The Portland daily press., 1881-09-29

in his lower extremities, or dlminutlon OF the
natural sensibility at aay point. The pains 10
his ankles, however, were accompanied with
hyperasthesia of the integument; and few
days later it was observed that there was by
perAsthesia of the right side of the scrotum.
All of these symptoLs-the pain and the hy-
Observation-Disclosures wholly in the course
of the first week or two and never returned.
On the morning Of the 4th of July, the patient
being partially under the influence OF NOR
phine, was not suffering pain, the bowels were
tympanitic and the pulse was feeble.
PROBING THE WOUND WITH FINGERS
AT the first consultation, the question hav-
ing arisen as to the probable course of the ball
it was stated that Surgeon-General Wales of
the Navy had on the day OF the receipt OF the
injury, introduced his finger to its full extent
and that he had declared that it penetrated the
substance of the liver, the structure Of which
ne recognized by its granular feel; and DIR.
Bliss stated that he had introduced o probe
about three inches, which seemed TO have
passed in the same direction.
THE BALL DECLARED BEYOND REACH.
This testimony was regarded as sufficient to
determine that the ball was at least beyond
our reach and beyond the reach OF safe explo-
ratiop DIR. Woodward had introduced his
finger sufficiently deep into the wound to de-
termine that the rib was broken. Finding up
on raisonal examination and inspection that
the track of the wound was completely closed
by firm clot | refused to make any further
eI Iploration. From this time forward great
uncertainty existed in the minds of the medi-
cal tendants as to the actual course and pres
ent situation of the ball. On the 24th of July,
and after the complese subsidence OF the tym-
paliteS, circumscribed point OF induration
was discovered in the right lilac fossa, which
at once led to the suspicion that the ball had
oeen DETECTED, eoursing along the interior sur
face OF tre lumbar muscles, and that this indu-
ration Indicated its present seat. This suspl-
cion was sustained by the hyperesthesa of the
right side Of the scrotum which, as Professor
Weisse had already shown in bis anatomical
observations, would be the natural result OF an
injury of the ileo-inguinal or ilec-hypogastric
nerves, which lie in the course OF the then
track OF the ball. Still further con-
firmation was added when on the 9th OF July,
we found that a flexible catheter could be car
ried downward in the direction OF the supposed
situation of the bail TO the distance OF seven
incheg The poiat of induration in the right
lilac fossa gradually moved downward and be-
came nlore hard and defined, conveying the
imnression that it was the ball and that lt was
encysted. At the autopsy, it having been de-
termined that this was not the ball, further
examination of the channel in this direction
was not prosecuted. Indeed, this induration
had entirely disappeared after death, and It is
now presumed that it only indicated the lower
cad Of the long sinus already described.
THE FORMATION OF PTS.
About this period small pouch of pus was
formed in connection with the ain channel,
extending underneath the intsgumshts OF the
back, causing rigors which were at once re-
lieved bv free incison; and little later rig
ors followed in consequences of the temporary
obstruction of the channel caused hy the hoat-
ing Of a small fragment of the rib into the orl-
fee, which were relieved on the removal OF tue
fragment
On the 8th Of August great difficulty having
,or,o ood in fhqi infrOduCt1On
drainage tube in this long suppurating canal
an inciSion was made below tue twelfth rib
the patient being under the influence OF eth
er About week later the stomach OF the
President became exceedingly irritable and 1t
was found necessary to suspend alimentatlon
by the mouth, and for three or four days he
was nourished only by enemata. On the
fourth day after the suspension of alimentation
by the mouth, the right parotid gland began to
enlarge august ID and on August u suPpur-
ated, and was incised, the fret incision giving
exit only to few drops of pus Subsequently
il opened into the moath and meatus auditori-
us externus, and three or four incisions were
made at different points on the surface for the
exit of matter. Al the time OF death the sup
puration and swelling of the parotid gland had
almost entirely disappeared.
BRONCHITIS NEXT DEVELOPED.
Following the parotitis was a gradual de vel.
opment of bronchitis in the right lung; and
finally broncho pneumonia OF the lower por-
tion of the right lung, indicated By well-de-
fined dullness, and total absence OF the res
piratory murmur in that region. From this
time until the period of his removal from
Washington there are no events OF striking In
terest worthy of being related IN tRls Drlei
summary, except the alarming weakness and
great somnolency of the patient, which oc-
CURED on the 24th, 25th and Goth of August,
and which led to an apprehension, that fatal
issue was at hand. The patient was evidently
suffering from atmospheric influences, the
heat being intense and oppressive, and most OF
the tiIne 10 air being mctionless, SO that
leaf could not be seen to stir upon the trees
the White House. There was no
evidence, however, at any time, that the pa
tient suffered from malaria having It's source
in the house drainage or the marshes ln the
and which latter at later time IN the
season had always been regarded as pestiIer-
GUS.
THE REMOVAL TO LONG BRANCH
His removal to Long Branch occurred on
The Och OF September, and was etfecTed With
out injury or discomfort to the patient, with
only slight amount OF fatigue, manifested al
ter his arrival, and from which on the follow
ing morning he had completely recovered.
There was no day while he lay IN the cottage
1t Long Branch that he did not express him.
self as pleased and even delighted with the
change: nor was he ever oppressed by the
heat although one of the days, the first after
his arrival, was the hottest day OF the season.
AT o'clock in the afternoon of this day, when
the heat was the greatest, IN reply TO my IN
ouiry. he said he experienced. no discomfort.
From this time until the period OF his death,
which was sudden and unexpected, although
in no sense unanticipated, there Is no incident
worthy of special note-escept that there was
a gradual change in the last two or three days
for the worse The manner OF his deatA aud
the result of the subsequent autopsy are snfil-
ciently explained in the official bulletin"
Here follows the official bulleLin of the
post mortem examination as already published
in the PREss.]
NO Assesses IN THE LUNGS.
fIt may be necessary, however, to repeat
as contrary statements have peen
made. that the lungs contained not even tne
most minute assesses, and there was no mt
examined except one less than half an mon
in diameter near the surface OF the leIt kldney.
There were three small Serious cSsts unuer tne
peritoneal covering on the vortex euge OF thS
right kidney, each about the SIZE OF Verucal
saetion Of a large pea. The abscess found be-
twean The transverse colon and the liver was
evidently not metastatic, but probably was
cansed bv the original injury. There was no
cicatrix or wound of the liver, nor anything to
indicate that it had suffered injury ia the
slightest degree.
Since it has been thought by some that it
was the duty of the surgeons TO have ascer-
tanned positively the course and location of the
ball, it is proper to cansider whether either the
one or the other were practicable.
THE BALL COULD NOT HAVE BEEN EXTRACTED
AS TO determining the course OF the ball by
a probe, every anasomist will see that II was
he will consider the very tortu-
ons course which the ball must have taken to
reach its final destination; that 1t passed
through the solid structure of the verte6ra and
thar no metallic instrument sufficiently
firm 10 give indications Of the course and di-
rection which it took within the BODY coulo
aver have reached the ball; nor would any sur
geon of experience, familiar with gunshot
wounds of the belly, in the absence OF any sat