登陆注册
4281000000292

第292章

Rupture of the heart from contusion of the chest is not always instantly fatal. According to Ashhurst, Gamgee has collected 28cases 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 is not traumatic, in which the rupture occurs spontaneously, the predisposing cause being fatty degeneration, dilatation, or some other pathologic process in the cardiac substance. It is quite possible that the older instances of what was known as "broken-heart," which is still a by-word, were really cases in which violent emotion had produced rupture of a degenerated cardiac wall. Wright gives a case of spontaneous rupture of the heart in which death did not occur for forty-eight hours. Barth has collected 24 cases of spontaneous rupture of the heart, and in every instance the seat of lesion was in the left ventricle. It was noticed that in some of these cases the rupture did not take place all at once, but by repeated minor lacerations, death not ensuing in some instances for from two to eleven days after the first manifestation of serious symptoms. A more recent analysis is given by Meyer of cases reported since 1870: Meyer collects 25 cases of rupture of the left ventricle seven of the right ventricle, and four of the right auricle. Within the last year Collings has reported a case of idiopathic rupture of the heart in a man of fifty-three, who had always lived a temperate life, and whose only trouble had been dyspepsia and a weak heart. There was no history of rheumatism or rheumatic fever. The man's father had died suddenly of heart disease. After feeling out of sorts for a time, the man experienced severe pain in the precordium and felt too ill to leave his bed. He gradually became worse and sick after taking food. Speech became thick, the mouth was drawn to the right, and the right eye was partially closed. The left arm became paralyzed, then the right leg. The tongue deviated to the right on protrusion. The sphincters were unaffected. The heart sounds were faint and without added sounds. The man was moved to a water-bed, his body and head being kept horizontal, and great care being taken to avoid sudden movement. Later, when his pelvis was raised to allow the introduction of a bed-pan, almost instantaneous death ensued. Upon postmortem examination prolonged and careful search failed to reveal any microscopic change in the brain, its vessels, or the meninges. On opening the pericardium it was found to be filled with blood-clot, and on washing this away a laceration about 1 1/2 inches in length was found in the left ventricle; the aperture was closed by a recent clot. The cavities of the heart were dilated, the walls thin and in advanced stage of fatty degeneration. There was no valvular disease. The aorta and its main branches were atheromatous. Both lungs contained calcifying tubercle; the abdomen was loaded with fat; the spleen was soft; the kidneys were engorged, but otherwise healthy.

Stokes gives the case of a man who was severely crushed between the arms of a water-wheel of great size and the embankment on which the axle of the wheel was supported; a peculiar factor of the injury being that his heart was displaced from left to right.

At the time of report, after recovery from the injury, the patient exhibited remarkable tolerance of great doses of digitalis. When not taking digitalis, his pulse was 100 to 120, regular, and never intermittent.

Hypertrophy of the Heart.--The heart of a man of ordinary size weighs nine ounces, and that of a woman eight; in cases of hypertrophy, these weights may be doubled, although weights above 25 ounces are rare. According to Osler, Beverly Robinson describes a heart weighing 53 ounces, and Dulles has reported one weighing 48 ounces. Among other modern records are the following:

Fifty and one-half ounces, 57 ounces, and one weighing four pounds and six ounces. The Ephemerides contains an incredible account of a heart that weighed 14 pounds. Favell describes a heart that only weighed 3 1/2 ounces.

Wounds of the aorta are almost invariably fatal, although cases are recorded by Pelletan, Heil, Legouest, and others, in which patients survived such wounds for from two months to several years. Green mentions a case of stab-wound in the suprasternal fossa. The patient died one month after of another cause, and at the postmortem examination the aorta was shown to have been opened; the wound in its walls was covered with a spheric, indurated coagulum. No attempt at union had been made.

Zillner observed a penetrating wound of the aorta after which the patient lived sixteen days, finally dying of pericarditis.

Zillner attributed this circumstance to the small size of the wound, atheroma and degeneration of the aorta and slight retraction of the inner coat, together with a possible plugging of the pericardial opening. In 1880 Chiari said that while dissecting the body of a man who died of phthisis, he found a false aneurysm of the ascending aorta with a transverse rupture of the vessel by the side of it, which had completely cicatrized.

同类推荐
  • Songs From The Mountains

    Songs From The Mountains

    本书为公版书,为不受著作权法限制的作家、艺术家及其它人士发布的作品,供广大读者阅读交流。汇聚授权电子版权。
  • 渊源道妙洞真继篇

    渊源道妙洞真继篇

    本书为公版书,为不受著作权法限制的作家、艺术家及其它人士发布的作品,供广大读者阅读交流。汇聚授权电子版权。
  • 瑜伽焰口注集纂要仪轨

    瑜伽焰口注集纂要仪轨

    本书为公版书,为不受著作权法限制的作家、艺术家及其它人士发布的作品,供广大读者阅读交流。汇聚授权电子版权。
  • 太上化道度世仙经

    太上化道度世仙经

    本书为公版书,为不受著作权法限制的作家、艺术家及其它人士发布的作品,供广大读者阅读交流。汇聚授权电子版权。
  • Democracy An American Novel

    Democracy An American Novel

    本书为公版书,为不受著作权法限制的作家、艺术家及其它人士发布的作品,供广大读者阅读交流。汇聚授权电子版权。
热门推荐
  • 总裁在上:娇妻别想逃

    总裁在上:娇妻别想逃

    沐子溪有着能让所有男人着迷的脸,但她也有拖后腿拖到后山的家境,她更有一个恨她入骨的男人,恨不得扒她的骨,抽她的筋!某夜,他把钞票砸到她的脸上:“出来卖,总是要动真格的!”“不!我后悔了!”“晚了!你只能是我的!”--情节虚构,请勿模仿
  • 完结碎笔

    完结碎笔

    多年以后,这腔热血恐怕早已被生活带去了温度,平淡无奇,熟练锋芒。美好的青春啊,怎少得了无尽的幻想,不知将它们写下,会不会让血液感受到那时的余热?或澎湃激昂,或平静温和,到头来也只是多愁善感在呼唤着。
  • 中国现代诗导读(1937-1949)

    中国现代诗导读(1937-1949)

    中国现代诗,也叫“新诗”,是指发端于“五四”时期到1949年新中国成立这一段时间的白话诗,即应用现代汉语的、自由抒发思想感情的、形式上不拘一格的诗歌。本书收录了多篇诗人与解诗者的文学对话。
  • 三月星辰恰似你

    三月星辰恰似你

    男人冷若冰霜的脸缓缓凑到风星辰的耳边,胸腔中发出的低沉的声音一字一句的传入她耳中,“星辰……我爱你,但是我们注定有缘无份……”早知如此绊人心,何如当初莫相识。重生18岁,这次她宁可断情绝爱,也要扭转局面,扼住命运的咽喉将其掌控在自己手中。只是她没有料到,厉墨以竟然也有着前世的记忆!并且一直默默的替她扫清障碍,只为能再把她拥入怀中宠成一个小公主?!
  • The Perfect Wagnerite

    The Perfect Wagnerite

    本书为公版书,为不受著作权法限制的作家、艺术家及其它人士发布的作品,供广大读者阅读交流。汇聚授权电子版权。
  • 我的女皇养成计划

    我的女皇养成计划

    我是一代军神韩信,一不小心穿越到了异世界。结果命犯桃花,承蒙诸多美女错爱。帝国女皇娜塔莉说:“韩信,做朕的男人吧!我给你数不尽的荣耀。”光明圣女亚丝娜说:“圣殿骑士听令,把韩信给我绑回神殿,我要和他结婚。”人类最杰出的魔法师艾薇儿说:“韩信,和我在一起,不然我就用禁咒魔法轰死你。”高等精灵女皇薇薇安说:“向人类帝国宣战,目标抢回妾身的夫君韩信。”湖之仙女莉莉丝说:“韩信,成为我的眷属吧!我将赐予你一个王国。”龙族小公主雪妃说:“我用钱砸死你们,不许你们抢我的韩信。”
  • 恶魔别惹我哦

    恶魔别惹我哦

    恶魔,我只爱你。丫头,我只宠你。爱你爱进心中,宠你宠入骨髓。
  • 禅源诸诠集

    禅源诸诠集

    本书为公版书,为不受著作权法限制的作家、艺术家及其它人士发布的作品,供广大读者阅读交流。汇聚授权电子版权。
  • 步步为赢:职业废材逆袭记

    步步为赢:职业废材逆袭记

    昔日她还是废材七小姐,他说,他要娶她,保护她。她答:你可以不爱我,但绝不可以骗我。彼时她已经站在了巅峰,他却与她拔刀相向,就像前世那人一样,将匕首送进了她的胸口。她为他堕入魔道,神挡杀神,人挡杀人,嗜血狂傲。他为他舍身成仁,凤凰涅槃,浴火重生,傲视苍穹。是谁说,当神已无力,便是魔渡众生……
  • 因明入正理论

    因明入正理论

    本书为公版书,为不受著作权法限制的作家、艺术家及其它人士发布的作品,供广大读者阅读交流。汇聚授权电子版权。