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as certain to die。 The General himself thought it was grape…shot that traversed his chest。 He showed no signs of hemoptysis； and although in great pain； was able to give commands after reception of the wound。 In this case； the ball had evidently entered within the right nipple； had passed between the lungs； through the mediastinum； emerging slightly to the right of the spine。 Guthrie has mentioned a parallel instance of a ball traversing the thoracic cavity； the patient completely recovering after treatment。 Girard； Weeds； Meacham； Bacon； Fryer and others report cases of perforating gunshot wounds of the chest with recovery。
Sewell describes a case of transfixion of the chest in a youth of eighteen。 After mowing and while carrying his scythe home； the patient accidentally fell on the blade； the point passed under the right axilla； between the 3d and 4th right ribs； horizontally through the chest； and came out through corresponding ribs of the opposite side； making a small opening。 He fell to the ground and lay still until his brother came to his assistance； the latter with great forethought and caution carefully calculated the curvature of the scythe blade； and thus regulating his direction of tension； successfully withdrew the instrument。 There was but little hemoptysis and the patient soon recovered。 Chelius records an instance of penetration of the chest by a carriage shaft； with subsequent recovery。 Hoyland mentions a man of twenty…five who was discharging bar…iron from the hold of a ship； in a stooping position； preparatory to hoisting a bundle on deck； he was struck by one of the bars which pinned him to the floor of the hold； penetrating the thorax； and going into the wood of the flooring to the extent of three inches； requiring the combined efforts of three men to extract it。 The bar had entered posteriorly between the 9th and 10th ribs of the left side； and had traversed the thorax in an upward and outward direction； coming out anteriorly between the 5th and 6th ribs； about an inch below and slightly external to the nipple。 There was little constitutional disturbance； and the man was soon discharged cured。 Brown records a case of impalement in a boy of fourteen。 While running to a fire； he struck the point of the shaft of a carriage； which passed through his left chest； below the nipple。 There was； strangely； no hemorrhage； and no symptoms of so severe an injury； the boy recovered。
There is deposited in the Museum of the Royal College of Surgeons in London； a mast…pivot； 15 inches in length and weighing between seven and eight pounds； which had passed obliquely through the body of a sailor。 The specimen is accompanied by a colored picture of the sufferer himself in two positions。 The name of the sailor was Taylor； and the accident occurred aboard a brig lying in the London docks。 One of Taylor's mates was guiding the pivot of the try…sail into the main boom； when a tackle gave way。 The pivot instantly left the man's hand； shot through the air point downward striking Taylor above the heart； passing out lower down posteriorly； and then imbedded itself in the deck。 The unfortunate subject was carried at once to the London Hospital； and notwithstanding his transfixion by so formidable an instrument； in five months Taylor had recovered sufficiently to walk； and ultimately returned to his duties as a seaman。
In the same museum； near to this spike； is the portion of a shaft of the carriage which passed through the body of a gentleman who happened to be standing near the vehicle when the horse plunged violently forward； with the result that the off shaft penetrated his body under the left arm； and came out from under the right arm； pinning the unfortunate man to the stable door。 Immediately after the accident the patient walked upstairs and got in bed； his recovery progressed uninterruptedly； and his wounds were practically healed at the end of nine weeks； he is reported to have lived eleven years after this terrible accident。
In the Indian Medical Gazette there is an account of a private of thirty… five； who was thrown forward and off his horse while endeavoring to mount。 He fell on a lance which penetrated his chest and came out through the scapula。 The horse ran for about 100 yards； the man hanging on and trying to stop him。 After the extraction of the lance the patient recovered。 Longmore gives an instance of complete transfixion by a lance of the right side of the chest and lung； the patient recovering。 Ruddock mentions cases of penetrating wounds of both lungs with recovery。
There is a most remarkable instance of recovery after major thoracic wounds recorded by Brokaw。 In a brawl； a shipping clerk received a thoracic wound extending from the 3d rib to within an inch of the navel； 13 1/2 inches long； completely severing all the muscular and cartilaginous structures； including the cartilages of the ribs from the 4th to the 9th； and wounding the pleura and lung。 In addition there was an abdominal wound 6 1/2 inches long； extending from the navel to about two inches above Poupart's ligament； causing almost complete intestinal evisceration。 The lung was partially collapsed。 The cartilages were ligated with heavy silk； and the hemorrhage checked by ligature and by packing gauze in the inter…chondral spaces。 The patient speedily recovered； and was discharged in a little over a month； the only disastrous result of his extraordinary injuries being a small ventral hernia。
In wounds of the diaphragm； particularly those from stabs and gunshot injuries； death is generally due to accompanying lesions rather than to injury。 Hollerius； and Alexander Benedictus； made a favorable diagnosis of wounds made in the fleshy portions of the diaphragm； but despaired of those in the tendinous portions。 Bertrand； Fabricius Hildanus； la Motte； Ravaton； Valentini； and Glandorp； record instances of recovery from wounds of the diaphragm。
There are some peculiar causes of diaphragmatic injuries on record； laughter； prolonged vomiting； excessive eating； etc。； being mentioned。 On the other hand； in his 〃Essay on Laughter （du Ris）；〃 Joubert quotes a case in which involuntary laughter was caused by a wound of the diaphragm； the laughter mentioned in this instance was probably caused by convulsive movements of the diaphragm； due to some unknown irritation of the phrenic nerve。 Bremuse gives an account of a man who literally split his diaphragm in two by the ingestion of four plates of potato soup； numerous cups of tea and milk； followed by a large dose of sodium bicarbonate to aid digestion。 After this meal his stomach swelled to an enormous extent and tore the diaphragm on the right side； causing immediate death。
The diaphragm may be ruptured by external violence （a fall on the chest or abdomen）； or by violent squeezing （railroad accidents； etc。）； or according to Ashhurst； by spasmodic contraction of the part itself。 If the injury is unaccompanied by lesion of the abdominal or thoracic viscera； the prognosis is not so unfavorable as might be supposed。 Unless the laceration is extremely small； protrusion of the stomach or some other viscera into the thoracic cavity will almost invariably result； constituting the condition known as inter