American citizen. [volume] (Canton, Miss.) 1864-1890, 1881-10-15

| ton Of the substance of the liver except the
| surface with winch it was in contact, and no
communication could be detected between IL
| and any part CT the wound.
Some recent peritoncal adhesions existed
| between the upper surface of the right lobo
Of the liver and the diaphragm The liver
| was larger than normal, weighing eighty
| -FOUR otinces. Its substance was iirrh but of q
| pale, yel,owish color on, its surface ami
| througho out the interiof Of the organ, from
| fatty degeneration. No evidence that it had
| been penetrated by the bullet could be found,
nor were there there any abscesses or infurc-
| tons in any part of the tissue.
The spleen was connected by diaphragm adj
| hesfous. There were several rather deep
congenial assures in its margins, giving it a
| lobulated appearance. 1t was abnormally
| large, weighing eighteen ounces, of very
dark lake red color, both on the surface and
on section. Its parencbyma was soft and fab
BY but contained no Assesses or infurctions.
There were some recent Ieritoneal arhe-
eions betwe the posterior wall of the stoul-
ach and the posterior abdominal particles.
With this except ion no abnormalties were dis
| covered in the stomach or intestines, nor were
any other evidences of gene. al or local peri
tonitis found besides those already specified.
| The fight kidney weighed six ounces; the
| teft kidney seven: JUST beneath the capsule
| of the left kidney, at about the middle Of its
convex border, there was little nbsccss one
third of an inch in .ameter. 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 b!add n was empty.
behind the right kidney. 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 n half
to the right of the tertebrl spine, the missile
| had gone 10 the left obliguely forward, passs
| ing Through the bHdy Of the fist lumbar ver-
zebra and lodging in the adippse 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 linn-
bar veriebra was cons .derably dlated
and the pus had burrowed downwards
through the adipose tissue behind
found its way between the peritoneum and
the right iiiac fascia making a descending
channel, which extended almost to the groin.
The adipose tissue behind the kidney, in the
vicinity of his descending channel, was much
| thicker ed and condensed by Inflammation. In
the channel, which found almost free
from pus, lay the flexible catheter, introduced
into the wound at the commencement OF tho
autopsy. Its extremity was found Dubbed
upon itself Immediately beneath the per.to-
neum. reposing upon the lilac fascia, where
the channel was diIated into a pouch of con-
siderable size This understanding 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 vertebre and the twelfth rib,
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 1t entered involved the intcrvertebral
cartilage next above, and was situated just
below and anterior to the intervertcbrai
fpramen, from which its upper margins were
shout one-quarter of an inch distant. Passing
oblfqueIy to the left and forward through the
upper part of the body of the first lumbar
vcrtebra, 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 intcrvertebral cartilage next
above the cancellatcd tissue. The body Of the
first lumbar vertcbra was very much COM
minuted, and the fragments somewhat DIS
placed. Several deep assures extended from
the track of the bullet into the lower art of
the body of the twelfth dorsal vertcbra. 9th
bra into the intervcrtcbral cartilage between
1t and the second lumbar vertcbrl. Beth this
cartilage and that next above were partly do
stroycd by liberation. number of minute
fragments from tho fractured lumbar vcrtc-
bro had been driven into the adjacent soft
pants. II was further found that the right
twelfth rib also was fractured at II point one
inch and n quarter to the riRhfee'vhc trans
verse process OF thc twelfth dorsal vert cbrn.
This Injury had not been recognized during
life.
On saving through the vertebra a little to
the right of the median line, it was found
that the spinal column was not involved by
the track of the bullet. The spinal cord and
other contents OF this portion of the spinal
canal presented no abnormal appearances.
The rest of the spinal cord was not examined.
Beyond the first lumbar vertebra the buliet
continued to go to the left, passing behind the
pancreas to the point where it was found.
Here it was enveloped in firm cyst of con-
nective tissue, which contained, besides the
ball. minute quantity of inspissated, some
what cheesy pus, which formed q thin layer
over a portion Of the surface of the lead
There was also black shred adhering to a
part of the cyst wall which proved. on micro
scopic examination, to be the remains of q
blood clot. For about an inch from this cyst,
the track OF the ball behind the
pancreas was completely obliterated by
the healing process. Thence, as far back
ward as the body of the first lumbar
vertebra, the track was filled with coagulated
blood. which extended on the left into a regu-
lar space rent in the adjoining adipos. tissue.
Behind the pertoneum and above the pam
creas the blood had worked its way to the left,
burrowing finally through the peritoneum be-
hind the spleen into the abdominal cavity.
The rendnR of the tissues by the extravasa-
ton of this blood was undoubtedly the cause
of the paroxysms of pain which occurred a
short time before death This mass of coagu-
lated blood was Of irregular form. and nearly
rs large as a mans fist. 1t could be distinctly
seen from in front, through the peritoneum,
after its site behind the greater curvature of
the stomach had been exposed by the disco
ton of the greater omentum from the stOm-
ach, and especially after some delicate adj
hesions between the stomach and part of the
peritoneum covering the blood-mass had been
broken down by the fingers.
From the relations of the mass, as thus seen,
It was believed that the hemerrha9e had
proceeded from one of the mesenteric arte.
ries, but, as it was clear that a minute disco
ton would be required to determine the par
ticular branch involved. it was agreed that
the infiltrated tissues and adjoining soft parts
should be preserved for subsequent study.
On examination and dissection made in ac-
cOrdance with this agreement. it was found
that the fatal hcmorrhage proceeded from a
rent nearly four-tenths of an inch long in the
main trunk Of the splenic artery, two inches
and half to the left of the cueiac axis The
rent must have occurred at least several days
before death, since the everted edges in the
slit In the vessel were united by firm adhesion
to the surrounding connective tissue, thus
forming an almost continuous wall, bounding
the adjoining portion of the blood cot. More
over, the peripheral portion of the cIot in this
vicinity was disposed in pretty firm concentric
layers.
1t was further found that the cyst below the