anomalies and curiosities of medicine-第156部分

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ad　been　wounded　in　the　heart　in　the　course　of　their　lives；　and　after　their　ultimate　death　such　direct　evidence　as　the　presence　of　a　bullet　or　an　arrow　in　their　hearts　was　found。　Rodericus　a　Veiga　tells　the　story　of　a　deer　that　was　killed　in　hunting；　and　in　whose　heart　was　fixed　a　piece　of　arrow　that　appeared　to　have　been　there　some　time。　Glandorp　experimentally　produced　a　nonfatal　wound　in　the　heart　of　a　rabbit。　Wounds　of　the　heart；　not　lethal；　have　been　reported　by　Benivenius；　Marcellus　Donatus；　Schott；　Stalpart　van　der　Wiel；　and　Wolff。　Ollenrot　reports　an　additional　instance　of　recovery　from　heart…injury；　but　in　his　case　the　wound　was　only　superficial。

There　is　a　recent　case　of　a　boy　of　fourteen；　who　was　wounded　in　the　heart　by　a　pen…knife　stab。　The　boy　was　discharged　cured　from　the　Middlesex　Hospital；　but　three　months　after　the　reception　of　the　injury　he　was　taken　ill　and　died。　A　postmortem　examination　showed　that　the　right　ventricle　had　been　penetrated　in　a　slanting　direction；　the　cause　of　death　was　apoplexy；　produced　by　the　weakening　and　thinning　of　the　heart's　walls；　the　effect　of　the　wound。　Tillaux　reports　the　case　of　a　man　of　sixty…five；　the　victim　of　general　paralysis；　who　passed　into　his　chest　a　blade　16　cm。　long　and　2　mm。　broad。　The　wound　of　puncture　was　5　cm。　below　the　nipple　and　2　cm。　to　the　outside。　The　left　side　of　the　chest　was　emphysematous　and　ecchymosed。　The　heart…sounds　were　regular；　and　the　elevation　of　the　skin　by　the　blade　coincided　with　the　ventricular　systole。　The　blade　was　removed　on　the　following　day；　and　the　patient　gradually　improved。　Some　thirteen　months　after　he　had　expectoration　of　blood　and　pus　and　soon　died。　At　the　necropsy　it　was　seen　that　the　wound　had　involved　both　lungs；　the　posterior　wall　of　the　ventricle　and　the　inferior　lobe　of　the　right　lung　were　traversed　from　before　backward；　and　from　left　to　right；　but　the　ventricular　cavity　was　not　penetrated。　Strange　to　say；　the　blade　had　passed　between　the　vertebral　column　and　the　esophagus；　and　to　the　right　of　the　aorta；　but　had　wounded　neither　of　these　organs。

O'Connor　mentions　a　graduate　of　a　British　University　who；　with　suicidal　intent；　transfixed　his　heart　with　a　darning…needle。　It　was　extracted　by　a　pair　of　watchmaker's　pliers。　In　five　days　the　symptoms　had　all　abated；　and　the　would…be　suicide　was　well　enough　to　start　for　the　Continent。　Muhlig　was　consulted　by　a　mason　who；　ten　years　before；　had　received　a　blow　from　a　stiletto　near　the　left　side　of　the　sternum。　The　cicatrix　was　plainly　visible；　but　the　man　said　he　had　been　able　to　perform　his　daily　labors；　although　at　the　present　time　suffering　from　intense　dyspnea　and　anasarca。　A　loud　bellows…sound　could　be　heard；　which　the　man　said　had　been　audible　since　the　time　of　reception　of　the　injury。　This　was　a　double　bruit　accompanying　systole；　and　entirely　obscuring　the　physical　signs。　From　this　time　the　man　speedily　failed；　and　after　his　death　there　were　cicatricial　signs　found；　particularly　on　the　wall　of　the　left　ventricle；　together　with　patency　of　the　interventricular　septum；　with　signs　of　cicatrization　about　this　rent。　At　the　side　of　the　left　ventricle　the　rent　was　twice　as　large　and　lined　with　cicutricial　tissue。

Stelzner　mentions　a　young　student　who　attempted　suicide　by　thrusting　a　darning…needle　into　his　heart。　He　complained　of　pain　and　dyspnea；　in　twenty…four　hours　his　symptoms　increased　to　such　an　extent　that　operation　was　deemed　advisable　on　account　of　collapse。　The　5th　rib　was　resected　and　the　pleural　cavity　opened。　When　the　pericardial　sac　was　incised；　a　teaspoonful　of　turbid　fluid　oozed　out；　and　the　needle　was　felt　in　an　oblique　position　in　the　right　ventricle。　By　pressure　of　a　finger　passed　under　the　heart；　the　eye　of　the　needle　was　pressed　through　the　anterior　wall　and　fixed　on　the　operator's　finger…nail。　An　attempt　to　remove　by　the　forceps　failed；　as　the　violent　movements　of　the　heart　drew　the　needle　back　into　the　cavity。　About　this　stage　of　the　operation　an　unfortunate　accident　happenedthe　iodoform　tampon；　which　protected　the　exposed　pleural　cavity；　was　drawn　into　this　cavity　during　a　deep　inspiration；　and　could　not　be　found。　Notwithstanding　subsequent　pneumothorax　and　extensive　pleuritic　effusion；　the　patient　made　a　good　recovery　at　the　end　of　the　fourth　week　and　at　the　time　of　report　it　was　still　uncertain　whether　the　needle　remained　in　the　heart　or　had　wandered　into　the　mediastinum。　During　the　discussion　which　followed　the　report　of　this　case；　Hahn　showed　a　portion　of　a　knitting…needle　which　had　been　removed　from　the　heart　of　a　girl　during　life。　The　extraction　was　very　slow　in　order　to　allow　of　coagulation　along　the　course　of　the　wound　in　the　heart；　and　to　guard　against　hemorrhage　into　the　pericardial　sac；　which　is　so　often　the　cause　of　death　in　punctured　wounds　of　this　organ。　Hahn　remarked　that　the　pulse；　which　before　the　removal　had　been　very　rapid；　sank　to　90。

Marks　reports　the　case　of　a　stab…wound　penetrating　the　left　9th　intercostal　space；　the　diaphragm；　pleura；　pericardium；　and　apex　of　the　heart。　It　was　necessary　to　enlarge　the　wound；　and；　under　an　anesthetic；　after　removing　one　and　one…half　inches　of　the　9th　and　10th　ribs；　the　wound　was　thoroughly　packed　with　iodoform　gauze　and　in　twenty…one　days　the　patient　recovered。　Lavender　mentions　an　incised　wound　of　the　heart　penetrating　the　right　ventricle；　from　which　the　patient　recovered。　Purple　gives；　an　account　of　a　recovery　from　a　wound　penetrating　both　ventricles。　The　diagnosis　was　confirmed　by　a　necropsy　nine　years　thereafter。　Stoll　records　a　nonfatal　injury　to　the　heart。

Mastin　reports　the　case　of　a　man　of　thirty…two　who　was　shot　by　a　38…caliber　Winchester；　from　an　ambush；　at　a　distance　of　110　yards。　The　ball　entered　near　the　chest　posteriorly　on　the　left　side　just　below　and　to　the　outer　angle　of　the　scapula；　passed　between　the　7th　and　8th　ribs；　and　made　its　exit　from　the　intercostal　space　of　the　4th　and　5th　ribs；　2　1/4　inches　from　the　nipple。　A　line　drawn　from　the　wound　of　entrance　to　that　of　exit　would　pass　exactly　through　the　right　ventricle。　After　receiving　the　wound　the　man　walked　about　twenty　steps；　and　then；　feeling　very　weak　from　profuse　hemorrhage　from　the　front　of　the　wound；　he　sat　down。　With　little　or　no　treatment　the　wound　closed　and　steady　improvement　set　in；　the　patient　was　discharged　in　three　weeks。　As　the　man　was　still　living　at　last　reports；　the　exact　amount　of　damage　done　in　the　track　of　the　bullet　is　not　known；　although　Mastin's　supposition　is　that　the　heart　was　penetrated。

Mellichamp　speaks　of　a　gunshot　wound　of　the　heart　with　recovery；　and　Ford　records　an　instance　in　which　a　wound　of　the　heart　by　a　buckshot　was　followed　by　recovery。　O'Connor　reports　a　case　under　his　observation　in　which　a　pistol…ball　passed　through　three　of　the　four　cavities　of　the　heart　and　lodged　in　the　root　of　the　right　lung。　The　patient；　a　boy　of　fifteen；　died　of　the　effects　of　cardiac　disease　three　years　and　two　months　later。　Bell　mentions　a　case　in　which；　six　years　after　the　receipt　of　a　gunshot　wound　of　the　chest；　a　ball　was　found　in　the　right　ventricle。　Christison　speaks　of　an　instance　in　which　a　bullet　was　found　in　the　heart　of　a　soldier　in　Bermuda；　with　no　apparent　signs　of　an　opening　to　account　for　its　entrance。　There　is　a　case　on　record　of　a　boy　of　fourteen　who　was　shot　in　the　right　shoulder；　the　bullet　entering　through　the　right　upper　border　of　the　trapezius；　two　inches　from　the　acromion　process。　Those　who　examined　him　supposed　the　ball　was　lodged　near　the　sternal　end　of　the　clavicle；　four　or　five　inches　from　where　it　entered。　In　about　six　weeks　the　boy　was　at　his　labors。　Five　years　later　he　was　attacked　with　severe　pneumonia　and　then　first　noticed　tumultuous　action　of　the　heart　which　continued　to　increase　after　his　recovery。　Afterward　the　pulsation　could　be　heard　ten　or　12　feet　away。　He　died　of　another　attack　of　pneumonia　fifteen　years　later　and　the　heart　was　found　to　be　two　or　three　times　its　natural　size；　soft　and　flabby；　and；　on　opening　the　right　ventricle；　a　bullet　was　discovered　embedded　in　its　walls。　There　was　no　scar　of　entrance　discernible；　though　the　pericardium　was　adherent。　Biffi　of　Milan　describes　the　case　of　a　lunatic　who　died　in　consequence　of　gangrene　of　the　tongue　from　a　bite　in　a　paroxysm　of　mania。　At　the　necropsy　a　needle；　six　cm。　in　length；　was　found　transfixing　the　heart；　with　which　the　relatives　of　the　deceased　said　he　had　stabbed　himself　twenty…two　months　prior　to　his　death。　There　is　a　collection　of　cases　in　which　bullets　have　been　lodged　in　the　heart　from　twenty　to　thirty　years。

Balch　reports　a　case　in　which　a　leaden　bullet　remained　twenty　years　in　the　walls　of　the　heart。　Hamilton　mentions　an　instance　of　gunshot　wound　of　the　heart；　in　which　for　twenty　years　a　ball　was　embedded　in　the　wall　of　the　right　ventricle；　death　ultimately　being　caused　by　pneumonia。　Needles　have　quite　frequently　been　found　in　the　heart　after　death；　Graves；　Leaming；　Martin；　Neill；　Piorry；　Ryerson；　and　others　record　such　cases。　Callender　mentions　recovery　of　the　patient　after　removal　of　a　needle　from　the　heart。

Garangeot　mentions　an　aged　Jesuit　of　seventy…two；　who　had　in　the　substance　of　his　heart　a　bone　4　1/2　inches　long　and　possibly　an　inch　thick。　This　case　is　probably　one　of　ossification　of　the　cardiac　muscle；　in　the　same　connection　Battolini　says　that　the　heart　of　Pope　Urban　VII　contained　a　bone　shaped　like　the　Arab　T。

Among　the　older　writers　we　frequently　read　of　hairs；　worms；　and　snakes　being　found　in　the　cavities　of　the　heart。　The　Ephemerides；　Zacutus　Lusitanus；　Pare；　Swinger；　Riverius；　and　Senac　are　among　the　authorities　who　mention　this　circumstance。　The　deception　was　possibly　due　to　the　presence　of　loose　and　shaggy　membrane　attached　to　the　endocardial　lining　of　the　heart；　or　in　some　cases　to　echinococci　or　trichine。　A　strange　case　of　foreign　body　in　the　heart　was　reported　some　time　since　in　England。　The　patient　had　swallowed　a　thorn　of　the　Prunus　spinosa　（Linn。）；　which　had　penetrated　the　esophagus　and　the　pericardium　and　entered　the　heart。　A　postmortem　examination　one　year　afterward　confirmed　this；　as　a　contracted　cicatrix　was　plainly　visible　on　the　posterior　surface　of　the　heart　about　an　inch　above　the　apex；　through　which　the　thorn　had　penetrated　the　right　ventricle　and　lodged　in　the　tricuspid　valve。　The