The New York herald., 1922-12-24
Hearts and Lungs Repaired
By the MarpelS of War Surgery

ence led him to practice transfusioo
In two precisely similar cases at the
beginning Of 1918. Exactly the same
phenomena were observed, and the
cases again recovered.
Injuries in the Heart Region
the Subject Of Special Study
The War Office collection sr path
illogical specimens contains a series
of injuries to the heart which illus
trates practically every form of lesion
encountered in an accumulation of
experience. yet, according to Major
Gen. Sir G. Fl. Makins. little reliable
data is available with regard to tho
| frequency of such injuries owing to
the fact that interest in the subject
of wounds In the chest seemed to be
confined to the lungs and pleura.
Nevertheless the record shows some
amazing achievements In surgery OF
the pericardium and Of the heart IT.
self. The clinical records of opera
tions in this region are summarized:
(1) Closure Of a rent in the PERI
cardial sac
CD Closure Of q rent involving
both the pericardial and pleural cavL-
ties.
CD Drainage Of tho pericardial sac.
(4) Repair Of wound In tho heart.
CD Removal Of foreign bodies from
(a) ~the neighborhood Of tho heart.
(b) the pericardium, (c) tho wall Of
the heart (d) one Of tho cavities OF
the heart. A case that well illustrates
the daring achievement In this branch
of surgery involves q patient, who had
a bullet removed from a wound in the
chest and was sent on to a casualty
clearing station with diagnosis OF
a penetrating gunshot wound Exs-
animation showed an entrance wound
the size of n half dollar ON the left
side Of the chest opposite the sixth
rib. There was similar exit wound
from which a shell fragment had been
removed at the field ambulance. The
tissues intervening between tho
wounds tapped In and out during
respiration and there was leakage
of air through the external wound
The usual signs of shock were pres
ent. but the general condition was
good. An operation was performed a.
soon as possible after admission. The
entrance and exit wounds wcro ex-
cised and then Joined up by an iI1s
cision through the superficial tissueR
The intervening ribs and costal oartil.
ages had all been fractured. and por.
tions of cartilage had been carried
away. The splintered ends were cut
off, giving good exposure. There was
wound through the thin anterior
part Of the left lung; a single linear
tear in the pericardium measuring one
and a half inches in length. and eubad.
jacent to this a similar gutter wound
in the left ventricle of the heart The
wound of the ventriclc was gaping
widely and was half an inch deep at !,
it's center, where there was small.
firm blood clot around which blood
Shrapuel Wound in Heart
Healed Year After inflicted
Without disturbing the clot the left
ventricle was stitched with interrupted
catgut sutures on a round curved
needle the needle being entered half
an inch from the edges and passing
down to the bottom OF the wound.
The pericardium was washed out with
weak Dakin's fluid. dried out and
closed completely with a continuous
buttonhole catgut suture. The pleura
was similarly washed out and dried
and the pleural cavity closed by an
airtioht suture of muscle and the
patient sent to the base hospital ten
days later and ultimately discharged
Another case reported by Sir
Berkeley Moynihan was that of
man admitted one year after receiving
a shrapnel wound In the lung. He
complained of shortness of breath, but
had no pain or cough. An X-ray exc
animation showed a shrapnel ball em-
bedded in the wall of the left ventricle.
The third left rib was lifted. fxa-
ton stitches were introduced on either
side of the ball, an incision made over
1t and it was lifted from Its cavity
by q SCOOP. The cavity was treated
with pure carbolic acid and oblitcrated
by two sutures. Recovery was speedy
and unimpeded.
Major Gen. Makins concluding his
chapter on Injuries TO the Pericar-
dium and Heart observes:
published results fully confirmed
the Justification and the hopefulness
of active surgical intervention In cases
of wounds of the heart. but tho large
series Of collected instances perhaps
shows results In a more favorable
light than is actually correct. This
for two reasons. first that. as Is COM
monty the case favorable results have
been more freely recorded than fall
ures, and secondly. because the
recorded cases differ materially IN
severity of the LESSONS dealt with.
In any future series OF statistics It
would seem better to draw sharp dis
tinction between the cases in which
the cavity OF the heart is opened ana
those in which this Is not the case.
since the two types of injury stand on
a quite different basis both from the
point of view of technical difficulty
and from that of risk to the patient.