Hill reports the case of a soldier who was stabbed with a bowie-knife nine inches long and three inches wide. The blade passed through the diaphragm, cut off a portion of the liver, and severed the descending aorta at a point about the 7th dorsal vertebra; the soldier lived over three hours after complete division of this important vessel. Heil reports the case of a man of thirty-two, a soldier in the Bavarian army, who, in a quarrel in 1812, received a stab in the right side. The instrument used was a common table-knife, which was passed between the 5th and 6th ribs, entering the left lung, and causing copious hemorrhage.
The patient recovered in four months, but suffered from amaurosis which had commenced at the time of the stab. Some months afterward he contracted pneumonia and was readmitted to the hospital, dying in 1813. At the postmortem the cicatrix in the chest was plainly visible, and in the ascending aorta there was seen a wound, directly in the track of the knife, which was of irregular border and was occupied by a firm coagulum of blood.
The vessel had been completely penetrated, as, by laying it open, an internal cicatrix was found corresponding to the other. Fatal hemorrhage had been avoided in this case by the formation of coagulum in the wound during the syncope immediately following the stab, possibly aided by extended exposure to cold.
Sundry Cases.--Sandifort mentions a curious case of coalescence of the esophagus and aorta, with ulceration and consequent rupture of the aorta, the hemorrhage proceeding from the stomach at the moment of rupture.
Heath had a case of injury to the external iliac artery from external violence, with subsequent obliteration of the vessel.
When the patient was discharged no pulse could be found in the leg.
Dismukes reports a case in which the patient had received 13wounds, completely severing the subclavian artery, and, without any medical or surgical aid, survived the injury two hours.
Illustrative of the degree of hemorrhage which may follow an injury so slight as that of falling on a needle we cite an instance, reported by a French authority, of a child who picked up a needle, and, while running with it to its mother, stumbled and fell, the needle penetrating the 4th intercostal space, the broadened end of it remaining outside of the wound. The mother seized the needle between her teeth and withdrew it, but the child died, before medical aid could be summoned, from internal hemorrhage, causing pulmonary pressure and dyspnea.
Rupture of the esophagus is attributable to many causes. Dryden mentions vomiting as a cause, and Guersant reports the case of a little girl of seven, who, during an attack of fever, ruptured her esophagus by vomiting. In 1837 Heyfelder reported the case of a drunkard, who, in a convulsion, ruptured his esophagus and died. Williams mentions a case in which not only the gullet, but also the diaphragm, was ruptured in vomiting. In this country, Bailey and Fitz have recorded cases of rupture of the esophagus.
Brewer relates a parallel instance of rupture from vomiting. All the foregoing cases were linear ruptures, but there is a unique case given by Boerhaave in 1724, in which the rent was transverse. Ziemssen and Mackenzie have both translated from the Latin the report of this case which is briefly as follows: The patient, Baron de Wassenaer, was fifty years of age, and, with the exception that he had a sense of fulness after taking moderate meals, he was in perfect health. To relieve this disagreeable feeling he was in the habit of taking a copious draught of an infusion of "blessed thistle" and ipecacuanha. One day, about 10.30 in the evening, when he had taken no supper, but had eaten a rather hearty dinner, he was bothered by a peculiar sensation in his stomach, and to relieve this he swallowed about three tumbler-fuls of his usual infusion, but to no avail. He then tried to excite vomiting by tickling the fauces, when, in retching, he suddenly felt a violent pain; he diagnosed his own case by saying that it was "the bursting of something near the pit of the stomach." He became prostrated and died in eighteen and one-half hours; at the necropsy it was seen that without any previously existing signs of disease the esophagus had been completely rent across in a transverse direction.
Schmidtmuller mentions separation of the esophagus from the stomach; and Flint reports the history of a boy of seven who died after being treated for worms and cerebral symptoms. After death the contents of the stomach were found in the abdominal cavity, and the esophagus was completely separated from the stomach.
Flint believed the separation was postmortem, and was possibly due to the softening of the stomach by the action of the gastric acids. In this connection may be mentioned the case reported by Hanford of a man of twenty-three who had an attack of hematemesis and melanema two years before death. A postmortem was made five hours after death, and there was so much destruction of the stomach by a process resembling digestion that only the pyloric and cardiac orifices were visible. Hanford suggests that this was an instance of antemortem digestion of the stomach which physiologists claim is impossible.
