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this cavity during a deep inspiration； and could not be found。 Notwithstanding subsequent pneumothorax and extensive pleuritic effusion； the patient made a good recovery at the end of the fourth week and at the time of report it was still uncertain whether the needle remained in the heart or had wandered into the mediastinum。 During the discussion which followed the report of this case； Hahn showed a portion of a knitting…needle which had been removed from the heart of a girl during life。 The extraction was very slow in order to allow of coagulation along the course of the wound in the heart； and to guard against hemorrhage into the pericardial sac； which is so often the cause of death in punctured wounds of this organ。 Hahn remarked that the pulse； which before the removal had been very rapid； sank to 90。
Marks reports the case of a stab…wound penetrating the left 9th intercostal space； the diaphragm； pleura； pericardium； and apex of the heart。 It was necessary to enlarge the wound； and； under an anesthetic； after removing one and one…half inches of the 9th and 10th ribs； the wound was thoroughly packed with iodoform gauze and in twenty…one days the patient recovered。 Lavender mentions an incised wound of the heart penetrating the right ventricle； from which the patient recovered。 Purple gives； an account of a recovery from a wound penetrating both ventricles。 The diagnosis was confirmed by a necropsy nine years thereafter。 Stoll records a nonfatal injury to the heart。
Mastin reports the case of a man of thirty…two who was shot by a 38…caliber Winchester； from an ambush； at a distance of 110 yards。 The ball entered near the chest posteriorly on the left side just below and to the outer angle of the scapula； passed between the 7th and 8th ribs； and made its exit from the intercostal space of the 4th and 5th ribs； 2 1/4 inches from the nipple。 A line drawn from the wound of entrance to that of exit would pass exactly through the right ventricle。 After receiving the wound the man walked about twenty steps； and then； feeling very weak from profuse hemorrhage from the front of the wound； he sat down。 With little or no treatment the wound closed and steady improvement set in； the patient was discharged in three weeks。 As the man was still living at last reports； the exact amount of damage done in the track of the bullet is not known； although Mastin's supposition is that the heart was penetrated。
Mellichamp speaks of a gunshot wound of the heart with recovery； and Ford records an instance in which a wound of the heart by a buckshot was followed by recovery。 O'Connor reports a case under his observation in which a pistol…ball passed through three of the four cavities of the heart and lodged in the root of the right lung。 The patient； a boy of fifteen； died of the effects of cardiac disease three years and two months later。 Bell mentions a case in which； six years after the receipt of a gunshot wound of the chest； a ball was found in the right ventricle。 Christison speaks of an instance in which a bullet was found in the heart of a soldier in Bermuda； with no apparent signs of an opening to account for its entrance。 There is a case on record of a boy of fourteen who was shot in the right shoulder； the bullet entering through the right upper border of the trapezius； two inches from the acromion process。 Those who examined him supposed the ball was lodged near the sternal end of the clavicle； four or five inches from where it entered。 In about six weeks the boy was at his labors。 Five years later he was attacked with severe pneumonia and then first noticed tumultuous action of the heart which continued to increase after his recovery。 Afterward the pulsation could be heard ten or 12 feet away。 He died of another attack of pneumonia fifteen years later and the heart was found to be two or three times its natural size； soft and flabby； and； on opening the right ventricle； a bullet was discovered embedded in its walls。 There was no scar of entrance discernible； though the pericardium was adherent。 Biffi of Milan describes the case of a lunatic who died in consequence of gangrene of the tongue from a bite in a paroxysm of mania。 At the necropsy a needle； six cm。 in length； was found transfixing the heart； with which the relatives of the deceased said he had stabbed himself twenty…two months prior to his death。 There is a collection of cases in which bullets have been lodged in the heart from twenty to thirty years。
Balch reports a case in which a leaden bullet remained twenty years in the walls of the heart。 Hamilton mentions an instance of gunshot wound of the heart； in which for twenty years a ball was embedded in the wall of the right ventricle； death ultimately being caused by pneumonia。 Needles have quite frequently been found in the heart after death； Graves； Leaming； Martin； Neill； Piorry； Ryerson； and others record such cases。 Callender mentions recovery of the patient after removal of a needle from the heart。
Garangeot mentions an aged Jesuit of seventy…two； who had in the substance of his heart a bone 4 1/2 inches long and possibly an inch thick。 This case is probably one of ossification of the cardiac muscle； in the same connection Battolini says that the heart of Pope Urban VII contained a bone shaped like the Arab T。
Among the older writers we frequently read of hairs； worms； and snakes being found in the cavities of the heart。 The Ephemerides； Zacutus Lusitanus； Pare； Swinger； Riverius； and Senac are among the authorities who mention this circumstance。 The deception was possibly due to the presence of loose and shaggy membrane attached to the endocardial lining of the heart； or in some cases to echinococci or trichine。 A strange case of foreign body in the heart was reported some time since in England。 The patient had swallowed a thorn of the Prunus spinosa （Linn。）； which had penetrated the esophagus and the pericardium and entered the heart。 A postmortem examination one year afterward confirmed this； as a contracted cicatrix was plainly visible on the posterior surface of the heart about an inch above the apex； through which the thorn had penetrated the right ventricle and lodged in the tricuspid valve。 The supposition was that the thorn had been swallowed while eating radishes。 Buck mentions a case of hydatid cysts in the wall of the left ventricle； with rupture of the cysts and sudden death。
It is surprising the extent of injury to the pericardium Nature will tolerate。 In his 〃Comment on the Aphorisms of Hippocrates；〃 Cardanus says that he witnessed the excision of a portion of the pericardium with the subsequent cure of the patient。 According to Galen； Marulus； the son of Mimographus； recovered after a similar operation。 Galen 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…