The Case of the Sick Statesman With a Bullet in His Belly

Albert B. Lowenfels, MD

Disclosures

March 23, 2010

The Case

The patient was a 49-year-old man who enjoyed good health until the day prior to his death when he was injured in a duel with a political enemy.

Medical and Family History

His mother died of fever at age 38 (1767) when the patient was 12 years old. The father's health status is unknown. He had one older brother without known health problems.

Prior to this injury, the patient had occasional attacks of fever thought to be caused by malaria, but he was otherwise free of major physical symptoms. However, throughout his life he had intermittent bouts of depression. He drank alcohol but did not smoke cigarettes. At the time of his death, he was married with 7 children; one son died at age 19 from a gunshot wound.

Course of Illness

The patient was shot at close range, with the bullet entering the right side of the abdomen above the hip. The patient immediately collapsed and his physician rushed up to him. Just before becoming unconscious, the patient said, "This is a mortal wound, doctor." His pulse was not palpable, but after application of ammoniated spirits, he revived somewhat, saying, "My vision is indistinct." Palpation of the abdomen was painful. He had no sensation in his lower extremities, but his back was painful. He was seen by several other physicians, all of whom agreed that the patient had sustained a fatal injury. To relieve his pain, he received several doses of an opiate. He remained conscious and lucid, but died quietly about 30 hours after the injury without regaining the use of his lower extremities.

Autopsy Findings

After the patient's death, his friend and physician performed an autopsy limited to the abdomen. The description of the findings is as follows: "The ball struck the second or third false rib...then passed through the liver and diaphragm, and [appeared] to lodge in the first or second lumbar vertebra...which was considerably splintered so that spiculae were distinctly perceptible. About a pint of clotted blood was found in the cavity of the belly."

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