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 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.
