ove the left nipple, 3 1/4 inches to
the left of the median line, the incision being 2 1/4 inches in length
and its direction parallel with the 3d rib. The man's general condition
was fairly good, and the wound was examined. It was impossible to trace
its depth further than the 3d rib, although probing was resorted to; it
was therefore considered a simple wound, and dressed accordingly.
Twelve hours later symptoms of internal hemorrhage were noticed, and at
8 A.M., February 6th, the man died after surviving his injury
thirty-two hours. A necropsy was held three hours after death, and an
oblique incision 3/4 inch in length was found through the cartilage-end
of the 3d rib. A similar wound was next found in the pericardium, and
upon examining the heart there was seen a clean, incised wound 1/2 inch
in length, directly into the right ventricle, the endocardial wound
being 3/8 inch long. Both the pericardium and left pleura were
distended with fresh blood and large clots. Church reports a case of
gunshot wound of the heart in a man of sixty-seven who survived three
hours. The wound had been made by a pistol bullet (32 caliber), was
situated 1 1/4 inches below the mammary line, and slightly to the left
of the center of the sternum; through it considerable blood had
escaped. The postmortem examination showed that the ball had pierced
the sternum just above the xiphoid cartilage, and had entered the
pericardium to the right and at the lower part. The sac was filled with
blood, both fresh and clotted. There was a ragged wound in the anterior
wall 1/2 inch in diameter. The wound of exit was 5/8 inch in diameter.
After traversing the heart the ball had penetrated the diaphragm,
wounded the omentum in several places, and become lodged under the skin
posteriorly between the 9th and 10th ribs. Church adds that the "Index
Catalogue of the Surgeon-General's Library" at Washington contains 22
cases of direct injury to the heart, all of which lived longer than his
case: 17 lived over three days; eight lived over ten days; two lived
over twenty-five days; one died on the fifty-fifth day, and there were
three well-authenticated recoveries. Purple tabulates a list of 42
cases of heart-injury which survived from thirty minutes to seventy
days.

Fourteen instances of gunshot wounds of the heart have been collected
from U.S. Army reports, in all of which death followed very promptly,
except in one instance in which the patient survived fifty