, 1881-10-02

wen-organized. and probably. DID,
: IA foot-uote here says: These adhes,on,
and the firm ones on the right side, as well =.
those Of the spleen, possibly date back to an a.,
tack Of chronic dysentery, from which tha DID,
:ient Is said to have suffered during the CIrf
War. On the right side there were few sni..
adhesions and Il number Of more delicate and
probably rcceat oues.1
i mAss OF black, coagt1lated blood covered
and concealed the spleen and the left margin n
the greater omcntum. -
On raising this omenttitn it was found that th5.
blood mass extended thro19h the laft iusab,,
and lilac regions, and dropped down Into ,he
peiris. in which there was some clotted bloo1
and rather more thun pint Of bloody tuid
| Ii foot-note here: says: ~ lArEe part OF th{s
fluid had probably trunsudcd from the injection
| material Of tho etnbalmers.'
| The blood cougula, having been turned cut
| and collected. measured very nearly pint
| It WAS now evident that secouary henorrhac,
had bcGn~ tho immediate cause Of deutb, bur
the point from which tho blood had ESCAPED
was not at once apparent.
Tho otneuturn wA5 NOT adherenr to the intes.
tines, which were moderately dlstended With
| gas.
No Intestinal adhesions were found otbe,
than those between the transverse colon and
the liver already mentioned.
The abdominal cavity being now washed out
as thoroughly us possible, fruitless attempt
wus made to obtain sumo Indication OF the pod.
tion Of the bullet before making any further In
! cisionS.
By pushing the intestiucs aside, the extremity
| OF tho catheter, which bad passed into the
| wound, could he felt between the perironeum
! and the right lilac fascin, hut it had evidently
doubled upon itself, and, although PROLONGED
| search WAS made. nothing could be seen or fek
to Indicate tho presence OF the bullet, either in
that region or cl5ewherr-
The abdominal visccra were then carefully
removed from the body, placed In suitable vcs-
sels, and examined seriatlul, with the following
result:
The adhe=ion5 between the live- and trans
verse colOn proved to bUunu an nb3ce$5 cavity
between tho under surface Of the liver and the
transverse 1nesn- colon, which Invoked tho gall
bladder and extended to about tue same distance
on cach side OF it, measuring six inches trans
ycrsey and four inches from before bacAWa I'd.
This cavity WAS lined bv 4 thick pyogeulc men,
brane, which completely replaced the capsule
OF that pnct of the under surface Of the liver
cuped BY the abiceas+ 1t contained about twu
OUNCES OF .recnish- yellow tlud-a mixture Of
2us und hillary NATTER This ahscess did not
involve any portion OF the substance Of tho
liver except tho surfuce with which 1t was in
contact, and no communication could be detect
ed between 1t und uny part Of the wound.
Some recent pcritOneAl adhe5lons existed he
tween the upper surface OF the right lobe Of the
liver nnd the diaphragm. The liver was larger
than normal, weighing ei.hsy-four ounces Its
substance was tirm, but Of pale ye!lowfsh color i
OIL its surface and throughout the interior OK
the organ, from fatty de9eueFariou- No eri-
dencc that 1t had beon penetrated by the bullet !;
could be found, nor were there any absce5ses Of
infnrctiuEs iit any part Of its tissue. L
The spleen WAS connected By diaphra GIN ad- !
hcsUns- . (
There were several rather deep conEennl :
hssures Ia It's margins, giving It lobulated ap-
pearancc. It WIS abuoruuly large, Weighing !:
eighteen ounces, OF II very dark lake rel color, "
both on the surface and On section. Its !.
parenchyma was soft and flabby, but contained !:
no absc:sses or infurctions. !:
There were some recent peritoneal adhesioos :
between the posterior wall OF the stomach and !:
the posterior abdominal pureties. )
WIKI this exception, abnnr1nalties were !:
discovered III the stomach or 1utIsttnes. nor ::
were any other evidences OF general or local ::
pcritonitis found besides those already specified.
The right kidney weighed six ounces; the left !
kidney seven. :
jus, beneath tho capsule of the left kidney, !.
Mt about the middle Of its convex bortIer. shera 7:
little abscess one third Of an iueh in diam
cter.
convex border OF the right kidney, Just beneath !:
its capsule. ~-' !:
In erresrects tho tissue Of both kiaueys !:
was normal in appearance und i'll texture !:
Tho urinary bladder .ras empty, 4
Behind the right kidney, after the removal OF !:
that organ frum the body. the di;ated track Of 7:
the bullet was ulssectcl into. 1t was found that F
from the point ut which 1t had fractured the !.
right eleventh rib three inches aud a bait to
the right Of the vertebrui spine} the missile +
hnd gone to tho left obiquey forward, -
passing thrnugh tho body Of tho first .
lumbar vcrtehra. and lodging In the adipose
connective tissue Immediately below the lower
border Of the pAncrcas, about two inches and a
half to the left Of the spinal column, md behind
the pcrtoncuttl. r
tbnd become completely cncystcd-
The track Of tho bullet between the point at
which it had fractured the eleventh rib aud
that at which it entered tho first Iumbur yer1o-
bra wis considerably tillatcd. and the pus had
burrowe'l downwards through the adipose tts-
sue behind the right kidney, and thence had
fonuu its way between the rertoneutn and the
right lilac fascin. making descending channel
which extended almost to the groin.
The adspose tissue behind the kidney, Ia the
vicinity Of this ascending channel, WAS much :
ind condensed bv Inflammation.
In the channel, which was found almost free
from pus, lay the flexible catheter: introduced
into the wound at the commencement Of the
autopsy. Ii extremity was found doubled upon
itself, Immediately beneath the perit 'ncum. re-
posing upon the lilac fascia, wher9 the chanacl !
vas dilatcd into pouch Of considerable site.
This Notwithstanding chaunel, now clearly s'en
20 have been caused b. the burrowtng OF pus
from the wound, was supposed during life to
lave been the truck Of the bullet
The last dorsal, together with the first and sec
3nd lumbar rertebr;c and the tn elfIh rib, we're +
:hen removed from the body for moro thorough
When this examination was made 1t was found j
hat the bullet had penetrated the first lumbar 7.
'ertcbra in rhe upper part of the right side Of !
Is body The aperture BY which it entered in- !,
'o1ved the intcrvcrtebra cartilage next above.
md was situated just below and anterior to tho :
forane1a, from which its upper )
margins wore about one-q quarter OF au inch dis
ant.
Passing obliquely to the left and forward !
hroteh the upper part Of the body Of the first
lumbar yertebrn, the bullet emerged by an
perture, the centre Of which was about bait an
nch to the left Of the 1nedtan line, and which
lso inEo.ved the fnter-vertebra1 cartilage next
bove the cance!lated TISSUE The body OF the
'rst lumbar vertchra was very much COM