crossing the abdomen just below the umbilicus. The four flaps thus formed were turned back and the abdominal viscera exposed. The subcutaneous adipose tissue divided by the incisions was little more than one-eighth of an inch thick over the thorax, but was thicker over the abdomen, being about a quarter of an inch thick along the linea alba, and as much as half an inch thick towards the outer extremity of the transverse incision.

On inspection of the abdominal viscera, in situ, the transverse colon was observed to lie a little above the line of the umbili

It was firmly adherent to the anterior edge of the liver. The greater omentum covered the intestines pretty thoroughly from the transverse colon almost to the pubis. It was still quite fat, and was very much, blackened by venous congestion. On both sides its lateral margins were adherent to the abdominal parietes opposite the eleventh and twelfth ribs. On the left side the adhesions were numerous, firm, well organized, and probably old ;* on the right side there were a few similar adhesions and a number of more delicate and probably recent

ones.

A mass of black, coagulated blood covered and concealed the spleen and the left margin of the greater omentum. On raising the omentum it was found that this blood-mass extended through the left lumbar and iliac regions and dipped down into the pelvis, in which there was some clotted blood and rather more than a pint of bloody fluid. The bloodcoagula having been turned out and collected, measured very nearly a pint. It was now evident that secondary hemorrhage had been the immediate cause of death, but the point from which the blood had escaped was not at once apparent.

The omentum was not adherent to the intestines, which were moderately distended with gas. No intestinal adhesions. were found other than those between the transverse colon and the liver, already mentioned.

The abdominal cavity being now washed out as thoroughly as possible, a fruitless attempt was made to obtain some indication of the position of the bullet before making any further incision. By pushing the intestines aside, the extremity of the catheter, which had been passed into the wound, could be felt between the peritoneum and the right iliac fascia; but it had evidently doubled upon itself, and although a prolonged

*These adhesions, and the firm ones on the right side, as well as those of the spleen, possibly date back to an attack of chronic dysentery from which the patient is said to have suffered during the civil war.

† A large part of this fluid had probably transuded from the injecting material of the embalmer.

search was made, nothing could be seen or felt to indicate the presence of the bullet, either in that region or elsewhere.

The abdominal viscera were then carefully removed from the body, placed in suitable vessels, and examined seriatim, with the following result:

The adhesions between the liver and the transverse colon proved to bound an abscess-cavity between the under surface of the liver, the transverse colon, and the transverse mesocolon, which involved the gall-bladder, and extended to about the same distance on each side of it, measuring six inches transversely and four inches from before backward. This cavity was lined by a thick pyogenic membrane, which completely replaced the capsule of that part of the under surface of the liver occupied by the abscess. It contained about two ounces of greenish-yellow fluid-a mixture of pus and biliary matter. This abscess did not involve any portion of the substance of the liver except the surface with which it was in contact, and no communication could be detected between it and any part of the wound.

Some recent peritoneal adhesions existed between the upper surface of the right lobe of the liver and the diaphragm. The Liver was larger than normal, weighing eighty-four ounces; its substance was firm, but of a pale yellowish color on its surface and throughout the interior of the organ, from fatty degeneration. No evidence that it had been penetrated by the bullet could be found, nor were there any abscesses or infarctions in any part of its tissue.

The Spleen was connected to the diaphragm by firm, probably old peritoneal adhesions. There were several rather deep congenital fissures in its margins, giving it a lobulated appearance. It was abnormally large, weighing eighteen ounces; of a very dark, lake-red color, both on the surface and on section. Its parenchyma was soft and flabby, but contained no abscesses or infarctions.

There were some recent peritoneal adhesions between the posterior wall of the Stomach and the posterior abdominal parietes. With this exception no abnormities were discovered in the stomach or Intestines, nor were any other evidences of general or local peritonitis 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 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 a half to the right of the vertebral spines) the missile had gone to the left, obliquely forward, passing through the body of the first lumbar vertebra, and lodging in the adipose connective tissue immediately below the lower border of the pancreas, about two inches and a half to the left of the spinal column, and behind the peritoneum. It had become completely encysted.

The track of the bullet between the point at which it had fractured the eleventh rib and that at which it entered the first lumbar vertebra was considerably dilated, and the pus had burrowed downward through the adipose tissue behind the right kidney, and thence had found its way between the peritoneum and the right iliac fascia, making a 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 into the wound at the commencement of the autopsy; its extremity was found, doubled upon itself, immediately beneath the peritoneum, reposing upon the iliac fascia, where the channel was dilated into a pouch of considerable size. This long-descending channel, now clearly seen to have been caused by the burrowing of pus from the wound, was supposed during life to have been the track of the bullet.

The last dorsal, together with first and second lumbar vertebræ and the twelfth rib, were then removed from the body for more thorough examination.

When this examination was made it was found that the bullet had penetrated the first lumber vertebra in the upper part of the right side of its body. The aperture by which it entered involved the intervertebral cartilage next above, and was situated just below and anterior to the intervertebral foramen, from which its upper margin was about one-quarter of an inch distant. Passing obliquely to the left and forward through the upper part of the body of the first lumber 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 of the body of the first lumbar vertebra was very much comminuted and the fragments somewhat displaced. Several deep fissures extended from the track of

the bullet into the lower part of the body of the twelfth dorsal vertebra. Others extended through the first lumbar vertebra into the intervertebral cartilage between it and the second lumbar vertebra. Both this cartilage and that next above were partly destroyed by ulceration. A number of minute fragments from the fractured lumbar vertebra had been driven into the adjacent soft parts.

It was further found that the right twelfth rib also was fractured at a point one inch and a quarter to the right of the transverse process of the twelfth dorsal vertebra; this injury had not been recognized during life.

On sawing through the vertebra, a little to the right of the median line, it was found that the spinal canal was not involved by the track of the ball. The spinal cord and other contents of this portion of the spinal canal presented no abnormal appearances. The rest of the spinal 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 it was found. Here it was enveloped in a firm cyst of connecFig. 3.

I. The point at which the splenic artery gave way. 2, 2. The splenic artery. 3. The coeliac axis. 4. The superior mesenteric artery. 5, 5. The splenic vein. 6. The cyst in which the ball was found. 7, 7. A portion of the mass of extravasated blood. 8, 8. The pancreas. 9, 9. Adipose tissue behind the transverse meso-colon.