CLINICAL PROGRESS Penetrating Wounds of the Heart and Aorta

MANY centuries ago it was believed that a heart, wound was inevitably lethal. This dictum stood unchallenged until the eighteenth century, when it was first recog-nized that an individual might suffer a heart wound and continue to live without evidence of serious injury. For the detailed historical evolution of the treatment of traumatic heart disease the reader is referred to Sir Charles Ballance 's outstanding Bradshaw Lecture' and Beck's more recent2 amplification. The first successful pericardiocentesis for hemo-pericardium was performed in 1829,1 but it was 39 years later before Fischer 's3 classic work on heart wounds was published. He based his observations on 452 cases in which the mortality was 84 per ceiit. Suture of cardiac wounds was suggested by Roberts4 in 1881, and a year later it was performed experimentally in animals by Block.5 Cap-pelen6 was the first to attempt suture of a wound of the human heart; his patient died, but the following year Rehn 's attempt was successful. By 1909 Peck8 had collected 160 cases of heart wounds treated surgically, and since then surgical therapy in such cases has become relatively commonplace. Table 1 is aln analysis of our postmortem series of missile and stal) wounds of the heart, and aorta. The site and the cause of the penetrating injury have been listed in rela-tion to death and length of survival. Al-though 72, or 15.7 per cent, of the patient