Savannah morning news. [volume] (Savannah) 1868-1887, 1881-09-30
ESTABLISHED 1850.


tebree, driving number of small fragments
OF bone into the adjacent soft parts and
lodging below the pancreas, about two
inches and half to the left of the
spine and behind the peritoneum, where
1t had become completely encysted
The immediate cause of death was second
ary hemorrhage, from one of the mesen-
teric arteries adjoining the track of the ball.
the blood Tupturtng the peritoneum and
| nearly pint escaping into the abdomi-
nal cavity. This hemorrhage is believed to
have been the cause of the severe pain in
the lower part of the chest complained of
! just before death. An abscess cavity, six
inches by four In dimension, was found in
the vicinity of the gall bladder, between the
liver and the transverse colon, which was
strongly adherent. 1t did not involve the
substance of the liver, and no communica-
tion was found between 1t and the wound.
| long suppurating channel extended
from the external wound, between
the loin muscles and the right kid
ney, almost to the right groin. This
channel, now known to be due to the bur
rowing Of pus from the wound, was sup
! posed during life to have been the track
| Of the ball. On an examination of the
organs Of the chest evidences of severe
bronchitis were found on both sides, with
broncho-pneumonia of the lower portion of
the right lung, and, though to a much less
no assesses and the heart no clots. The
| liver was enlarged and fatty, but free from
| assesses. Nor were any found in any
other organ except the left kidney, which
contained near its surface small abscess
about one-third of an inch in diameter.
In reviewing the history Of the case in con-
nection with the autopsy 1t is quite evident
that the different suppurating surfaces, and
especially the fractured, spongy tissue of
the vertebra, furnish a sufficient explana-
tion Of the septic condition which existed"
NO ABsCEssEs IN THE LUNGS.
1t may be necessary, however, to repeat,
inasmuch as contrary statements have been
made, that the lungs contained not even
the most minute abscess, and that there
was no .metastatic abscess found in any OF
the structures examined, except one less
than half inch In diameter near the surface
of the left kidney. There were three small
serious cysts under the peritoneal covering
on the convex edge Of the right kidney,
each about the size of a vertical section Of
large pea. The abscess found between
the tranverse colon and the liver was evil
IDENTIFY not metastatic, but probably caused
by the original injury. There was no cicatrix
nor wound Of the liver, nor anything to indi-
cate that 1t had suffered injury in the slight
est degree.
Since it has been thought by some that 1t
was the duty of the surgeons to have ascer-
tanned positively the course and location of
the ball, 1t is proper to consider whether
either the one or the other were practicable.
AS to determining the course Of the ball
by probe, every anatomist will see that it
was impossible-if he will consider the verv
tOrtuous course which the ball must have
taken to reach its final destination; that it
passed through the solid structure of the
vertebra, and that no metallic instrument
sufficiently firm to give indications of the
course and direction which 1t took within
the body could ever have reached
the ball nor would any surgeon
of experience, familiar with gunshot
wounds of the belly, in the absence of any
satisfactory or conclusive evidence as to
what course the ball had taken, venture to
introduce probe into the abdominal cavity
for the purpose OF exploring the supposed
track; nor, indeed, If he had evidence as to
the course and situation of the ball could he
have been justified In such an exploration.
No point is better settled In surgery than
that interference of this sort In gunshot
wounds of the belly is meddlesome, useless
and dangerous, and had it been done and a
fatal peritonitis in consequence been set up
the surgeon doing it would have been Justly
held responsible for the fatal result.
AS TO THE EXTRACTION OF THE BALL.
AS to the possibility of the extraction of
the ball safely, it would have required
large documentary and muscular incision as
q means of approach to the spinal column;
the actual removal Of the whole of the
twelfth lumbar vertebra In order to furnish
a sufficient channel through which the bold
surgeon should advance with his instrument
for extraction; and, after emerging from
the cavity thus made in the spinal column,
he would have to penetrate or grope his way
cautiously between the ganglionic system Of
nerves and arteries, veins, lymphatics, In
Guiding the thoracic duct, ali of which are
vital structures almost inextricably Joined
to each other on the front and sides of the
spinal column, and the lesion of any one of
which must have proved inevitably fatal.
Throughout the whole course Of the
treatment, contrary to what has been pub
licly said repeatedly, so far as 1t was posi-
BILE TO apply the system Of antiseptic sur
gerry advocated by MIR. Lister to a wound of
this character, 1t was vigorously employed.
l am reminded now to say, In reply to
some sugges ions made from time to time,
that we ought to have made a counter
opening In the lower portion of the long
sinus which terminated in the right lilac
fossa, that there was no period of time
during the progress of the case in which we
felt absolutely certain that what we recog-
niZed in the fossa as point of induratiOn
was the ball; nor were we entirely certain at
any time where the lower end of the sinus
WAC dCIudhf oltudbcu, uObuluk DuG u very hex"
Bile instrument could ever be introduced, and
inasmuch ss, when introduced, its presence
in the track could not be recognized by the
sense of touch, we were left without any
means of determining with a sufficient de-
gree Of accuracy to justify an operation
where the lower end of the channel was.
Indeed it is probable that the flexible ca
thetic employed never reached the lower
end of the channel, but doubled upon itself
near the rest of the ileum. To have cut
through or between the great mass of mus
cles in the lower portion of the lumbar
region for the purpose Of making counter
incision into small channel, the course of
which we did not and could not know, even
approximately, would have been under any
circumstances an uniustihable procedure,
and especially so in the case of the Presi- |
dent, whose hold upon life during all this
long period seemed to depend upon a
thread.