postmortem examination, by revealing the presence of
cicatrices in the heart, confirming the original diagnosis. This
question is one of great interest as, in recent years, there has been
constant agitation of the possibility of surgical procedures in cardiac
as well as cerebral injuries. Del Vecchio has reported a series of
experiments on dogs with the conclusion that in case of wounds in human
beings suture of the heart is a possible operation. In this connection
he proposes the following operative procedure: Two longitudinal
incisions to be made from the lower border of the 3d rib to the upper
border of the 7th rib, one running along the inner margin of the
sternum, the other about ten mm. inside the nipple-line. These
incisions are joined by a horizontal cut made in the fourth intercostal
space. The 4th, 5th, and 6th ribs and cartilages are divided and the
outer cutaneous flaps turned up; pushing aside the pleura with the
finger, expose the pericardium and incise it longitudinally; suture the
heart-wound by interrupted sutures. Del Vecchio adds that Fischer has
collected records of 376 cases of wounds of the heart with a mortality
two to three minutes after the injury of 20 per cent. Death may occur
from a few seconds to nine months after the accident. Keen and Da Costa
quote Del Vecchio, and, in comment on his observations, remark that
death in cases of wound of the heart is due to pressure of effused
blood in the pericardial sac, and, because this pressure is itself a
cheek to further hemorrhage, there seems, as far as hemorrhage is
concerned, to be rather a question whether operative interference may
not be itself more harmful than beneficial. It might be added that the
shock to the cardiac action might be sufficient to check it, and at
present we would have no sure means of starting pulsation if once
stopped. In heart-injuries, paracentesis, followed, if necessary, by
incision of the pericardium, is advised by some surgeons.

Realizing the fatality of injuries of the heart, in consequence of
which almost any chance by operation should be quickly seized by
surgeons rather than trust the lives of patients to the infinitesimal
chance of recovery, it would seem that the profession should carefully
consider and discuss the feasibility of any procedure in this
direction, no matter how hypothetic.

Hall states that his experience in the study of cardiac wounds, chiefly
on game-animals, would lead him to the conclusion