The Wellington enterprise. [volume] (Wellington, Ohio) 1867-188?, 1881-10-05

W. Oub COuNAlucu no hDoCttot3 OF lnIurCIlOub-
There were some recent peritoneal adhc-
sions betwet n the posterior wall of the stom-
ach and the posterior abdominal parieties-
With this exception no abnormalties were dis
covered in the stomach or intestines, nor were
any other evidences of general or local peri
tonitis found besides those already specified.
The right kidney weighed six ounces; the
left kidney seven. Just beneath the capsule
of the left kidney, at about the middle OF its
convex border, there was a little abscess one
third Of an inch in diameter. There were three
small serous 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 bladder was empty.
Behind the right kidney. after the removal
of that organ from the body, the dilated track
of the bullet was dissected into. It was found
that from the point at which It had fractured
the right eleventh rib three inches and q half
had gone to the left obliquely forward, pass
ing through the body of the first lumbar YER
zebra and lodging in the adipose connective
tissue Immediately below the lower border of
the panoreas, about two inches and q half 10
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 II entered the first lum-
bar vertebra was considerably dilated
and the pus had burrowed downwards
through the adipose tissue behind
the right kidney, and thence had
found its way between the peritoneum and
the right lilac fascia, making q descending
channel, which extended almost to the groin.
The adipose tissue behind the kidney, in the
vicinity OF this descending channel, was much
thickened and condensed by Inflammation. In
the channel, which was found almost free
from pus, lay the flexible catheter, introduced
fraf, fhs.x .,,,1 aN
autopsy. Its extremity was found doubled
upon itself. Immediately beneath the perito-
neum. reposing upon the lilac fascia, where
the channel was dilated into a pouch of con-
siderable size. This long-descendlng channel,
now clearly seen to have been caused by the
burrowing of pus from the wound, sup
posed during life to have been the track OF the
bullet.
The last dorsal, together with the first and
second lumbar vertebrIe and the twelfth rib,
were then removed from the body for moro
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 il entered involved the intervertebral
cartilage next above, and was situated Just
below and anterior to the Intervertebral
foramen, from which its upper margins were
about one-quarter of an inch distant. Passing
ObLQucy 10 luG lcAl anu IOrWaTu IuSOQNu Lnc
upper part OF the body of the first lumbar
vertebra, 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 intervertebral cartilage next
above the cancellated tissue The body OF the
first lumbar vertebra was very much CON-
minuted, and the fragments somewhat dis
placed Several deep assures extended from
the track of the bullet into the lower part of
the body of the twelfth dorsal vertcbra. 9th
ers extended through the first lumbar vcrte-
bra into the intervertebral cartilage between
It and the second lumbar vertebra- Roth this
cartilage and that next aLove were partly de-
stroycd by liberation number OF minute
fragments from the fractured lumbar vertc-
brs had been driven into the adjacent soft
pats. II was furthor found that the right
twelfth rib also was fractured at point one
inch and a quarter to the right OF the trans
verse process OF the twelfth dorsal vertebra.
This INJURY bad not been recognized during
life.
On saving through the vertebra q 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 spinar cord was not examined.
Beyond the first lumbar vertebra the bullet
continued to go to the left, passing behind the
pancreas to the point where IL was found.
Here It was enveloped in q firm cyst OF con-
nective tissue, which contained, besides the
ball. a minute quantity of inspissated, some
what cheesy pus, which formed thin layer
/ over a portion of the surface of the lead.
There was also q black shred adhering to
| 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 ohliteratef by
the healing process. Thence. far back
ward as the body of the first lumbar
vertebra, the track was filled with coagulated
blood. which extended on the left into regu-
lar space rent in the adjoining adipose tissue.
| Behind the peritoneum 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 rendlnF of the tissues by the eItravasa-
| ton of this blood was undoubtedly the cause
| afIthe paroxysms of pain which occurred q
! short time before death. This mass of coagu-
lated blood was of irregular form, and nearly
/ rs large as a mans fist. II 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 ad-
hesions between the stomach and part of the
| peritoneum covering the blood-mass had been
broken down by the fingers
4 From the relations of the mass, as thus seen,
II was believed that the hemorrhage had
proceeded from one of the mesenteric arte-
ries, but, as IL was clear that a minute disseo-
/ ton would be required to determine the par
ticular branch involved, it was agreed that
4 the innltrated 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 hemorrhage proceeded from a
| rent nearly four-tenths of an inch long in the
main trunk of the splenic artery, two inches
T and half to the left Of the coeliac axis. The
4 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 clot. More
over the peripheral portion of the clot in this
vicinity was disposed in pretty firm concentric
| layers.
| 1t was further found that the cyst below the
| lower margin OF the pancreas, in which the
| bullet was found, was situated three inches
| and a half to the left of the ceIiac axis
| Besides the mass OF coagulated blood just
described. another about the size of a walnut
| was found In the greater omentum, near the
splenic extremity of the stomach The COM
/ munication, II any, between this and the
larger hemorrhagio mass could not be made
| out.
The examination OF the thoracIc viscera
| resulted as follows:
The heart weighed eleven ounces. Ali the
cavities were entirely empty except the right
/ yentricle, In which a few shreds of soft red
| dish coagulated blood adhered to the internal
surface. On the surface OF the mitral valve
| there were several spots Of fatty de-
| generation With this exception the
| cardiac valves were normal The mus
/ cular tissue of the heart was soft, and
tore easily. A few spots Of fatty degenera-
! tion existed in the lining membranes Of the
| aorta, Just above the semilunar valves, and q
slender cIot OF fibrin was found in the aorta,
/ where II was divided about two inches from
these valves for the removal of the heart.
On the right side slight pleuritic adhesions
| existed between the convex surface OF the
| lower lobe of the lung and the costal pleura,
/ and firm adhesions between the anterior edge
/ of the lower lobe, the pericardium, and the