began shooting. The first shot took effect, as was afterward ascertained, in the left breast of one of them, who, after being shot, and while staggering back some 12 feet, cocked and fired his pistol twice, his second shot going into the air, for by that time he was on his back."

He included a description of the bullet wounds he most often treated: "The.44 and.45 caliber Colt revolver,.45-60 and.44-40 Winchester rifles and carbines were the toys with which our festive or obstreperous citizens delight themselves." The.45-caliber Colt Peacemaker round contained 40 grains of black powder that shot a thumb-sized, 250-grain slug at the relatively slow velocity of 910 feet per second. But the large bullet could smash through a 3.75-inch-thick (9.5 cm) pine board at 50 yards (46 m). Goodfellow saw the effect of these large-caliber weapons up close and was very familiar with their powerful impact. In an article titled "Cases of Gunshot Wound of the Abdomen Treated by Operation" in the Southern California Practitioner of 1889 he wrote, "the maxim is, shoot for the guts; knowing death is certain, yet sufficiently lingering and agonizing to afford a plenary sense of gratification to the victor in the contest." His article described five patients with penetrating abdominal wounds, four of whom survived, and the laparotomies he completed on all of them. He wrote, "it is inexcusable and criminal to neglect to operate upon a case of gunshot wound in the abdominal cavity."

Goodfellow learned that the caliber of the bullet determined whether a medical procedure was needed. If the bullet was.32-caliber or larger, it "inflicted enough damage to necessitate immediate operation." He noted, "Given a gunshot wound of the abdominal cavity with one of the above caliber balls [.44 and.45], if the cavity be not opened within an hour, the patient by reason of hemorrhage is beyond any chance of recovery.”^] W.W. Whitmore wrote in an October 9, 1932, article in the Arizona Daily Star that Goodfellow "presumably had a greater practice in gunshot wounds of the abdomen than any other man in civil life in the country."

 

Conceived of bulletproof fabrics

On February 25, 1881, faro dealer Luke Short and professional gambler and gunfighter Charlie Storms got into an argument in Tombstone. Storms had successfully defended himself several times with his pistol, but had inaccurately sized Short up as someone he could "slap in the face without expecting a return." Bat Masterson initially defused a confrontation between the two men, but Storms returned, yanked Short off the sidewalk, and pulled his cut-off Colt.45 pistol. Luke Short was quicker and pulled his own pistol, shooting Charlie Storms twice before he hit the ground. The first shot was from such close range it reportedly set fire to Storms' shirt. Short's actions were ruled self-defense.

In an autopsy of Storms' body, Goodfellow found that he had been shot in the heart but was surprised to see "not a drop of blood" exiting the wound, and noted that the bullet that struck Storms would ordinarily have passed through the body. He discovered that the bullet had ripped through the man's clothes and into a folded silk handkerchief in his breast pocket. He extracted the intact bullet from the wound and found two thicknesses of silk wrapped around it and two tears where it had struck the vertebral column. Goodfellow showed the slightly flattened.45-caliber bullet and bloody handkerchief to George Parsons.

Another case that attracted his attention was an incident when Assistant City Marshal Billy Breakenridge shot Billy Grounds from 30 feet (9.1 m) with a shotgun, killing him. Goodfellow examined Billy and found that two buckshot grains had penetrated Billy's thick Mexican felt hat band, which was embroidered with silver wire. These two buckshot and two others penetrated his head and flattened against the posterior wall of the skull, and others penetrated the face and chest. He also noted that one of the grains had passed through two heavy wool shirts and a blanket-lined canvas coat and vest before coming to rest deep in his chest. But Goodfellow was fascinated to find, in the folds of a Chinese silk handkerchief around Grounds' neck, two shotgun pellets but no holes. The Tombstone Epitaph reported, "A silken armor may be the next invention."

In a third instance, he described a man who had been shot through the right side of the neck, narrowly missing his carotid artery. A portion of the man's silk neckerchief had been carried into the wound by the bullet, preventing a more serious injury, but the scarf was undamaged.^[11] To Goodfellow, the remarkable protection offered by the silk was plainly evident from these examples, with the second case of the buckshot perhaps best illustrating the protection afforded by silk. In 1887, Goodfellow documented these cases in an article titled "Notes on the Impenetrability of Silk to Bullets" for the Southern California Practitioner. He experimented with designs for bullet-resistant clothing made of multiple layers of silk. By 1900, gangsters were wearing $800 silk vests to protect themselves. In 2018, the US military began conducting research into the feasibility of using artificial silk as body armor.

OTHER MEDICAL FIRSTS

Goodfellow was an innovative physician who was forced to experiment with differing methods than those utilized by physicians in more civilized eastern practices. He pioneered the idea of treating tuberculosis patients by exposing them to Arizona's dry climate. Along with performing the first laparotomy, Goodfellow recorded several other surgical firsts, including performing the first appendectomy in the Arizona Territory. During 1891 at St. Mary’s Hospital in Tucson, he performed what many consider to be the first perineal prostatectomy, an operation he developed to treat bladder problems by removing the enlarged prostate. He traveled extensively across the United States over the next decade, training other physicians to perform the procedure. Among these was Dr. Hugh Young, a well-known and respected urology professor at Johns Hopkins University. Goodfellow completed 78 operations and only two patients died, a remarkable level of success for the time period. He was among the first surgeons anywhere, let alone on the frontier of the United States, to implement the use of spinal anesthesia, which he improvised by crushing cocaine crystals in spinal fluid and re-injecting the mixture into the patient's spine.

 

DEATH

Goodfellow fell ill in the summer of 1910 with an illness which he had reportedly been exposed to during the Spanish–American War. He sought treatment from his sister Mary's husband, Dr. Charles W. Fish, in Los Angeles. Over the next six months his health gradually declined, and soon a nervous disorder prevented him from performing surgery. He was hospitalized for several weeks at the end of 1910 at Angelus Hospital in Los Angeles.

Goodfellow declared he did not want to live any longer and on December 7, 1910, he died. His brother-in-law gave his cause of death as "multiple neuritis".His obituary attributed his death to a nervous breakdown. However, a local urologist and others thought alcoholism may have played a role in his death. Goodfellow was buried in the Angelus-Rosedale Cemetery in Los Angeles.

  LEGACY

Goodfellow is credited as the United States' first civilian trauma surgeon.^[86] His pioneering work in the treatment of abdominal wounds, specifically those caused by gunshots, as well as his recognition of the significance of sterile technique at a time when much of the medical establishment had not yet accepted it as a surgical necessity, has contributed to his modern image as a physician well ahead of his time. Decades after his death, by the late 1950s, mandatory laparotomy had become and remains the standard of care for managing patients with abdominal penetrating trauma. To recognize financial supporters, the University of Arizona School of Medicine established the George E. Goodfellow Society.

 

  

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