New-York tribune. [volume] (New York [N.Y.]) 1866-1924, 1881-09-23


ihe adjacent tissues. The blood sac behind
the pcritonedm, but the autopsy revealed that 1T
had ruptured into the cavity of the peritoneun,
probably just before the occurrence of DEATH and
at least pint of blood coaguated was found in the
peritoncal cavity. The abscess spoken OF In the
official report of the autopsy not in this region
precisely, but somewhat more to the right between
abe liver and transverse colon. No connection was
discovered between this and the external wouhu
made by the bullet, and there are no means Oh
kno owing whether it communicated with the original
track at some earlier period in the history OF the
case or not 1t may have done so, and become sub
sequently closed or it may have been the result OF
the extension of Inflammation from the original
track 10 the adjacent tissues There was no lesion
of the liver recent ancient, indicated in the
autopsy.
ence of the ball in the situation in which it was
found was not the immediate cause of deaf h. as it
was completely encysted, and must have long since
ceased to cause irritation The small fragments of
bone and the great lesion of the lumbar vertebra
are the pathological facts which alone could en-
danger the patients life. This lesion of the YER
zebra the surgeons had means of repairing, nor
could 1t have been repaired by the processes of
mature. The small fragments of bone Gf they
should prove to be SUCH widely disseminated the
adjacent tissues certainly could not have been re-
moved by any surgical operation. 1t was deter
mined by the autopsy that the necessity did not
exist for removing the ball, or in other words that
had there been no other lesion it might have been
carried for many years without causing death or
even inconvenience. STILL it may be proper 70
inquire whether by surgical operation the bullet
could have been safely removed. If it had been
arrested by the spine or even lodged IN the sub
stance of the spinal column, possibly with bold
and very extensive dissection it might have been
safely reached and extracted. 1t is questionable
however whether the history of surgery furnishes
any example of success under the circumstances
now supposed. But the fact is that the bullet
versed the spine and lodged at point distance
removed from it, passing miraculously through
various vital structures which surround the anterior
and lateral walls of the vertebre.
"The front of the spine in the region traversed and
both of its sides presenting toward the interior OF
the belly are literally covered by important blood
vessels-arteries and veins-the most important
nerves of the body-the sympathetic or ganghonic
system of nerves, also nerves of common sensation
and motion, and by lymphatics including the great
thoracc duct, through which nutrition from
the alimentary canal is conveyed to the heart The
injury of almost any of the foregoing, excepting
the nerves of common sensation and motion, would
inevitably destroy life and i'll the midst of this
pexus of arteries. veins. nerves and ymphatics the
surgeon would have had to carry his knife in search
of a ball the situation of which has only been re-
means of knowing the situation of the ball during
life, as it gave no indications of its presence
could 1t possibly have been reached and recognized
by any form of surgical probe. That death would
have been immediate and the inevitable result of
any such daring adventure is almost absolutely
certain.
However much individually or collectively
may have made ourselves liable to just criticism in
the matter of diagnosis prognosis, and whatever
doubts may be entertained by medical men as to
the propriety of the treatment in certain
respects, / cannot believe that one intelli-
gent surgeon will hereafter think that at
any period in the progress of the case the
ball or the fragments of bone which it sent before
it could have been successfully removed nor H.
deed that any serious attempt in that direction
would not have resulted in speedy death Viewing
the case in the light of our present knowledge, am
prepared to affirm that surgery has resources by
which the fatal result could have been averted.
This the sad consolation which felt justi6edn
given to the grief-stricken wife and family, and
which all my associates believe can give to an
offiicted people,"