WATER WORKS SUPPLY. 
Pure and Impure Water in a Sanitary Point of View. 
By WM. G. BULLOCH, M. D., 
SAVANNAH, GA. 
As the subject of the water works supply has been a matter 
discussed of late at the meetings of the Medical Society of this city 
and is now under consideration, I understand, by the City Council, 
as well as a matter of interest to the whole community, and I am 
myself deeply interested in the subject, I take this occasion to lay 
my views before the public, hoping thereby to elicit some diecuseiou 
of a matter of such vital importmce to our citizens, from those who 
may have more enlightened vie vs affecting the health, happiness 
and prosperity of this city. 
Now, as, I am but a tyro in science, I admit, and may not possess 
a personal knowledge of the subject in all its bearing3, but I have 
for some time past been studying up the subject, aod in an article 
I prepared for publication some years since, I presented my own 
views and substantiated them by quotations from the best authori- 
ties I could find. And first, I relerred to what Dr. Parks pays in 
his work on “Medical Hygiene,” prepared especially for use in 
the medical service of the British army, and furnished by our own 
government, from its intrinsic merits, for the benefit of the medical 
staff of the United States army. 
“Soldiers,” says Dr. Parks, “should be taught by their med cal 
officers that there is danger in drinking turbid water, as they will 
often do when they are overcome with thirst. Not only all sorts 
of suspended matters may be gulped down, but even minute ani- 
mals. Oa some occasions the French army in Algiers suffered 
from the men swallowing small leeches, which brought on dan- 
gerous bleeding. The leeches are so small as to look like small bits 
of vegetable matter, fixing themselves in the pharynx (the poste- 
rior part of the mouth), the posterior nares, etc., more rarely in the 
larynx, causing repeated haemoptysis, epistaxis, or asphyxia ” 
An instance of this occurred in this city, and came to my 
knowledge, from the use of the hydrant water, with a gentleman 
who was in the habit of throwing the water up in his face and 
dipping his face into the basin of water while bathing. Suddenly 3 
without ever having had a hemorrhage from the noBe, dropa of' 
blood began to trickle down, and after making an effort to blow his 
nose, a leech from a quarter to half an inch long was expelled 
theiefrom, to his manifest relief, and the consequent arrest of the 
hemorrhage. Upon careful inquiry in no other possible way could 
the leech have attached itself within the nostril but in the way de- 
scribed, and irom the use of the hydrant water. 
Again, as consequences of an insufficient and impure supply of 
water, the Health of Towns Commission in their invaluable re- 
ports to the British Government collected much valuable informa- 
tion on this point. 
The result of such a state of things is a general lowered state of 
health among the population. It is thought also that certain skin 
diseases, and the epiphytic affections especially—that is, diseases 
arising from vegetable parasites getting into the system—and 
ophthalmia, in some cases, arise from thie cause, and are thus 
propagated. 
It has also appeared that the remarkable cessation of spotted 
typhus among civilized nations is in part owing, not merely to 
better ventilation, but to the use of a purer and better supply of 
water. 
The deficiency of water, leading to the insufficient cleasing of 
sewers, has a great effect in the spread of typhoid and choleric 
diarrhoea. And cases have been known in which outbreaks of the 
latter disease have been arrested by a heavy fall of rain. This, 
then, shows the importance to the health of the city of Council 
providing a full supply of pure water, and also such a connection 
between the water works and tin sewers running through the city 
as to provide for their regular and thorough cleansing in times of 
drought. For to this in part I am disposed to attribute the good 
health of the city in heavy falls of rain. At present, owing to 
the difficulty of making accurate analysis of water, the exact con- 
nection between impure water and disease does not stand on so 
precise an experimental basis as might be wished. There are 
some who deny that even considerable organic or mineral impu- 
rity in water can be proved to produce any bad effect, while oth- 
ers believe that some mineral ingredients, such as carbonate of 
lime, are useful. One writer, indeed, has proposed to add carbon- 
ate of lime to water to supply lime lor our bones, and even so 
excellent a writer as Johnston has supposed that in Ireland the 
deficiency of lime salts is supplied by the large amount of lime in 
the water which in so many parts of the country is supplied from 
the mountain limestone. 
It may be true that water containing a large quantity of organic 
matter, or much sulphate of lime or magnesia, has been used for 
long periods without any ill effects, examples of which are stated 
by two French writers, Parant Duchatelet and Boudet. 4 
In some of these cases, however, very little careful inquiry has 
been made into the state of health of those using; the water, and 
that most fallacious of all evidences, a general impression, without 
careful collection of facts, has often been the only ground on which 
the opinion has been formed. As well observed by Mr. Simon, in 
one of his philosophical reports (second annual report to the city of 
London), we cannot expect to find the effect of impure water al- 
ways sudden and violent; its results are indeed often gradual, 
and may elude ordinary observation, yet be not the less real and 
appreciable, by a close inquiry In fact, it is only when striking 
and violent effects are produced that public attention is arrested to 
the subject, the minor and more insidious, but not less certain, 
evils are borne with the indifference and apathy of custom. This 
much seems to be certain, that, as precise investigations proceed, 
and indeed, in proportion to the care of the inquiry and the accu- 
racy of the chemical examination, a continually increasing class of 
cases is found to be connected with the use of impure water, and it 
seem9 only reasonable to infer that a still more rigid inquiry will 
further prove the frequency and importance of this mode of origin 
of some diseases. Animal organic matter, especially when of foecal 
origin, vegetahle organic matter, when derived from marshee, and 
some salts, are the principal noxious ingredients. The quantities 
of these ingredients, which should not be exceeded in good drink- 
ing water, I may give hereafter, as well as the methods of getting 
rid of them, but as they do not come within the scope of this arti- 
cle I will omit them at present. 
Of the various mineral ingredients the least hurtful substances ap- 
pear to be carbonate of soda and chloride of sodium when not pres- 
sent in too great quantity. Carbonate of lime, when not exceeding 
twelve to sixteen grains per gallon, is not usually considered un- 
wholesome, though it remains to be seen whether a more careful 
inquiry will not indicate some effect on digestion or assimilation 
to be produced by the constant use of such water. The salts usu- 
ally considered hurtful, except when in very small quanties, are 
sulphates of lime and magnesia, chlorides of "calcium and magne- 
sium, nitrates and nitrites, and butyrate of lime. 
In consonance with my expressed design of treating this subject 
in a practical way by enumerating diseases which have, on good 
evidence, been attributed to impure water, I will first allude to 
affections of the alimentary mucous membrane. 
It is reasonable to suppose that the impurities of water would be 
likely to produce their greatest effect upon the membrane with 
which they come first in contact. This is found to be the case. 
Symptoms which may be referred to the cmvenient term of dyb- 
pepsxa, aDd which consist in some loss of appetite, vagne uneasiness 
or actual pain at the epigastrium (pit of the stomach), and slight 
nausea and constipation, with occasional diarrhcei, are caased by 5 
water containing any quantity of sulphate of lime, chloride of cal- 
ciam, and the magnesian salts. Br. Sutherland found the hard 
water of the red sand stone rocks, which was formerly much used 
in Liverpool, to have a decided effect in producing constipation, 
lessening the secretions, and causing visceral obstructions; and in 
Glasglow, the substitution of soft for hard water lessens, according 
to Dr. Leech, the prevalence of dyspeptic complaints. 
It is well known that grooms object to giving hard water to 
their horses, on the ground that it makes the coat rough—a result 
which has been attributed to some derangement of digestion. 
Diarrhoea has been known to be produced by such conditions. 
First. Suspended mineral substances —clay, marl—as io cases of 
the waters of the Mississippi, the Missouri, Rio Grande, Kansas, of 
the Ganges, and many other rivers, which at certain times of the year 
produce diarrhoea, especially in persons unaccustomed to tbe 
water. 
Second. Suspended animal, and especially fcecal matters, have 
produced diarrhoei in mauy instances, such water always contains 
dissolved organic matters, to which the effect may be partially 
owing. The case of Croyden in 1854 (Oarpeuter), is one of the 
most stiiking on record. Incases in which the water is largely 
contaminated with sewage, it is important to observe that- the 
symptoms are often markedly choleraic, (purging, vomiting, cramps, 
and even some loss of heat). This point has been lately again 
noticed by Oldekop, of Astrachan, who found strong choleraic 
symptoms to be produced by the water of the Volga, which is im- 
pregnated with sewage. Suspended animal and vegetable substan- 
ces, washed off the ground by heavy rains into shallow wells, often 
produce diarrhoea, as at Prague, in 1860, when an epidemic of 
“catarrh of the alimentary canal” was produced by heavy floods 
washing impurities into the wells. 
SUSPENDED VEGETABLE SUBSTANCES. 
In England, and also during the late civil war in this country, 
instances have occurred of diarrhoea arising from the use of surface 
and ditch water, which ceased when wells were sunk. Assistant 
Surgeon Gore, of the British army, has recorded a violent outbreak 
of diarrhoea at Bulama, on the west coast of Africa, produced by 
the water of a well. The water was itself pure, but was turbid 
from suspended matters, consisting of tbe debris of plants, chloro- 
phyll, minute cellular and branched algae, monads, polygastrica, 
and minute particles of sand and clay. Wbeu filtered the water 
was quite harmless. 
DISSOLVED ANIMAL ORGANIC MATTER. 
Tbe opinion is very widely diffused that dissolved and putres- 
cent animal organic matter to the amount of three to ten graue per 
gallon may produce diarrbcei. 6 
FCETID GASES. 
Water containing much sulphuretted hydrogen will give rise to 
diarrhoea, especially if organic matter he also present In the lute 
Franoo-Mexican wars the French troops suffered at Orizaba from a 
peculiar dyspepsia and diarrhoea, attended with immense disen- 
gagements of gas and enormous eruc'ations after meals from the 
impure water. 
Dissolved mineral matters, if passing a certain point, produce 
diarrhoea. 
Occasionally animal organic matter acts in an indirect way by 
producing nitrates and nitritep, which act on metals. 
Dr. Baedeker, a physician of Witten, and otbeip, report cases of 
sickness produced by impure water. The water was found to contain 
a considerable quantity of copper, which seemed to be in combination 
with some organic matter, and the solution was aided by the large 
amount of nitrates whicb are produced by the passage of exc-eta 
into the water and subsequent oxidation. 
Dysentery, also, is decidedly produced by impure water. And 
this cance ranks high in the etiology of dysentery. Several of the 
British army surgeons refer to this cause. Pringle does so Beveral 
times, and Donald Munroe, in the campaigns in Flanders and Ger- 
many. In the West Indies, Lempriere, in 1799, noticed the in- 
crease of bowel complaints in Jamaica in the month of May. After 
floods the water was bad and turbid, “and loaded with dirt and 
filth Davis (Treatise on the Walcheren Fever) mentions as a 
curious fact in reference to the West Indies, that ships' crews, when 
ordered to Tortola were invariably seized with fluxes.’’ The dysen- 
tery at Walcheren in 1804 was in no small degree owing to the 
bad water. The epidemio at Guadaloupe in 1849, recorded by 
Cornuel, seems also quite conclusive as to the effect of impure water 
in causing it. 
In i860, at Prague, there were many casts ot dysentery clearly 
traced to the use of impure water. 
On the west coast of Africa (Cape Coast Castle) an epidemic of 
dyeentery was traced by Assistant Surgeon Oakes, of the British 
army, to the use of impure water. That in the East Indies a great 
deal of dysentery has been produced by impure water is a matter 
too familiar almost to be mentioned. 
The impurities which thus produced dysentery appear to be of 
the same bind as those which cause the allied condition, diarrhoea, 
suspended earthy matter, suspended animal organic matter, sul- 
phates and chloride of lime, and magnesia, nitrate of lime and 
ammonia, etc. 
AFFECTIONS OF OTHER MUCOUS MEMBRANES BESIDES TnE AL1MEN- 
METALLIC IMPREGNATION OF WATER. 
TARY. 
Little has been done to trace out this point. At Prague, after 7 
the severe flood of 1860, bronchial catarrh was frequent, probably 
caused chiefly by the chills arising from the great evaporation ; 
but it was noticed that bronchial catarrh was most common where 
the drinking water was foulest, and produced dysentery. 
That some of the specific diseases are disseminated by drinking 
water is a fact which has only attracted its due share of late 
years. 
Hippocrates states that the spleens of those who drink the water 
of marshes become enlarged and hard, and Rbazes not only asserted 
this, but affirmed that it generated fevers. Little attention seems 
to have been paid to this remark, and in modern times the opinions 
of Lancisi, that the air of marshes is the sole cause of iutermittents, 
has been so generally adopted that the possibility of the introduc- 
tion of the cause by means of water as well as air, has been over- 
looked. Still it has been a very general belief among the inhabi- 
tants of marshy countries that the water could produce fever. 
Henry Marshall (Topography of Ceylon) says the fevers of the 
country is attributed to the use of impure water. Dr. Bettington 
(Indian Annals, 1856) states that it is “notorious that the water 
produces lever and affections of the spleen.” In the Landes (of 
Southwest France) the water from the extensive sandy plains con- 
tains much vegetable matter, which it obtains from the vegetable 
deposits, which bind together the siliceous particles of the subsoil. 
It has a marshy smell, and, according to Dr. Faure, produces in- 
termittents and visceral engorgements. 
At Sheerness the use of ditch water, which is highly impure 
With vegetable debris, has been considered to be one of the chief 
causes of the extraordinary insalubrity. At Versailles, a sudden 
attack of ague in a regiment of cavalry was traced to the use of 
surface water taken from a marshy district. 
One very important circumstance, says Dr. Parker, is the ra- 
pidity of development of the malarious disease and its fatality 
when introduced by water. It is the same thing as in the case of 
diarrbcet and dysentery. Either the fever-making cause must be 
in large quantity in the water, or, what is more probable, must be 
readily taken up into the circulation and carried to the spleen, 
than when the cause enters the lungs. 
MALARIOUS FEVERS. 
The belief that typhoid fever can spread by means of water as 
well as air appears to be also entertained by competent observers. 
The fever at Gottingen in 1760 was attributed in part to the use 
of impure water. In 1822 Walz affirmed that an outbreak of 
“typhus” (typhoid) in Rhenish Prussia was caused by impure water. 
In 1848 Richter published an account of an outbreak of typhoid 
fever which occurred at Vienna, due to impure water. In 1852-3 
a severe outbreak of yellow fever took place at Croydon and was 
TYPHOID FEVER. 8 
thoroughly investigated by many competent observers, and it was 
shown by Dr. Carpenter, of Croyden, that it was partly, at any 
rate, spread by the pollution of the drinking water. 
Ir 1856 Dr. itoutb published a pamphlet of cases arising from 
the use of impure water. In 1859 Dr. W. Budd jublisbed two 
very conclusive cases of this sort. Id I860 an outbreak of typhoid 
fever occurred at the Convent of the Sisters of Charity at Munich, 
traced to the use of water impregnated with much organic 
matter. 
The propagation of typhoid fever in Bedford would certainly 
appear, from Mr. Simon’s report, to have been partly through the 
medium of the water. That water may be the medium of propa- 
gating typhcid, thus seems to be proved by sufficient evidence; and 
it has been admitted by men who have paid special attention to the 
subject, as Jenner, W. Budd, Simon, and other distinguished phy- 
sicians of England and France. 
CHOLERA. 
Dr. Muller of Haoover, Dr. Snow of London, Dr. John Marshall, 
Dr. Dundas Thompson, Dr. Ackland, Dr. Aitken, and many others, 
in papere drawn up with great logical power, the various Indian 
medical leport?, and reporte made to the British Government of 
outbreaks of cholera in Great Britain contained m09t convincing 
evidence that the poipon of cholera may, and does, often find its 
way into the body through the drinking water. 
Ae, like dysentery, typhoid fever and cholera, the alimentary 
mucous membrane is often found primarily affected in yellow 
fever, there is a priori probability that the cause is swallowed also 
in this case, and that it may possibly enter with the drinking 
water. Boudin (Traiie de Geo., et de Stat. Med. 1857,) quotes a 
case from Rochard in which a French frigate took in water at San 
Sago, where yellow fever prevailed. Several days after yellow 
fever broke out with such violence that two-thirds of the crew 
were attacked. “And the proof that the only cause was the 
water,” says Rochard, “was that the persons living with the Cap- 
tain had with them water from Europe, and ail of these escaped.” 
Boudin very properly remarks thaf this evidence is very defect- 
ive, but yet we must remember how completely the propagation of 
marsh and typhoid fever and of cholera has been overlooked. 
The Barrack Commissioners have also directed attention to the 
“fact of the great imparity of the water at Gibraltar at the time 
of the yellow fever epidemic." Diseases of the skin, diseases of 
the bones, calcnli, goitre eutozons, such as tape worms, the round 
worm, Guinea jvorro, I might proceed to show have all been intro- 
duced into the system by impure water, either internally or exter- 
nally applied, but as I have fully established the point aimed at 
YELLOW FEVER. 9 
in the discussion of this subject, and this article has already at- 
tained too great a length I fear, I will content myself with stating 
the conclusions arrived at by scientific men, and, with a few sug- 
gestions, will close : 
1. An epidemic of diarrtcea in a community is almost always 
owing«eitber to impure air, water or food. It it affects a number 
of persons suddenly, it is probably owing to one of the two last 
causes; and if it extends over many families, almost certainly to 
impure water. 
2. Diarrhoea or dysentery, constantly affecting a community, or 
returning periodically at certain times of the year, is far more 
likely to be produced by bad water than by any other cause. 
3. A very sudden and localized outbreak of either typhoid fever 
or cholera is almost certainly owing to the introduction of poison 
by water. 
4. The same fact holds good in cases of malarious fevers, and 
especially if the cases are very grave, a possible introduction by 
water should be carefully inquired into 
5. The prevalence of intestinal worms (lumbrici), guinea worm 
or the broad tape worm should always excite suspicions of the 
drinking and bathing water. 
I have cited authorities freely, I acknowledge, in the above 
statement, not only because I thought the ideas of one brought up 
on this sandy bluff, where, from the small size of the city, we 
might be supposed to have contracted views and few sources of 
information, but because they carry with them the essence of 
truth and aie the well expressed views of have devoted 
time and study to their elucidation. The people, and the City 
Council too, ought to be informed ou this subject, for the plentiful 
and regular supply of pure water is all important to the heilth of 
a community. I have dealt with the sanitary, and Dot with the 
financial question of a pure and impure water supply. The mains 
and pipes ought to be larger, so as to convey a greater body of 
water to the different parts of the city. The forcing pump ought 
to be more powerful, but, as these are points mo-e within the 
province of an engineer, and are now, I understand, under con- 
sideration by the authorities, I will say nothing more under that 
head. I would urge the necessity of removing the buildings and 
establishing basins higher up the river—a mile at least, if not 
more—for on a visit to the water works I noticed that the mouth 
of the trunk supplying the basins with water opens just above the 
lock of the Ogeechee canal and in the neighborhood of the Cen tral 
Railroad wharf, where the garbage and refuse matter of the ships*, 
that lie there are poured into the river, as well as that carried by 
the tides aloDg the whole river front of the city, contaminating the 
water with organic impurities in a state of solution and decompo- 
sition. 10 
I would here also take occasion to urge a suggestion, which I 
am aware has been under consideration from time to time, of es- 
tablishing a filtering apparatus in connection with the water works. 
Chaicoal, for instance, be used, and other agents to purify 
the water used as a diiok by ho mmy thousands of our people. 
The answer I anticipote—the cost; it is necessary to economtse the 
city resources. What is money when the health of the commu- 
nity is concerned ? Cannot a small water tax in addition to the 
water rates be assessed, if necessary, to carry out this important 
measure? If suitable hydrants or pumps with the wster filtered 
from the water works were made, the nueigbtly pumps now seen 
about the city might be dispensed with, containing as they do 
much solid residue of unwholesome iugrediente. (See Dr. N. A. 
Pratt’s Analysis, Cavannah Journal of Medicine). 
Composition of River and Tump Water Compared, and calculated 
for 100,000 parts of the Water. 
RIVER. 
PUMP. 
Specific Gravity at 60°F 
10.0005 
10001 
Residue from 100.000 gra. of Water 
2.843 
10.709 
Tois residue consists of 
Carbonate of Lime 
0.684 
2.086 
*• “ Magnesia 
0.132 
0.238 
Chloride of Sodiurg 
0.276 
2 607 
“ “ Calcium, ) 
0.302 
trace 
“ “ Magnesia. 
0 081 
Sulphate of Lime 
0.010 
“ “ Soda, | 
“ “ Magnesia, { 
0 332 
1.933 
Silicia 
0148 
0317 
Peroxide of Iron 
0.061 
0.262 
Alumina 
0.110 
0.846 
, T f chiefly Vegetable Matter 
by I<?n,tlOD. | „ •>Amm0Dlacal Salt8 
1.094 
2.524 
Loss in Analysis 
0.006 
0.006 
Total Salts 
2.843 
10.709 
The above analysis of the waters of Savannah was takeo in J859 
by N. A. Pratt, Professor of Chemistry, Savannah Medical Col* 
lege. 11 
Published, in the “ Morning News," August 17th, 1881. 
Comments on Ex-Surgeon General Ham- 
mond’s Criticism on President Gar- 
field’s Medical Attendants. 
Mr. Editor : 
I read with surprise iu your issue of this morning a notice of a 
letter written by ex-SurgeoD General Wm. A. Hammond, of New 
York, in which, it is said, ‘ he tabes strong ground against the 
course pursued by President Garfield’s attending surgeons. Iam 
no apologist for those gentlemen, nor do I intend to take up the 
gauntlet in their defence, as I presume they are abundantly ca- 
pable of taking care of their own professional reputations. I 
think it remarkable that a gentleman of Dr. Hammond’s 
professional standing, and a member of the “National Medical 
Association,” should commit, in the first place, such a breach 
of professional etiquette as to arraign the President’s medi- 
cal attendants, among whom I see the name of the Surgeon 
General of the United States army, on tbe charge of in> 
competency and want of skill in the management of the 
President’s case, in a letter addressed to a secular paper, as I un- 
derstand it. His remarks might be justified if he confined his 
criticism to some of his medical friends and acquaintance in 
private, but when he writes a letter to a daily print, ho not only 
does injustice to those gentlemen, but injures the profession at 
large, in my view, by bringing them before the publice and expose 
ing their mistakes, if they made any, to the public gaze. Thous- 
ands have, ere this, read his letter, and think, no doubt, what a 
set of asses the President must have had around him as his 
medical advisers. What are medical men’s opinions and know- 
ledge worth, if the President was allowed to lie a sufferer on his 
back for thirty-five days, when Dr. Hammond or seme other astute 
surgeon like himself could, in the incipiency of the case, have dis- 
covered the situation of the ball, removed the fragments of cloth- 
ing and of bone, and thus saved the great suffering of the Presi- 
dent while “his strength was at the maximum, and before tbe 
track had been partially closed by the swelling of the soft 
parts ?” 12 
In order to get at the facta of the case I quote from the New 
York Medical Record the account first of Dr. Townahend, Health 
Officer of the District, who is reported to have said, "I found the 
President about five? minutes after the shooting occurred, in a 
vomiting and fainting condition. From the pulse at the wrist I 
♦ bought he was dying After administering restoratives,” he goes 
on to say, ‘‘he (the President) rullied considerably, and I proceed- 
ed to examine his wounds, I found that the Uet bullet bad entered 
his back about two and a half inchps to the right of the vertebrre. 
I introduced my finger into the bullet wound. Some hemorrhage 
followed.” 
Bes des the official bulletins, it had been eUted, prior to July 
4th, that the wound wae located between the tenth and eleventh 
ribs, four inches to the right of the median line of the back; that a 
finger introduced into the wound had felt that the eleventh rib 
was fractured; that at another exploration the finger had felt the 
substance of the liver; that a probe had been passed in a distance 
of three inches. By the two latter examinations the direction of 
the wound was found to be downward and forward. 
“On July 4th a careful analysis of the symptoms that had 
eented up to that date was made by Faneuil D. Weisse, D D., Pro- 
fessor of Practical Surgical Anatomy, Medical Depirimeut of the 
University of the City of New York.” I will here briefly state the 
result of his analysis. First. A pistol wound was located between 
the tenth and eleventh ribs, four inches from the median line of 
the back. Second. Upon receipt of the wound the President fell, 
or rather sank down to the right side, not losing consciousness. 
Third. Vomiting occurred as be fell, which had continued from 
time to time. Fourth. Within five minutes alarming failure of 
heart’s action occurred. Fifth. Immediate pain of right leg and 
foot. Sixth. Hemorrhage from wound, though not excessive. 
Seventh. Lowering of the temperature to 98.8 degrees Fahr. dur- 
ing shock. Eighth. Equable, almost normal standard of respira- 
tion. Ninth. Pulse fluctuating from slight causes. Tenth. Pains 
in legs and feet. Eleventh. Slight tympanitis. Negative evi- 
dence existed which seemed to exclude injury having been inflicted 
to either of the following parts, which would in all probability ba7e 
seriously complicated the lease, if not have proved fatal. No ar- 
tery or vein of any considerable siz-i was wounded; neither the lung 
nor pleura was injured; the diaphragm was not injured, nor the 
right kidney; the spinal cord was not injured, nor the ascending 
colon, when not covered by peritoneum. From the President’s 
good general condition up to that time, there appeared a cbauce 
that the peritoneum and the organs invested by it—the liver, 
stomach, small intestine, large intestine and spleen had eecaped in- 
jury. It remained to determine how a bal'et, entering where the 
President was wounded, could escape injuring the right pleura, the 13 
right long, the diaphragm, the peritoneum, the liver, the right kid- 
ney, the ascendiog coIod, the email intestine, or the spinal column, 
and the life of the wounded person be spared, by deflection of the 
bullet in such a peculiar way as to reach one or more of the nerves 
that contributed to the sacral plexus, and which was the cause, 
doubtless, of the pains in the legs and feet.” 
Neither time nor space will allow me to follow up the analysis 
of Prof. Weisse, nor will it be interesting to the majority of the 
readers of your paper. I will here only introduce an extract 
from a let1 er of Prof. Hamilton, one of the great guns of New 
York city, whose reputation as a surgeon I presume Dr. Hammond 
will not gainsay, to Prof. Weisse, in which he remarks : “I have 
from the first sought to encourage you in your present line of study, 
not because I bad by any means dttermined in my own mind the 
course of the bullet, but because it seemed proper to determine 
anatomically all the possibilities in the case.” Now, sir, we read 
Prof Hamilton, an experienced, erudite surgeon, writing that he 
had not by any means determined in his own mind the course the 
bullet had taken, and that after he had seen and presumably had 
made satisfactory, if not a thorough, examination. It is the 
ground taken if not laid down by all teachers of the science and 
are of surgery, as well in their oral teachings as in their writ- 
ings, that none of the great cavities of the body should be probed, 
especially in gunshot wounds ofthe abdominal cavity or of the head, 
lest, in the latter case, if the brain is penetrated by a ball, increas- 
ed injury may be done to that organ. Even if the locality 
of the ball in the brain could be discovered, how could it be got 
out ? In the former case, if the liver or kidney is injured, irre- 
pressible hemorrhage might be occasioned, aud if the intestines were 
penetrated an increased outflow of its contents might be brought 
about, developing fatal peiitonitis. And yet Dr. Hammond has 
the temerity to arraign the surgeons in attendance for not making 
a thorough exploration of the wound, which two of them had al- 
ready done with their fingers, one of them having had the whole 
length of his finger in the wound. 
Again he arraigns them for neglect in not removing the frag- 
ments of clothing and bone, and for neglecting to extract the ball 
while the “strength of the patient was at its maximum.” If these 
gentlemen were so unskillful, why did not the great New York 
surgeon and the g eat Philadelphia surgeon, the consulting sur- 
geons, do this at their first visit to the President? No, they wait 
for days, if not some weeks after, when an abscess has evidently 
formed, and, after a great parade, while the patient was under the 
influence of ether, they open the abscess and discover that there 
was a piece of bone aud a fragment of clothing contained in the 
abscess with the pus. Aud now, while they have ascertained the 
exact position of the ball imbedded in the muscular tissues outside 14 
the peritoneum, they refrain from cutting down and extracting it 
where there are no important blood vessels, no vi’al organ to be 
injured by this surgical procedure. 
My remarks being sufficiently extended, though I might say 
much more about the track of the ball, bow is fills up, and what, 
is the usual course of treatment in such cases, I will finish by say- 
ing that in my judgment Dr. Hammond has violated the code of 
et\ics of the National Medical Association, and if the ball ought 
to be taken out so easily, why does Dr. Hammond not offer to go 
on to Washington and extract the ball, one cause at least of the 
President’s continued suffering? Because it is easier to criticise 
at a distance than to do the right thing in the right place and at 
the right time. 
It is extremely difficult, at times impossible, to follow up the 
track of a ball that has entered the oody. Every surgeon who 
knows anything about gunsLot wounds must coincide wi h me in 
this opinion. A ball entering the body will pursue a straight 
course, unless meeting with an obstacle sufficiently dense and com- 
pact to rpsist and deflect it from its true line or straightforward 
course. What direction it will take depends upon the angle st 
which it impinges upon that bone, or whatever obstacle it encoun- 
ters, in its passage through the tissues of the body. A tendoL has 
been known to do it. If a ball, then, takes another than a direct 
course, it is often impossible for the surgeon to tell where it has 
gone unless it can be felt under the surface, for no probe can be 
made to follow its track, unless it is known where the track lies, 
and the probe can be bent to follow its tortuous course. The sur- 
geons in attendance had every reason to believe at first that the 
ball had penetrated the abdominal cavity, and at least had 
wounded the peritoneum, if nothing more, producing traumatic 
peritonitis, a dangerous kind of inflammation, and apt to terminate 
fatally. 
It is reported in the daily papers that there was a discoloration 
of the skin over the spot which I learn is fixed upon by the eur- 
geons as the present position of the ball, confirmed by the induction 
balance invented by Prof. Bell, a compound of galvanic battery 
and a telephone. It is claimed that this apparatus has shown, with 
reasonable certainty, that the bullet lies in the front wall of the 
abdomen, about five inches to the right and below the navel. If I 
understand rightly that the surgeons located the ball at that place 
indicated by the ecchymosis or discoloration of the skin, it is a mat- 
ter of v;onder to me why they did not cut down at that point and 
remove the ball. In this view of the case, I find fault with the at- 
tendant surgeons for not searching for the ball and cutting down 
and removing it, and after Drs. Hamilton and Agrjew were called 
in why did they not do it is a point I would like to have explained. 
Bat the ball did not pursue the couree indicated, in my humble 15 
judgment, and if I may be allowed to hazard an opinion, when it 
struck the rib, it drove the broken fragment of bone in one direc- 
tion, while it was caused to be deflected obliquely backwards as it 
was impelled on, and will be found somewhere on the left side of 
the body. 
Since I commenced this communication I learn that the Presi- 
dent has had a return of fever and alarming symptoms. If the 
statements are true about the course and position of the ball, I do 
not believe that this is the cause of tis relapse, but that it is mias- 
matic, or as it is fashionable to call it malarial fever assailing an 
already weakened system, predisposed thereby to the poisoned 
emanations of an infected atmosphere. Gov. Blackburn’s idea that 
the spine was injured is, I think, untenable with the light before 
me. None of the symptoms show it, except the pains in the feet 
and legs, which may be accounted for by 4,he nerves springing 
from the spinal marrow and supplying the lower extremities hav- 
ing been injured by the ball. There would have been also para- 
plegia, or paralysis of the lower extremities, in all probability, if, 
the spinal marrow had been wounded. If the surgeons had paid 
less attention to figuring up daily the temperature of the body, 
and frequency of the respiration and pulse, and spent part of that 
time in examining and searching for the ball, I think they would 
have done better. I have indulged in a little criticism myself, it 
is true, above, but it is only on the supposition that the informa- 
tion I have received is correct. 
W. G. BULLOCH, M. D., 
Savannah, Ga.