Savannah morning news. [volume] (Savannah) 1868-1887, 1881-09-28
A DIAGNOSIS.
DR.. Hamilton Describes the Late
Presidents WOund-The Ball Not
the Cause of Death.


Washington Star.
DR.. Hamilton, in conversation with New
York Tribune reporter, has dictated the fol-
lowing ''The ball entered the inter-yerte-
bral space on the right side, between the
last dorsal and the first lumbar vertebra, at
point very near the transverse and oblique
processes; that is, obliquely from behind.
1t passed little downward and forward,
penetrating the body of the first lumbar
vertebra escaped from the vertebra 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 pam
creas and nearer its posterior or dorsal
aspect than interior, behind the peri
tOneum, and therefore outside the cav
ity or the belly. The ball was
encysted, completely surrounded by firm
capsule, which invested it entirely and
closely, the capsule containing nothing but
the ball. Perhaps grain or two of white
tenacious substance attached to one 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 desiccated pus, or it
may prove to be the leaden stain occasioned
by the oxidation of the surface of the ball.
1t also contained a small fragment of black
Ia length and an eighth of an inch In
breadth, which under the microscope may
prove to be piece of cloth, but the exact
character Of which has not yet been de-
termined.
"Perhaps distant one or two inches, aud In
this neighborhood there could be felt dis
tlDctly under the finger innumerable small
substances, like grains Of sand, of greater
or less magnitude, which have not yet been
submitted to microscopic examination, but
which were supposed to be minute frag-
ments OF bone torn away from the broken
vertebra and thus widely disseminated In
the adjacent tissues. The blood sac was be-
hind the peritoneum, but the autopsy re-
vealed that it had ruptured into the cavity
the occurrence of death, and at
least q pint of blood coagulated was
found in the peritonel cavity. The abscess
spoken of In the official report of the au-
tOpsY was not in this region precisely, but
somewhat more to the right, between the
liver and transverse colon. No connection
was discovered between this and the exter-
nal wound made by the bullet, ard there are
no means of knowing whether 1t communi-
Gated with the original track at some earlier
period in the history of the case or not. It
may have done so, and become subsequently
closed, or it may have been the result of the
extension of Inflammation from the original
track to the adjacent tissues. There was no
lesion OF the liver, recent or ancient, indi-
Gated in the autopsy.
'It is evident from this account that the
presence of the ball in the situation In
which it was found was the immediate
cause of death, as it was completely en-
cysted, and must have long since ceased to
cause irritation. The small fragments of
bone and the great lesion of the lumbar YER
zebra are the pathological facts which alone
OOnld pn6an0ar tho naffaOf5a This
lesion of the vertebr2 the surgeons had no
means OF repairing, nor could it have been
repaired save by the processes of nature.
The small fragments of bone, il they
should prove to be such, widely dis
seminating in the adjacent tissues, Ger
tainly could not have been removed by
any surgical operations. 1t 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 been carried for many years
without causing death, or even incon-
venience. Still, it may be proper to inquire
whether by surgical operation the bullet
could have been safely removed. II 1t had
been arrested by the spine, or even lodged
In the substance of the spinal column, pos.
sibly with bold and very extensive dissec-
tion it might have been safely reached and
extracted. 1t is questionable, however,
whether the history of surgery furnishes
any example of success under the circum-
stances now supposed. But the fact is that
the bullet traversed the spine ard lodged
at point some distance removed from
1T, passing miraculouslY through vari-
Gus vital structures which surround
the anterior and lateral walls of the YER
zebra. The front of the spine in the region
traversed and both of its sides presenting
toward the interior of the belly are literally
GOV red by important blood vessels, arteries
and veins, the most important nerves OF the
body, including the sympathetic or gang
Ionic system of nerves, also the nerves of
common sensation and motion, and by SYM
pathY including the great thoracic duct
through which nutrition from the alimen-
tarY canal is conveyed to the heart. The
injury of almost any one of the foregoing,
excepting the nerves Of common sensation
and motion, would inevitably destroy life,
and In the midst of this plexus of arteries,
veins and lymphatics the surgeon would
have had to carry his knife in search of a
ball, the situation of which has only been
revealed by the autopsy. There were no
possible means of knowing the situation of
the bail during life, as 1t gave no indication
OF is presence; nor could It possibly have
been reached and recognized by any form
of surgical probe. That death would have
been immediate, and the inevitable result
OF any such daring adventure is almost
absolutely certain. However much we, in
dividuallY or collectively, may have made |
ourselves liable to just criticism in the |
matter of diagnosis or prognosis, and what
ever doubts may be entertained by medical
men as to the propriety of the treatment in
certain respects, cannot 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 |
it sent before it could have been success
fully removed. Nor, indeed, that any
serious attempt in the direction would |
not have resulted in speedy death. Viewing |
the case In the light of our present knowl |
edge, am prepared to affirm that surgery
has no resources by which the fatal result |
could have been averted. This was the sad |
consolation which l felt justified in giving |
to the grief-stricken wife and family, and |
which all my associates believe we can give |
to an afflicted people,"