The practice of surgery . mities, cyanotic; the pulse is soft and rapid;the heart-sounds are muffled. Frequently there is hemorrhage from theheart into the pericardium, with a consequent throttling of the hearts 1 Ellsworth Eliot, Jr., Suppurative Pericarditis, Ann. Surg., January, 1909. 2 L. L. Hill, Wounds of the Heart, Med. Rec, September 19, 1908. 500 THE CHEST action. If the homorrhao;e continues, the heart will be brought to astandstill. Our one and obvious expedient is to relieve the ]:)ressure byemptying the pericardium, and to check the hemorrhage by sewing upthe wound in the heart. T
The practice of surgery . mities, cyanotic; the pulse is soft and rapid;the heart-sounds are muffled. Frequently there is hemorrhage from theheart into the pericardium, with a consequent throttling of the hearts 1 Ellsworth Eliot, Jr., Suppurative Pericarditis, Ann. Surg., January, 1909. 2 L. L. Hill, Wounds of the Heart, Med. Rec, September 19, 1908. 500 THE CHEST action. If the homorrhao;e continues, the heart will be brought to astandstill. Our one and obvious expedient is to relieve the ]:)ressure byemptying the pericardium, and to check the hemorrhage by sewing upthe wound in the heart. The treatment I have outlined should be supi)lemented by properstimulation—hot bottles and blankets, raising the foot of the betl, ahypotlermic injection of morphin and atropin, the intravenous injectionof a pint or more of normal saline solution, with adrenalin (1 : 50,000),and the application of Criles pneumatic suit, if it is at hand. An anes-thetic rarely is desirable, and if any is given, ether only is Fig. .316.—Vaughans case of heart suturing (redrawn from sketch): 1, Heart: 2,deep sutures; .3, superficial sutures: 4, pericardium: o, left pleural space: 6, flap ofchest-wall, including fourth, fifth, and sixth ribs; 7, outhne of heart. The steps of the operation in detail are these: With the patient in amodified Trendelenburg position, clean up rapidly the skin; enlarge theexternal wound, and ascertain the condition of the underlying cartilagesand ribs. If they are found divided, advance through the opening thusprovided. If they are intact, turn back a rib in the fashion I have al-ready described. Seek and tampon any rent in the pleura. Exposethe pericardium and find the wound in that membrane; enlarge the peri-cardial wound; empty the pericardium of blood and clots, and look forthe wound in the heart. One may find great difficulty in discoveringthis heart wound. Gibbon^ reports an interesting and successful case, 1 John H. Gibbon, Jour. Amer. Med. Assoc
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