anomalies and curiosities of medicine-第155部分

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　rods　after　being　shot　with　a　rifle　ball　in　a　similar　manner；　on　the　other　hand；　death　was　practically　instantaneous　in　several　of　these　animals　in　which　the　base　of　the　heart　was　extensively　lacerated。　Again；　death　may　result　instantaneously　from　wounds　of　the　precordial　region；　or　according　to　Erichsen；　if　held　directly　over　the　heart；　from　the　discharge　of　a　pistol　containing　powder　alone；　a　result　occasionally　seen　after　a　blow　on　the　precordial　region。　It　is　well；　however；　to　state　that　in　times　of　excitement；　one　may　receive　an　injury　which　will　shortly　prove　fatal；　and　yet　not　be　aware　of　the　fact　for　some　time；　perhaps　even　for　several　minutes。　It　would　appear　that　the　nervous　system　is　so　highly　tuned　at　such　times；　that　it　does　not　respond　to　reflex　irritations　as　readily　as　in　the　absence　of　excitement。

Instances　of　Survival　after　Cardiac　Injuries。We　briefly　cite　the　principal　interesting　instances　of　cardiac　injuries　in　which　death　has　been　delayed　for　some　time；　or　from　which　the　patient　ultimately　recovered。

Pare　relates　the　case　of　a　soldier　who　received　a　blow　from　a　halberd；　penetrating　the　left　ventricle；　and　who　walked　to　the　surgeon's　tent　to　have　his　wound　dressed　and　then　to　his　own　tent　260　yards　away。　Diemerbroeck　mentions　two　instances　of　long　survival　after　cardiac　injuries；　in　one　of　which　the　patient　ran　60　paces　after　receiving　the　wound；　had　complete　composure　of　mind；　and　survived　nine　days。　There　is　an　instance　in　which　a　man　ran　400　paces　after　penetration　of　the　left　ventricle；　and　lived　for　five　hours。　Morand　gives　an　instance　of　survival　for　five　days　after　wound　of　the　right　ventricle。　Saucerotte　speaks　of　survival　for　three　days　after　injury　to　the　heart。

Babington　speaks　of　a　case　of　heart…injury；　caused　by　transfixion　by　a　bayonet；　in　which　the　patient　survived　nine　hours。　Other　older　cases　are　as　follows：　l'Ecluse；　seven　days；　the　Ephemerides；　four　and　six　days；　Col　de　Vilars；　twelve　days；　Marcucci；　eighteen　days；　Bartholinus；　five　days；　Durande；　five　days；　Boyer；　five　days；　Capelle；　twenty　six　hours；　Fahner；　eleven　days；　Marigues；　thirteen　days；　Morgagni；　eight　days；　la　Motte；　twelve　hours；　Rhodius；　Riedlin；　two　days；　Saviard；　eleven　days；　Sennert；　three　days；　Triller；　fourteen　days；　and　Tulpius；　two　and　fifteen　days；　and　Zittman；　eight　days。

The　Duc　de　Berri；　heir　to　the　French　throne；　who　was　assassinated　in　1826；　lived　several　hours　with　one　of　his　ventricles　opened。　His　surgeon；　Dupuytren；　was　reprimanded　for　keeping　the　wound　open　with　a　probe　introduced　every　two　hours；　but　this　procedure　has　its　advocates　at　the　present　day。　Randall　mentions　a　gunshot　wound　of　the　right　ventricle　which　did　not　cause　death　until　the　sixty…seventh　day。　Grant　describes　a　wound　in　which　a　ball　from　a　revolver　entered　a　little　to　the　right　of　the　sternum；　between　the　cartilages　of　the　5th　and　6th　ribs；　and　then　entered　the　right　ventricle　about　an　inch　from　the　apex。　It　emerged　from　the　lower　part；　passed　through　the　diaphragm；　the　cardiac　end　of　the　stomach；　and　lodged　in　the　left　kidney。　The　patient　remained　in　a　state　of　collapse　fifteen　hours　after　being　shot；　and　with　little　or　no　nourishment　lived　twenty…six　days。　At　the　postmortem　examination　the　wounds　in　the　organs　were　found　to　be　healed；　but　the　cicatrices　were　quite　evident。　Bowling　gives　a　case　of　gunshot　wound　of　the　shoulder　in　which　death　resulted　eleven　weeks　after；　the　bullet　being　found　in　the　left　ventricle　of　the　heart。　Thompson　has　reported　a　bayonet　wound　of　the　heart；　after　the　reception　of　which　the　patient　lived　four　days。　The　bayonet　entered　the　ventricle　about　1　1/2　inches　from　the　left　apex；　traversing　the　left　wall　obliquely；　and　making　exit　close　to　the　septum　ventriculorum。　Roberts　mentions　a　man　who　ran　60　yards　and　lived　one　hour　after　being　shot　through　both　lungs　and　the　right　auricle。　Curran　mentions　the　case　of　a　soldier　who；　in　1809；　was　wounded　by　a　bullet　which　entered　his　body　to　the　left　of　the　sternum；　between　the　2d　and　3d　ribs。　He　was　insensible　a　half　hour；　and　was　carried　aboard　a　fighting　ship　crowded　with　sailors。　There　was　little　hemorrhage　from　his　wound；　and　he　survived　fourteen　days。　At　the　postmortem　examination　some　interesting　facts　were　revealed。　It　was　found　that　the　right　ventricle　was　transversely　opened　for　about　an　inch；　the　ball　having　penetrated　its　anterior　surface；　near　the　origin　of　the　pulmonary　artery。　The　ball　was　found　loose　in　the　pericardium；　where　it　had　fallen　during　the　necropsy。　There　was　a　circular　lacerated　opening　in　the　tricuspid　valve；　and　the　ball　must　have　been　in　the　right　auricle　during　the　fourteen　days　in　which　the　man　lived。　Vite　mentions　an　example　of　remarkable　tenacity　of　life　after　reception　of　a　cardiac　wound；　the　subject　living　four　days　after　a　knife…wound　penetrating　the　chest　into　the　pericardial　sac　and　passing　through　the　left　ventricle　of　the　heart　into　the　opposite　wall。　Boone　speaks　of　a　gunshot　wound　in　which　death　was　postponed　until　the　thirteenth　day。　Bullock　mentions　a　case　of　gunshot　wound　in　which　the　ball　was　found　lodged　in　the　cavity　of　the　ventricle　four　days　and　eighteen　hours　after　infliction　of　the　wound。　Carnochan　describes　a　penetrating　wound　of　the　heart　in　a　subject　in　whom　life　had　been　protracted　eleven　days。　After　death　the　bullet　was　found　buried　and　encysted　in　the　heart。　Holly　reports　a　case　of　pistol…shot　wound　through　the　right　ventricle；　septum；　and　aorta；　with　the　ball　in　the　left　ventricle。　There　was　apparent　recovery　in　fourteen　days　and　sudden　death　on　the　fifty…fifth　day。

Hamilton　gives　an　instance　of　a　shoemaker　sixty…three　years　old　who；　while　carrying　a　bundle；　fell　with　rupture　of　the　heart　and　lived　several　minutes。　On　postmortem　examination　an　opening　in　the　heart　was　found　large　enough　to　admit　a　blowpipe。　Noble　speaks　of　duration　of　life　for　five　and　a　half　days　after　rupture　of　the　heart；　and　there　are　instances　on　record　in　which　life　has　been　prolonged　for　thirteen　hours　and　for　fifty…three　hours　after　a　similar　injury。　Glazebrook　reports　the　case　of　a　colored　man　of　thirty；　of　powerful　physique；　who　was　admitted　to　the　Freedmen's　Hospital；　Washington；　D。C。；　at　12。30　A。M。；　on　February　5；　1895。　Upon　examination　by　the　surgeons；　an　incised　wound　was　discovered　one　inch　above　the　left　nipple；　3　1/4　inches　to　the　left　of　the　median　line；　the　incision　being　2　1/4　inches　in　length　and　its　direction　parallel　with　the　3d　rib。　The　man's　general　condition　was　fairly　good；　and　the　wound　was　examined。　It　was　impossible　to　trace　its　depth　further　than　the　3d　rib；　although　probing　was　resorted　to；　it　was　therefore　considered　a　simple　wound；　and　dressed　accordingly。　Twelve　hours　later　symptoms　of　internal　hemorrhage　were　noticed；　and　at　8　A。M。；　February　6th；　the　man　died　after　surviving　his　injury　thirty…two　hours。　A　necropsy　was　held　three　hours　after　death；　and　an　oblique　incision　3/4　inch　in　length　was　found　through　the　cartilage…end　of　the　3d　rib。　A　similar　wound　was　next　found　in　the　pericardium；　and　upon　examining　the　heart　there　was　seen　a　clean；　incised　wound　1/2　inch　in　length；　directly　into　the　right　ventricle；　the　endocardial　wound　being　3/8　inch　long。　Both　the　pericardium　and　left　pleura　were　distended　with　fresh　blood　and　large　clots。　Church　reports　a　case　of　gunshot　wound　of　the　heart　in　a　man　of　sixty…seven　who　survived　three　hours。　The　wound　had　been　made　by　a　pistol　bullet　（32　caliber）；　was　situated　1　1/4　inches　below　the　mammary　line；　and　slightly　to　the　left　of　the　center　of　the　sternum；　through　it　considerable　blood　had　escaped。　The　postmortem　examination　showed　that　the　ball　had　pierced　the　sternum　just　above　the　xiphoid　cartilage；　and　had　entered　the　pericardium　to　the　right　and　at　the　lower　part。　The　sac　was　filled　with　blood；　both　fresh　and　clotted。　There　was　a　ragged　wound　in　the　anterior　wall　1/2　inch　in　diameter。　The　wound　of　exit　was　5/8　inch　in　diameter。　After　traversing　the　heart　the　ball　had　penetrated　the　diaphragm；　wounded　the　omentum　in　several　places；　and　become　lodged　under　the　skin　posteriorly　between　the　9th　and　10th　ribs。　Church　adds　that　the　〃Index　Catalogue　of　the　Surgeon…General's　Library〃　at　Washington　contains　22　cases　of　direct　injury　to　the　heart；　all　of　which　lived　longer　than　his　case：　17　lived　over　three　days；　eight　lived　over　ten　days；　two　lived　over　twenty…five　days；　one　died　on　the　fifty…fifth　day；　and　there　were　three　well…authenticated　recoveries。　Purple　tabulates　a　list　of　42　cases　of　heart…injury　which　survived　from　thirty　minutes　to　seventy　days。

Fourteen　instances　of　gunshot　wounds　of　the　heart　have　been　collected　from　U。S。　Army　reports；　in　all　of　which　death　followed　very　promptly；　except　in　one　instance　in　which　the　patient　survived　fifty　hours。　In　another　case　the　patient　lived　twenty…six　hours　after　reception　of　the　injury；　the　conical　pistol…ball　passing　through　the　anterior　margin　of　the　right　lobe　of　the　lung　into　the　pericardium；　through　the　right　auricle；　and　again　entered　the　right　pleural　cavity；　passing　through　the　posterior　margin　of　the　lower　lobe　of　the　right　lung；　at　the　autopsy　it　was　found　in　the　right　pleural　cavity。　The　left　lung　and　cavity　were　perfectly　normal。　The　right　lung　was　engorged　and　somewhat　compressed　by　the　blood　in　the　pleural　cavity。　The　pericardium　was　much　distended　and　contained　from　six　to　eight　ounces　of　partially　coagulated　blood。　There　was　a　fibrinous　clot　in　the　left　ventricle。

Nonfatal　Cardiac　Injuries。Wounds　of　the　heart　are　not　necessarily　fatal。　Of　401　cases　of　cardiac　injury　collected　by　Fischer　there　were　as　many　as　50　recoveries；　the　diagnosis　being　confirmed　in　33　instances　by　an　autopsy　in　which　there　were　found　distinct　signs　of　the　cardiac　injury。　By　a　peculiar　arrangement　of　the　fibers　of　the　heart；　a　wound　transverse　to　one　layer　of　fibers　is　in　the　direction　of　another　layer；　and　to　a　certain　extent；　therefore；　valvular　in　function；　it　is　probably　from　this　fact　that　punctured　wounds　of　the　heart　are　often　attended　with　little　or　no　bleeding。

Among　the　older　writers；　several　instances　of　nonfatal　injuries　to　the　heart　are　recorded。　Before　the　present　century　scientists　had　observed　game…animals　that　had　been　wounded　in　the　heart　in　the　course　of　their　lives；　and　after　their　ultimate　death　such　direc