The Milan exchange. (Milan, Gibson County, Tenn.) 1874-1978, 1881-10-08

and the liver already mentioned. The abdOm-
inal cavity being now washed out as thor
oughly us possible a fruitlcss attempt was
made to obtain some ind cation OF the posi-
ton of the bullet before making any further
missions. by pushing the intestines aside
the extremity of the catheter, which had
passed into the wound, could be felt between
the peritoneum and the right lilac fascia, Tut
it had evidently doubled upon itself and, al
though prolonged search was made, nothing
could be seen or felt 10 Indicate the pres
encc Of the bullet, either in that region or
elsewhere.
The abdominal viscera were then carefully
removed from the body, placed in suitable
vessels, and examined seriatim, with the fol-
lowing result:
The adhesions between the liver and trans
verse colon proved to bound all abscess cavity
between the under surface of the liver and
the transverse meso-colon, which involved he
Qa.Ebladder and extended to about the same
distance on each side of 1t, measuring six
inches transversely and four inches from be-
fore, backward. This cavity was lined by n
thick pyogeuic membrane, which completely
replaced the capsule Of that part of the under
surface of the liver occupied by the abscess
1t contained about two ounces of greenish-
yellow tiuid-a mixture of pus and hillary
matter This abscess did not involve any por-
ton Of the substance of the liver except the
surface with which it was in contact, and no
communication cOu be detected between 1t
and any part Of the wound.
Some recent peritoneal adhesions existed
between the upper surface of the right lobe
of the liver and the diaphragm. The liver
was larger than normal weighing eighty
four ounces. Its substance was firm, but of Il
pale yellOwish color on its surface and
throughout the interior of the organ, from
fatty degeneration. No evidence that IL had
been penetrated by the bullet could be found,
norwere there there any assesses or infuro-
tons in any part of the tissue.
Inc spleen was connected by diaphragm ad-
hesions. There were several rather deep
congenial assures in its margins, giving it a
lobulated appearance. 1t was abnormally
large, weighing eighteen ounces, of a very
dark lake red color, both on the surface and
on section. Its parenchyma was soft and fab
by, but contained no assesses or nfurctiOns
There were some recent peritoneal auhe-
sons betwe n the posterior wall of the stom-
ach and the posterior abdominal particles.
With this exception no abnormalties were dis
covered in the stomach or intestines nor were
any other evidences of general or local peri
tonitis found besides those already specified
The right kidney weighed six ounces the
left kidney seven. Just beneath the capsule
of the left kidney, at about the middle of its
convex border there was little absccss one
third of an inch in diameter. There were three
small Serious cysts on the convex border of the
right kidney, just beneath its capsule. In
other respects the tissue of both kidneys was
normal in appearance and in texture.
The urinary bladder was empty.
Behind the right kidney, after the removal
of that organ from the body the diated 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 spine the missile
had gone 10 the left obliquely forward, pass
ing through the body of the first lumbar YER
zebra and lodging in the adipose connective
tissue Immediately below the lower border of
the pancreas, about two inches and half to
the left of the spinal column, and behind the
peritoneum. 1t had become completely en-
cysted. The track of the bullet between the
point at which it had fractured the eleventh
rib and that at which it entered the first lum-
bar Yertebra was considerably dilated
and the pus had burrowed downwardS
through the adipose tissue behind
the right kidney, and thence had
| found its way between the peritoneum and
the right lilac fascia, making a descending
channel, which extended almost to the groin.
The adipose tissue behind the kidney, in the
thickeEed and condensed by 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. Its extremity was found doubled
| upon itself, Immediately beneath the perito-
neum, reposing upon the lilac tasCia, where
| the channel was dilated into pouch of con,
| siderable size. This long-desccnding channel
! now clearly seen TO have been caused by the
| burrowing of pus from the wound, was sup
| posed during life to have been the track of the
| bullet.
| The last dorsal, together with the first anC
second lumbar vertebr9 and the twelfth rib
were then removed from the body for more
thorough examination. When this ex
! animation was made it was found
| that the bullet had penetrated the first
| lumbar vcrtCbra in the upper part oil
the right side of its body. The aperture by
which it entered involved the intervertebra
| cartilage next above, and was situated JUS
| below and anterior to the lntervertebra
foramcn, from which its upper margins were
| about one-quarter of an inch distant Passing
obliquely to the left and forward through the
upper part of the body of the first lumbar
| vertCbra, the bullet emerged by an aperture
| the centre of which was about half an incl
TO the left of the medan line, and which alsC
involved the intervertebral cartilage mex
| above the cancellatcd tissue. The body of tn,
| first lumbar vertebra was very much com
mnuted and the fragments somewhat dis
| placed. Several deep assures extended from
| the track of the bullet into the lower part Of
the body of the twelfth dorsal vcrtcbra. 9th
| ers extended through the first lumbar verte
| bra into the intery cartilage between
| 1t and the second lumbar vertcbra. Both thi
| cartilage and that next above were partly de
| stroycd by liberation. A number of minute
| fragments from the fractured lumbar vcrte
! bra mud been driven into the adjacent sof
| pal Is. II was further found That the rgh
| twelfth rib also was fractured at 4 point ont
| inch and quarter to the right of the trans
] nrnnnss Of 10 t.rnLLLr .ln..nL ..nrt 10