Excerpt
from: "General Surgery: IV. Surgery of the Thorax," The Year-Book of Treatment for
1884-1899, vol.15, Cassell &
Co., Ltd
(1899), page 208. (source)
Surgical Diseases and Injuries of the Heart
from
A Treatise on Surgery by
American Authors (1896)
The following is a brief
synopsis of a case reported by H. C. Dalton, M.D., of St. Louis in 1894
1:
"A man in a fight was stabbed over the left breast; the wound was an
inch in length and an inch and a half above the left nipple. There was
little hemorrhage from the wound, and normal cardiac dulness was found
on percussion. The percussion of the chest showed absence of dulness.
The wound was closed and antiseptic dressings applied. Ten hours after
admission to the hospital percussion revealed dulness over the entire
left side, [his temperature had risen to 101ºF, his pulse rate
to 112]
1 and much pain was complained of. The
patient was removed to the operating theatre and the dressings taken
off, when it was found that blood and air gushed from the wound with
each inspiration. An incision was accordingly made, eight inches in
length, over and parallel to the fourth rib, and six inches of the rib
resected., The intercostal artery having been tied, the pleural cavity
was found full of clotted blood and fluid blood, which with each
inspiration, poured from the wound with great force. The patient was
turned on his left side, and with a long pair of forceps, armed with a
sponge, the pleural cavity was cleaned of blood. Subsequently it was
discovered that a transverse wound of the pericardium existed to the
extend to two inches, and steps were taken to suture the lesion. In
carrying out this procedure great difficulty was experienced, owing to
the pulsation—at the rate of 140 per minute—of the
heart. The pericardium with each pulsation of the heart rose
and fell, and in order to carry into effect that which was being
attempted, it was necessary to follow the movements of the organ.
Ultimately, a continuous suture of catgut was then thoroughly irrigated
with sterilized warm water, the external wound closed, without a
drainage-tube, and antiseptic dressing applied. It may be noted that at
several stages of the operation, which lasted an hour, the patient
seemed to be dying, and in order to avert collapse hypodermic
injections of whiskey and strychnia was resorted to. Before the
pericardial wound was sutured, examination of the heart was made with a
view to discovery of a wound in the organ, but no lesion was found. The
patient made an uninterrupted recovery."
Excerpt from "Surgical Diseases and Injuries of the
Heart," A Treatise on
Surgery by American Authors, vol.2, by Roswell Park, publ.
Lea Brothers (1896), Chap. III, page 130. (source)
Note: 1. Additional information from
Cardiac Surgery, by
Harris B. Shumacker,
Indiana University Press (1992) page 12: "The procedure was reported in
the state medical association's journal and another local periodical in
1894, and in
Annals of
Surgery the following year. In the latter Dalton made this
revealing statement: 'I had no precedent to guide me, no authority to
uphold me in attempting to sew up this wound over a heart that was
beating at the rate of 140 per minute.'"
See also:
- Today in
Science History event description
for date of Dalton's surgery on 6 Sep 1891