anomalies and curiosities of medicine-第157部分

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；　through　which　the　thorn　had　penetrated　the　right　ventricle　and　lodged　in　the　tricuspid　valve。　The　supposition　was　that　the　thorn　had　been　swallowed　while　eating　radishes。　Buck　mentions　a　case　of　hydatid　cysts　in　the　wall　of　the　left　ventricle；　with　rupture　of　the　cysts　and　sudden　death。

It　is　surprising　the　extent　of　injury　to　the　pericardium　Nature　will　tolerate。　In　his　〃Comment　on　the　Aphorisms　of　Hippocrates；〃　Cardanus　says　that　he　witnessed　the　excision　of　a　portion　of　the　pericardium　with　the　subsequent　cure　of　the　patient。　According　to　Galen；　Marulus；　the　son　of　Mimographus；　recovered　after　a　similar　operation。　Galen　also　adds；　that　upon　one　occasion　he　removed　a　portion　of　carious　sternum　and　found　the　pericardium　in　a　putrid　state；　leaving　a　portion　of　the　heart　naked。　It　is　said　that　in　the　presence　of　Leucatel　and　several　theologians；　Francois　Botta　opened　the　body　of　a　man　who　died　after　an　extended　illness　and　found　the　pericardium　putrefied　and　a　great　portion　of　the　heart　destroyed；　but　the　remaining　portion　still　slightly　palpitating。　In　this　connection　Young　mentions　a　patient　of　sixty…five　who　in　January；　1860；　injured　his　right　thumb　and　lost　the　last　joint　by　swelling　and　necrosis。　Chloroform　was　administered　to　excise　a　portion　of　the　necrosed　bone　and　death　ensued。　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。　The　longest　period　during　which　any　patient　survived　the　injury　was　fourteen　hours。

Among　the　older　writers　who　note　this　traumatic　injury　are　Fine；　who　mentions　concussion　rupturing　the　right　ventricle；　and　Ludwig；　who　reports　a　similar　accident。　Johnson　mentions　rupture　of　the　left　ventricle　in　a　paroxysm　of　epilepsy。　There　is　another　species　of　rupture　of　the　heart　which　is　not　traumatic；　in　which　the　rupture　occurs　spontaneously；　the　predisposing　cause　being　fatty　degeneration；　dilatation；　or　some　other　pathologic　process　in　the　cardiac　substance。　It　is　quite　possible　that　the　older　instances　of　what　was　known　as　〃broken…heart；〃　which　is　still　a　by…word；　were　really　cases　in　which　violent　emotion　had　produced　rupture　of　a　degenerated　cardiac　wall。　Wright　gives　a　case　of　spontaneous　rupture　of　the　heart　in　which　death　did　not　occur　for　forty…eight　hours。　Barth　has　collected　24　cases　of　spontaneous　rupture　of　the　heart；　and　in　every　instance　the　seat　of　lesion　was　in　the　left　ventricle。　It　was　noticed　that　in　some　of　these　cases　the　rupture　did　not　take　place　all　at　once；　but　by　repeated　minor　lacerations；　death　not　ensuing　in　some　instances　for　from　two　to　eleven　days　after　the　first　manifestation　of　serious　symptoms。　A　more　recent　analysis　is　given　by　Meyer　of　cases　reported　since　1870：　Meyer　collects　25　cases　of　rupture　of　the　left　ventricle　seven　of　the　right　ventricle；　and　four　of　the　right　auricle。　Within　the　last　year　Collings　has　reported　a　case　of　idiopathic　rupture　of　the　heart　in　a　man　of　fifty…three；　who　had　always　lived　a　temperate　life；　and　whose　only　trouble　had　been　dyspepsia　and　a　weak　heart。　There　was　no　history　of　rheumatism　or　rheumatic　fever。　The　man's　father　had　died　suddenly　of　heart　disease。　After　feeling　out　of　sorts　for　a　time；　the　man　experienced　severe　pain　in　the　precordium　and　felt　too　ill　to　leave　his　bed。　He　gradually　became　worse　and　sick　after　taking　food。　Speech　became　thick；　the　mouth　was　drawn　to　the　right；　and　the　right　eye　was　partially　closed。　The　left　arm　became　paralyzed；　then　the　right　leg。　The　tongue　deviated　to　the　right　on　protrusion。　The　sphincters　were　unaffected。　The　heart　sounds　were　faint　and　without　added　sounds。　The　man　was　moved　to　a　water…bed；　his　body　and　head　being　kept　horizontal；　and　great　care　being　taken　to　avoid　sudden　movement。　Later；　when　his　pelvis　was　raised　to　allow　the　introduction　of　a　bed…pan；　almost　instantaneous　death　ensued。　Upon　postmortem　examination　prolonged　and　careful　search　failed　to　reveal　any　microscopic　change　in　the　brain；　its　vessels；　or　the　meninges。　On　opening　the　pericardium　it　was　found　to　be　filled　with　blood…clot；　and　on　washing　this　away　a　laceration　about　1　1/2　inches　in　length　was　found　in　the　left　ventricle；　the　aperture　was　closed　by　a　recent　clot。　The　cavities　of　the　heart　were　dilated；　the　walls　thin　and　in　advanced　stage　of　fatty　degeneration。　There　was　no　valvular　disease。　The　aorta　and　its　main　branches　were　atheromatous。　Both　lungs　contained　calcifying　tubercle；　the　abdomen　was　loaded　with　fat；　the　spleen　was　soft；　the　kidneys　were　engorged；　but　otherwise　healthy。

Stokes　gives　the　case　of　a　man　who　was　severely　crushed　between　the　arms　of　a　water…wheel　of　great　size　and　the　embankment　on　which　the　axle　of　the　wheel　was　supported；　a　peculiar　factor　of　the　injury　being　that　his　heart　was　displaced　from　left　to　right。　At　the　time　of　report；　after　recovery　from　the　injury；　the　patient　exhibited　remarkable　tolerance　of　great　doses　of　digitalis。　When　not　taking　digitalis；　his　pulse　was　100　to　120；　regular；　and　never　intermittent。

Hypertrophy　of　the　Heart。The　heart　of　a　man　of　ordinary　size　weighs　nine　ounces；　and　that　of　a　woman　eight；　in　cases　of　hypertrophy；　these　weights　may　be　doubled；　although　weights　above　25　ounces　are　rare。　According　to　Osler；　Beverly　Robinson　describes　a　heart　weighing　53　ounces；　and　Dulles　has　reported　one　weighing　48　ounces。　Among　other　modern　records　are　the　following：　Fifty　and　one…half　ounces；　57　ounces；　and　one　weighing　four　pounds　and　six　ounces。　The　Ephemerides　contains　an　incredible　account　of　a　heart　that　weighed　14　pounds。　Favell　describes　a　heart　that　only　weighed　3　1/2　ounces。

Wounds　of　the　aorta　are　almost　invariably　fatal；　although　cases　are　recorded　by　Pelletan；　Heil；　Legouest；　and　others；　in　which　patients　survived　such　wounds　for　from　two　months　to　several　years。　Green　mentions　a　case　of　stab…wound　in　the　suprasternal　fossa。　The　patient　died　one　month　after　of　another　cause；　and　at　the　postmortem　examination　the　aorta　was　shown　to　have　been　opened；　the　wound　in　its　walls　was　covered　with　a　spheric；　indurated　coagulum。　No　attempt　at　union　had　been　made。

Zillner　observed　a　penetrating　wound　of　the　aorta　after　which　the　patient　lived　sixteen　days；　finally　dying　of　pericarditis。　Zillner　attributed　this　circumstance　to　the　small　size　of　the　wound；　atheroma　and　degeneration　of　the　aorta　and　slight　retraction　of　the　inner　coat；　together　with　a　possible　plugging　of　the　pericardial　opening。　In　1880　Chiari　said　that　while　dissecting　the　body　of　a　man　who　died　of　phthisis；　he　found　a　false　aneurysm　of　the　ascending　aorta　with　a　transverse　rupture　of　the　vessel　by　the　side　of　it；　which　had　completely　cicatrized。　Hill　reports　the　case　of　a　soldier　who　was　stabbed　with　a　bowie…knife　nine　inches　long　and　three　inches　wide。　The　blade　passed　through　the　diaphragm；　cut　off　a　portion　of　the　liver；　and　severed　the　descending　aorta　at　a　point　about　the　7th　dorsal　vertebra；　the　soldier　lived　over　three　hours　after　complete　division　of　this　important　vessel。　Heil　reports　the　case　of　a　man　of　thirty…two；　a　soldier　in　the　Bavarian　army；　who；　in　a　quarrel　in　1812；　received　a　stab　in　the　right　side。　The　instrument　used　was　a　common　table…knife；　which　was　passed　between　the　5th　and　6th　ribs；　entering　the　left　lung；　and　causing　copious　hemorrhage。　The　patient　recovered　in　four　months；　but　suffered　from　amaurosis　which　had　commenced　at　the　time　of　the　stab。　Some　months　afterward　he　contracted　pneumonia　and　was　readmitted　to　the　hospital；　dying　in　1813。　At　the　postmortem　the　cicatrix　in　the　chest　was　plainly　visible；　and　in　the　ascending　aorta　there　was　seen　a　wound；　directly　in　the　track　of　the　knife；　which　was　of　irregular　border　and　was　occupied　by　a　firm　coagulum　of　blood。　The　vessel　had　been　completely　penetrated；　as；　by　laying　it　open；　an　internal　cicatrix　was　found　corresponding　to　the　other。　Fatal　hemorrhage　had　been　avoided　in　this　case　by　the　formation　of　coagulum　in　the　wound　during　the　syncope　immediately　following　the　stab；　possibly　aided　by　extended　exposure　to　cold。

Sundry　Cases。Sandifort　mentions　a　curious　case　of　coalescence　of　the　esophagus　and　aorta；　with　ulceration　and　consequent　rupture　of　the　aorta；　the　hemorrhage　proceeding　from　the　stomach　at　the　moment　of　rupture。

Heath　had　a　case　of　injury　to　the　external　iliac　artery　from　external　violence；　with　subsequent　obliteration　of　the　vessel。　When　the　patient　was　discharged　no　pulse　could　be　found　in　the　leg。

Dismukes　reports　a　case　in　which　the　patient　had　received　13　wounds；　completely　severing　the　subclavian　artery；　and；　without　any　medical　or　surgical　aid；　survived　the　injury　two　hours。

Illustrative　of　the　degree　of　hemorrhage　which　may　follow　an　injury　so　slight　as　that　of　falling　on　a　needle　we　cite　an　instance；　reported　by　a　French　authority；　of　a　child　who　picked　up　a　needle；　and；　while　running　with　it　to　its　mother；　stumbled　and　fell；　the　needle　penetrating　the　4th　intercostal　space；　the　broadened　end　of　it　remaining　outside　of　the　wound。　The　mother　seized　the　needle　be