SCIENCE. 



The same risks would have to be taken in the extrac- 

 tion of the bullet that are familiar to the surgeon who 

 performs the latter operation. 



Leaving aside all speculative issues, let us trace out 

 the symptoms of the heroic and patient sufferer and 

 their basis, as inferable from the autopsy. 



When first struck by the bullet, the President suf- 

 fered from Surgical Shock. The wound was so severe 

 that liis death might have taken place in a few hours ; 

 death so occurs to soldiers on the field of battle, who 

 receive similar wounds. His treatment, which con- 

 sisted in the administration of stimulants and opium, 

 was eminently proper, "and doubtless aided by the 

 powerful constitution, overcame the tendency to a 

 fatal collapse. 



A tendency to such a collapse recurred at a later 

 period, when Dr. Wales thought the President dying. 

 The primary hemorrhage from the wound was insig- 

 nificant, no important blood vessels were injured, and 

 the hemorrhage seems to have been mainly external. 

 At a later period an escape of dark venous blood from 

 the wound seems to us to have indicated necrotic 

 usure of the large veins running in the substance of 

 the injured vertebral body. 



The painful sensations experienced in the distribu- 

 tion of all the nerves, originating from the crural and 

 particularly the sacral plexus, are attributable to the 

 sudden shock acting on the vertebral column. There 

 is no evidence that any hemorrhage occurred around 

 the nerve roots, or any inflammatory disturbance of 

 the cord or its membranes. The spontaneous disap- 

 pearance of these nervous symptoms proves conclu- 

 sively that they were due to the kind of shock, fre- 

 quently occurring in the practice of military surgeons, 

 and well described by Mitchell, Morehouse and 

 Keene in their work on nerve-injuries. That the 

 nerves on the right side suffered more than those of 

 the left, is attributable to the greater nearness of the 

 right vertebral bullet aperture to the inter-vertebral 

 foramen, where the nerves concerned in the tegumen- 

 tary supply of the most painful region in this case 

 emerge. 



The main injury done by the bullet in its further 

 course, consisted in the irritation of important nerve 

 filaments connected with the Solar Plexus of the 

 Sympathetic System. Irritation of this Plexus, or its 

 derivative branches, accounts for the obstinate and 

 frequently recurring spells of nausea and vomiting, as 

 well as for the great acceleration of the pulse rate, so 

 marked a feature of the President's history. These 

 same symptoms, through the same mechanism, occur 

 with peritonitis, and some of our best physicians sus- 

 pected the existence of this trouble, from these two 

 symptoms alone. It cannot be said that the imper- 

 fect and ambiguous post-mortem record quoted, 



proves them to have been wrong in their surmise. 



In view of the great irritability of the alimentary 

 canal, it is to be considered highly unfortunate that 

 the President's dietary was not properly attended to. 

 At least two of his relapses were due to the undue 

 massing of food in his stomach, at what were consid- 

 ered convalescent periods. Though it is denied that 

 he was allowed improper articles, yet in view of 

 the fact that much of what occurred in the sick- 

 chambers, was rigidly ignored or suppressed by the 

 medical staff, and that on their own confession he was 

 fed on so injurious a combination as milk and lemon- 

 juice for the first few days after the injury, we can not 

 consider that assertion as an invention, until a more 

 authoritative denial be made, than the one vouch- 

 safed by Dr. Bliss. 



Several days after the injury, when that examina- 

 tion of the wound was made, which should, in the 

 opinion of ninety-nine out of a hundred surgeons, 

 whom we have consulted or heard opinions from, been 

 made in the first place, a canal was found extending 

 downward to the pelvis. This is now known as the 

 fistulous tract represented on the body-diagram. It 

 was due to burrowing of the pus originating, be it 

 borne in mind, not from the bullet, not from the per- 

 forated vertebra, but from the neglected fragments of 

 the eleventh rib. The surgeons did all in their power 

 for a long period to oppose Nature's attempt to close 

 this passage. Thus the pus-absorbing surfaces were 

 largely increased, and with it the dangers of pyaemia. 



Without entering into the details of the management 

 of the case, let us conclude with an examination as 

 to the cause of death. The immediate cause of 

 death is stated by the attending surgeon to have been 

 hemorrhage from a dissecting aneurism of the splenic 

 artery. The evidence offered as to the existence of 

 such an aneurism is exceedingly feeble. It is founded 

 on an examination of the specimen after it had lain in 

 alcohol. Under such circumstances laminated layers, 

 as well as membranous precipitates are very apt to 

 form, and on the existence of these the diagnosis ap- 

 pears to rest. A far more natural explanation suggests 

 itself. Every medical student knows that when the 

 dead subject is injected for anatomical purposes 

 masses of blood or of the injecting material are very 

 apt to be found in the abdominal cavity, having es- 

 caped through rents in the arteries artificially pro- 

 duced. The pressure used by the embalmer when 

 injecting the President's body was so great that in 

 several' places Dr. Bliss is constrained to speak of 

 cavities, a large part of the fluid contained in which 

 had probably transuded from the injecting material of 

 the embalmer. The existence of other clots in the 

 omentum, and elsewhere in the peritoneal cavity, 

 shows that vessels altogether unconnected with the 



