St. Landry democrat., 1881-10-15

Ill. omentum was not adherent to the mites
tines, which we're moderately distended witt
| ras No intestinal adhesions were TO. nd 9th
| or than those between the transv" rse color
| and the liver already mentioned The abdom
inal cavity being now washed out as thor
ouphly as possible, a frutless attempt was
made to obtain some ind cation of the posi-
| ton of the bullet before max ing 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, but
it had evidently doubled upon itself, and, al
| though prolonged search was made, nothing
could be seen or felt to indicate the pres
ence Of the bullet, either in that region OF
| elsewhere.
| The abdominal vscera were then carefully
removed from the body. placed in suitable
vessels and examined seriatim, with the fol
| lowing result:
The adhesiops between the liver and trans
verse colon proved to bound an abscess cavity
! between the under surface of the liver and
| the transverse meso-colon, which involved he
| palI-bladder and extended to about the same
| distance on each side Of it, measuring six
inches transversely and four inches from be.
fore. backward. This cavity was lined by a
thick pyogenic 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 huid-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 it
and any part CT 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
pale, yellowish color on its surface and
throughout the interior Of the organ, from
fatty degeneration. No evidence that it had
been penetrated by the bullet could be found,
nor were there there any assesses or infurc-
lions in any part OF the tiss ue
The spleen was connected by diaphragm ad-
hesions. There were several rather deep
congenial assures in its margins, giving it
lobulated appearance. 1t was abnormally
large, weighing eighteen ounces, of very
dark lake red color, both on the surface and
on section. Its parenchyma was soft and fab
by, but contained no assesses or infurctions.
There were some recent Feritoneal auhe-
sions betwe Il the posterior wall of the stom-
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 a little abscess 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 TO the left obligueIy forward, pass
ing through the body of the first lumbar ver-
zebra 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 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-
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 descending
channel, which extended almost to the groin.
The adpose tissue behind the kidney, in the
vicinity of this descending channel, was much
thlckened 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-
neun rePosing upon the lilac fascia, where
the channel was dilated into pouch OF con-
siderable size. This long-descending 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 and
second lumbar vertebrse 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 vertebra in the upper part of
the right side of its body. The aperture by
which it entered involved the intervertebral
cartilage next above, and was situated just
below and anterior to the intervertebral
foramen, from which its upper margins were
about one-quarter of an inch distant. Passing
obllquely to the left and forward through the
upper part of the body of the first lumbar
vertebra, the bullet emerged by an aperture,
the centre of which was about half an inch
to the left of the median line. and which also
involved the interyertebral cartilage next
above the cancellated tissue. The body of the
first lumbar vertebra was very much COM
minuted, 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 vertebra. 9th
ers extended through the first lumbar verte-
bra into the international cartilage between
1t and the second lumbar vertebra Both this
CARTHAGE and that next above were partly de-
stroyed by liberation. A number of minute
fragments from the fractured lumbar verte-
bra mad been driven iOfo tho adiaoopt caff