Evening star. [volume] (Washington, D.C.) 1854-1972, 1881-09-24
THE EVENING STAR.
....SEPTEMBER -. 1881.
A nlAGNClSE
DIR. Hamilton Describes the Late Presidents
Wound

Wound
THE BALL NOT TIRE CAUSE OF DEATH
DIR. Hamilton. in conversation with \. Y. T.;-
5'tae reporter. has dictated the following. The
bail entered the ncr-vertebial space on the right
side. between the last dorsal and the first lam
har yeitebra. at a point very near the transverse
ana obllque processes: that is. obliqueiy from
| behind. II passed Little downward AID for
ward. penetrating the body OF the first lumbar
l.vcrtcDra; escaped from the veriebra very near
tue middle in front and Was found little To
the left of the body of the yertebra lying under
| the lower margin of the pancrcas and Nearer
/ MS posterior or dorSal aspect than interior.
/ behind the peritoneum. and therefore
| outside the cavity OF the belly. The hall was
encysted. completely surrounded by firm cap
suie, which invested it entirely and CLOSELY the
| capsule containing nothing bu, the bail Per-
maps grain or two OF white tenacious substance
attached to one point of its inner surface which
was not easily removed 10y the edge OF the knife
| ana which may be found under the microscope
| to consist OF "A drop OF deSicated pus or il MAY
| prove TO be the leaden stain occasioned by the
oxidation of the surface OF the ball II also
contained small fragment Of black mat rjaI
| perhaps three-quaIters of an inch in length ard
an eighth of an inch i'm breadth. which under the
| microscope may prove To be piece of cloth
but the exact character of which has not Vet
/ been determined.
Perhaps distant one or two inches. and in this
neighbOrhood there could be felt distinctly under
J
grains OF sand. of greater or less magnitude
which nave not yet been submitted Ia micro
scOplcal examination. but which were supposed
to he minute fragments of bone torn away from
the broken yertebra and thus widely dissent
mated in the adjacent tissues. The blood sac
was behind the peritoneum. but the autopsy
revealed that it had ruptured into the
cavity OF the peritoneun. probably lust
before the occurrence of death. and at
least pint of blood coagulatcd was
L m fhn snt...t nx-iN.- ,l-
| spoken of in the official report of the autopsy
was not IN this region precisely. but somewhat
more to the right. between the liver and trans
verse colon. No connection was discovered be-
tween this and the external wound made by the
outlet. and there are no means of knowing
whether it communicated with the original
track at some earlier period in the history of the
| case or not. 1t may have done so. aud become
subsequently closed or if may have been the re-
suit of the extension of inflammation from the
original track to the adjacent tissues There
| was no lesion of the liver, recent on ancient in
Dictated in the autopsy.
1t is evident from this account that the pres
ence of the ball in the situation i'm which it was
found was not the Immediate cause of death as
IL was completely encysted and must have long
since ceased to cause irritation. The small tlag-
ments of bone and the great lesion of the lum-
bar vcrtebra are the pathological facts which
| alone could endanger the patients life. This
lesion of the vertebra the surgeons had no means
| save by the processes of nature The small
fragments of bone. if they should prove to be
such. widely disseminating i'm the adjacent
tissues certainly could not have been re-
moved 10y any surgical operation. 1t was de-
termined 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 formany years without
causing death or even Inconvenience. Still. it
may be proper to inquire whether by a surgical
Annr innf hn hr,lg hatra l,n,, f.x
! moved. II it had been arrested by the spine or
even lodged i'm the substance of the spinal col
umn, possibly with a bold and very extensive
dissection it might have been safely reached and
extracted. Ii is questionable however. whether
the history OF surgery furnishes any example of
success under the circumstances now supposed.
But the fact is that the bullet trayersed the
spine and lodged at a point some distance
removed from it. Passing .miraculOusly
through various vital structures which sur
round the anterior and lateral walls of the ver-
zebra. The front of the spine i'm the region
traversed and both of its sides presenting to-
ward the interior of the belly are literally
covered by important blOod-vessels. arteries
and veins the most important nerves of the
body, including the sympathetic or ganglionic
system of nerves. also the nerves of common
sensation and motion. and by sympathy includ-
ing the great thOracc duct through which
nutrition from the alimentary canal is con-
veyed to the heart. The injury of almost
nerves of common sensation and notion
would inevitably destroy life, and in the midst
OF this pleXus of arteries, veins and lym-
phatics the surgeon would have had to carry
his knife in search of ball. the situation of
which has only been revealed by the autopsy
There were no possible means of knowing the
situation of the ball during life. as it gave no
indication of it's presence; nor could it possi-
bly, 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 Ger
tain. However much We, individually or col
lectively, may have made ourselves liable to
just criticism in the matter of diagnosis or
prOgn0sis. and whatever doubts may be en-
tertained by medical men as to the pro-
priety of the treatment i'm 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 frag-
ments of the bone which it sent before it could
have been successfully removed. Nor, indeed.
that any serious attempt in the direction would
not have resulted in speedy death. Viewing the
case i'm the light of our present knowledge, / am
prepared to affirm that surgery has no resources
by which the fatal result could have been averted.
This was the sad consolation which felt justified
in giving to the grief-stricken wife and family
and which all my associates believe We can give
to an afflicted DeODle i"