About this stage of
the operation an unfortunate accident happened--the 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.
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