per bag when struck by the hand. Other observers discard
this theory of M. Gosselin and claim that the rupture is due to direct
pressure, as in the cases in which the heart is ruptured without
fracture of the ribs. The theory of Gosselin would not explain these
cardiac ruptures from external violence on the thoracic walls, and,
therefore, was rejected by some. Pare, Morgagni, Portal, Hewson Smith,
Dupuytren, Laennec, and others mention this injury. Gosselin reports
two cases terminating in recovery. Ashurst reports having seen three
cases, all of which terminated fatally before the fifth day; he has
collected the histories of 39 cases, of which 12 recovered. Otis has
collected reports of 25 cases of this form of injury from military
practice exclusively. These were generally caused by a blow on the
chest, by a piece of shell, or other like missile. Among the 25 cases
there were 11 recoveries. As Ashhurst very justly remarks, this injury
appears more fatal in civil than in military life.

Pyle reports a case successfully treated, as follows:--

"Lewis W., ten years old, white, born in Maryland, and living now in
the District of Columbia, was brought in by the Emergency Hospital
ambulance, on the afternoon of November 10th, with a history of having
been run over by a hose-cart of the District Fire Department. The boy
was in a state of extreme shock, having a weak, almost imperceptible
pulse; his respirations were shallow and rapid, and his temperature
subnormal. There were no signs of external injury about his thoracic
cavity and no fracture of the ribs could be detected, although
carefully searched for; there was marked emphysema; the neck and side
of the face were enormously swollen with the extravasated air; the
tissues of the left arm were greatly infiltrated with air, which
enabled us to elicit the familiar crepitus of such infiltration when an
attempt at the determination of the radial pulse was made.
Consciousness was never lost. There were several injuries to the face
and scalp; and there was hemorrhage from the nose and mouth, which was
attributed to the fact that the patient had fallen on his face,
striking both nose and lip. This was confirmed subsequently by the
absence of any evidences of hemoptysis during the whole period of
convalescence. The saliva was not even blood-streaked; therefore, it
can be said with verity that there was no hemoptysis. Shortly after
admission the patient reacted to the stimulati