that transverse
wounds the lower portions of the heart, giving rise to punctures rather
than extensive lacerations, do not commonly cause cessation of life for
a time varying from some considerable fraction of a minute to many
minutes or even hours, and especially if the puncture be valvular in
character, so as to prevent the loss of much blood. However, if the
wound involve the base of the organ, with extensive laceration of the
surrounding parts, death is practically instantaneous. It would seem
that injury to the muscular walls of the heart is much less efficient
in the production of immediate death than destruction of the cardiac
nervous mechanism, serious irritation of the latter producing almost
instantaneous death from shock. In addition, Hall cites several of the
instances on which he based his conclusions. He mentions two wild geese
which flew respectively 1/4 and 3/4 of a mile after having been shot
through the heart, each with a pellet of BB shot, the base in each
instance being uninjured; in several instances antelope and deer ran
several rods after being shot with a rifle ball in a similar manner; on
the other hand, death was practically instantaneous in several of these
animals in which the base of the heart was extensively lacerated.
Again, death may result instantaneously from wounds of the precordial
region, or according to Erichsen, if held directly over the heart, from
the discharge of a pistol containing powder alone, a result
occasionally seen after a blow on the precordial region. It is well,
however, to state that in times of excitement, one may receive an
injury which will shortly prove fatal, and yet not be aware of the fact
for some time, perhaps even for several minutes. It would appear that
the nervous system is so highly tuned at such times, that it does not
respond to reflex irritations as readily as in the absence of
excitement.

Instances of Survival after Cardiac Injuries.--We briefly cite the
principal interesting instances of cardiac injuries in which death has
been delayed for some time, or from which the patient ultimately
recovered.

Pare relates the case of a soldier who received a blow from a halberd,
penetrating the left ventricle, and who walked to the surgeon's tent to
have his wound dressed and then to his own tent 260 yards away.
Diemerbroeck mentions two instances of long survival after cardiac
injuries, in one of which the patient ran 60 paces after receiving the
wound,