alen 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.

Rupture of the heart from contusion of the chest is not always
instantly fatal. According to Ashhurst, Gamgee has collected 28 cases
of rupture of this viscus, including one observed by himself. In nine
of these cases there was no fracture, and either no bruise of the
parietes or a very slight one. The pericardium was intact in at least
half of the cases, and in 22 in which the precise seat of lesion was
noticed the right ventricle was ruptured in eight, the left in three,
the left auricle in seven, the right in four. The longest period during
which any patient survived the injury was fourteen hours.

Among the older writers who note this traumatic injury are Fine, who
mentions concussion rupturing the right ventricle, and Ludwig, who
reports a similar accident. Johnson mentions rupture of the left
ventricle in a paroxysm of epilepsy. There is another species of
rupture of the heart which