Knoxville daily chronicle. [volume] (Knoxville, Tenn.) 1870-1882, 1881-10-04


dark-li red color, both on the surface and
on the section It's porenichyma was soft
and fabby, but contained no abscesses or in
fractions. There were some recent
peritoneal adhesions between the
postererial wall of the stomach
| and posterior abdominal parties. With this
exception no abnormities were discovered In
the stomach or intestines, nor were any
other evidences of general or local periton-
| tits found besides those already specified.
The right kidney weighed six ounces, the
| left kidney seven. Just beneath the cap
sule of the left kidney, at about the middle
of its convex border, there was little ab-
scess, one-third of an inch in diameter.
There were three small serons cysts on the
convex border of the right kidney, just be-
meath it's capsule. In other respects the
| tissue of both kidneys was normal in appear
ance and in texture. The urinary
bladder was empty. Behind the right kid
ney, after the removal of that organ from
| the body the dilated track of the bullet was
dissected into. 1t was found that from the
| point at which it had fractured the right
eleventh rib, three inches and half to the
right of the vertebral spines the missile had
gone to the left obliquely forwards, passing
through the body of the first lumbar verte-
bra and lodging in the adipose connective
tissue, Immediately below the lower border
of the pancreas, about two inches and a
half to the left of the spinal column, and
behind the peritoneum. 1t had become
| completely encysted.
The track of the bullet between the point at
which it had fractured the eleventh rib, and
that at which it entered the first lumbar
yertrebra was considerably dilated, and pus
had burrowed downwards through the ad-
| ipose tissue behind the right kidney, and
| thence had found its way between the per-
itoneum and right lilac fossa, makin5 de-
scending channel, which extended almost to
| the groin. The adipose tissue behind the
kidney in the vicinity of this descending
channel, was mu b thickened and con-
densed by Inflammation. In the
channel, which was found almost
free from pus, lay flexible
catheter, introduced into the wound at the
commencement of the autopsy. Its ex-
tremity was found doubled upon itself i'm
mediately beneath the peritoneum, reposing
upon the lilac, where the channel was dilated
into considerable size. This long descending
channel, now clearly seen to have been
caused by the burrOwing of pus from the
wound, was supposed, during life, to have
been the track of the bullet. The last
dorsal, together with the first and second
lumbar vertebra and twelfth rib, were then
removed from the body for more thorough
examination.
When this examination was made it was
found that the bullet had penetrated the
first lumbar vertebra in the upper part of
the right side of his body. The aperture
by which it entered involved the inter-ver-
tebral cartilage next above, and was severed
just below and anterior to the inter-vertebral
foramen, from which its upper margin was
about e-quarter of an inch distant. Pass
| ing obliquely to the left and forward through
| the upper part of the body of the first ium-
bar yertebra, the bullet emerged by an
| aperture, the center of which
Was about half inch to the left Of the me-
| dian line, and which also involved the inter-
vertebral cartilage next above. The cancel
| lated tissue of the body of the first lumbar
yertebra was very much communited and
the fragments somewhat displaced. Several
| deep assures extended from the track of the
bullet into the lower part of the body of the
twelfth dorsal vertebra. The others
extended through the first lumbar vertebra
into the inter-vertebra cartilage between
it and the second lumbar vertebra.
Both this cartilage and that next above,
were partly destroyed by liberation. A
number of minute fragments from the frac
tured lumbar vertebra had been driven into
the adjacent soft parts. 1t was further
found that the right twelfth rib also was
fractured at point one inch and a quarter
to the right of the transverse process Of the
twelfth dorsal vertebra. This injury had MOI
been recognized during life. On saving
through the vertebra little to the right OF
the median line it was found that tn,
spinal canal was not involved
by the track of the ball. The spinal cord ant
other contents of this portion of the spina
canal presented no abnormal appearances
The rest of the spinal cord was not exam
ined, beyond the first lumbar vertebra
the bullet continued to 60 to the left, pass
ing behind the pancreas to point where i
was found. Here it was enveloped in
firm cyst of connective tissue which con
tanned, besides the ball, minute quantit,
of inspissated somewhat cheesy pus whicl
formed thin layer over a portion of thu
surface of the lead. There was also q blacl
shred, adherent to part of the cyst wall
which proved on O microscopical examina
ton to be the remains of blood clot
For about one inch from this cyst, the tract
of the ball behind the pancreas was com
pletely obliterated by the healing process
Thence as far backward as the body of tn
lumbar vertebra, the track was filed Will
coagulated blood, which extended on tn
left into an irregular space, rent in the ad
joining adipose pressure behind the perito
neum and above the pancreas. Blood hat
worked it's way to the left, bursting tinall.
through the peritoneum behind the spleel
into the abdominal cavity. The rending o
tissue by the extravasation of this blood wa
undoubtedly the cause of the par
oxyisms of pain which occurred a short tim
before death. This mass of coagulatet
blood was of irregular form, and nearly a
large as a mans fist 1t could be distinctl
seen from in front through the peritoneum
after its site behind the greater curvature o
the stomach had been exposed by the dis
section of the greater omentum from tn
stomach, and especially after some delicat'
adhessions between the stomach and part o.
the peritoneum, covering the blood mass ha,
been broken down by the fingers. From
, the relations of the mass as thus seen it wa
believed that the hemorrhage had proceeds
, from one of the messenteric arteries; but
as it was clear that minute dissection
would be required to determine the particu
, lar branch involved, it was agreed that tn
infilterated tissues and adjoining soft part
, should be prepared for subsequent study
On examination and dissection, made in ac
cordance with this agreement, it was fount
that the fatal hemorrhage proceeded iron
q rent, nearly four-tenths of an inch long
. in the main trunk of the spleenic artery, tw,
inches and half to the left of the cecilia
axis. This rent must have occurred at leas
several DAYS before death, since the evertes
edges in the vessel were united b,
firm adhesiOns to the surrounding con
nective tissue, and was forming an almos