The Middlebury register. [volume] (Middlebury, Vt.) 1850-1882, 1881-09-30
DR.. Hamilton's Statement.

luinohr VerteDra, at a point very neat
tho transverse and oblique processes
that is, obliquely from behind. IL pas.
scd little downward and forward
penetrating the body of the first lum.
bar vertebra; escaped from the verte.
bra very near the middle in front, and
was found a little to the left of the
body OF the vertebra, lying under the
lower margin Of the pancreas, and
nearer its posterior OF dorsal ASPECT
than its anterior, behind the peritone.
um, and outside of the belly. The ball
was encysted, completely surrounded
by "a firm capsule, which invested Il
entirely and closely, tho capsule con.
tanning nothing but the ball. Perhaps
q grain or two of white tenacious sub.
stance attached to the point of its inner
surface, which was not easily removed
by the edge of the knife, and which
may be found under the microscope to
consist of drop of dessicated pus, OF
it may prove 10 be the leaden stain oc.
casioned by tho oxidation of the sur.
face of the ball. It also contained a
small fragment of black matter, per.
haps three-quarters of an inch in
length and an eighth of an inch in
breadth, which under microscope
may prove to be q piece of cloth, The
exact character of which has not vel
been determined. A most critical OK.
animation of this sac under q strong
light and with probe did not disclose
any connection between it and the
track of the ball. Not far removed
from the seat of the ball was the blood
cavity, perhaps distant one or two in.
ches, and in this neighborhood there
could be felt distinctly under the finger
innumerable small substances ike
grains of sand, of greater or less mag
nitude, which have not yet been sub
mittcd to microscopical examination,
but which were supposed to be minute
fragments of bone torn away from the
broken vertebra and thus widely dis
seminated in the adjacent tissues. The
blood sac was behind the peritoneum,
but the autopsy revealed that it had
ruptured into the cavity of the perito.
neum, probably just before the occur
renee of death, and at least a pint of
blood coagulated was found in the peri
toneal cavity The abscess spoken of in
the official report of the autopsy was
not in this region precisely, but some-
what more to the right, between the
| liver and the transverse colon, No
connection was discovered between
this and the external wound made by
the bullet, and there are no means OF
knowing whether it communicated
with the original track at some earlier
period in the case or not. 1t may have
done so and become subsequently clos.
ed, or it may have been tho result OF
the extension.of inflammation from the
original track to the adjacent tissues
There was no lesion of the liver, re.
cent or ancient, indicated in the autop
sy.
1t was evident from this account thai
the presence of the ball i'm the situation
in which 1t was found, was not the
completely encysted, and must have
long since ceased to cause irritation
The small fragments of bone and tho
great lesion OF the lumbar vertebra arc
the pathological facts which alone
could endanger the patients life, Thii
lesion of the vertebra tho surgeons hat
no means Of repairing, nor could /
have been repaired save by the process
ses of nature. The small fragments O
bone Gf they should prove to be such,
widely disseminated in the adjacen
tissues, certainly could not have beer
removed by any surgical operation. /
was determined by the autopsy that the
necessity did not exist for removing the
ball, or, in other words, that had there
been no other lesion It might have beer
carried for many years without causing
death or any Inconvenience. Still, il
may be proper to inquire whether by O
have been safely removed. If it had
been arrested by the spine, or even
lodged in the substance of the spinal
column, possibly, with bold and very
extensive dissection, it might have
been reached and extracted. II is
questionable, however, whether the
history of surgery furnishes any exam
pie of success under the circumstances
now supposed; but the fact is that the
bullet traversed the spine and lodged
at point some distance removed from
it, passing miraculously through vari-
GUS vital structures which surround
the anterior and lateral walls.
The front of the spine in the region
traversed, and both of its sides present
ing towards the interior of the belly,
are literally covered by important
blood vessels, arteries and veins, the
most important nerves of the body, in.
Guiding the sympathetic and ganglionic
system of nerves, also nerves Of COM
mon sensation and motion, and by alb
sorbents, including the great thoracic,
through which nutrition from tho ali.
mentary canal is conveyed to the heart.
The injury of almost any one of the
foregoing, excepting the nerves of COM
mon sensation and motion, would In.
evitably destroy life, and in the midst
of this plexns of arteries, veins and
lymphatics the surgeon would have to
carry his knife in search of ball, the
situation OF which has only been re.
vealed by the autopsy. There were no
possible means OF knowing the situa-
ton of the ball during life, as it gave
no indications of it's presence, nor could
it possibly have been reached and rec.
ognized by any form Of surgical probe.
That death wonld have been immediate
and the inevitable result of any such!dar-
ing adventure is almost absolutely GER
tain. However much we, individually
or collectively, may have made our
selves liable to just criticism in the
matter of diagnosis or prognosis, and
whatever doubts may be entertained
by medical men as to the propriety of
the treatment in certain respects, can.
not believe that one intelligent surgeon
will hereafter think that at any period
in the progress of the case the ball, or
the fragments of the bone which il sent
before 1t, could have been successfully
removed; nor, indeed, that any serious
attempt in that direction would not
have resulted in speedy death. View
ing the case in the light of our present
knowledge, am prepared to affirm
that surgery has no resources by which
the fatal result could have been avert
ed. This was the sad consolation
which / felt justified In giving to the
chief ot,;okou .xtco - r..Ie,I. "a