Postmortem
examination revealed gangrene of the heart and a remarkable
tendency to gangrene elsewhere (omentum, small intestines, skin,
etc.). Recently, Dalton records a remarkable case of stab-wound
of the pericardium with division of the intercostal artery, upon
which he operated. An incision eight inches long was made over
the 4th rib, six inches of the rib were resected, the bleeding
intercostal artery was ligated, the blood was turned out of the
pericardial cavity, this cavity being irrigated with hot water.
The wound in the pericardium, which was two inches long, was
sutured and the external wound was closed. Recovery followed.
Harris gives an instance of a man who was injured by a bar of
iron falling on his shoulder, producing a compound fracture of
the ribs as low as the 7th, and laying the heart and lungs bare
without seriously injuring the pericardium.
Rupture of the heart from contusion of the chest is not always
instantly fatal. According to Ashhurst, Gamgee has collected 28
cases of rupture of this viscus, including one observed by
himself. In nine of these cases there was no fracture, and either
no bruise of the parietes or a very slight one. The pericardium
was intact in at least half of the cases, and in 22 in which the
precise seat of lesion was noticed the right ventricle was
ruptured in eight, the left in three, the left auricle in seven,
the right in four.
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