It w te the k ' clanking" note which aceonipani orking of a pump when its irear is loose. There was the sucking in. and expulsion sound, together with this sharp '-riiliar note, which it is impossible to ribe, but which immediately suggested the probability that the pericardium had be-n opened, and that 'us which filled the wound was alternately being nicked into and ejected from its cavity. On examination tliis vii-w was oonfinned, as a small hole was found at tin- inferior and left lateral rspoct!' the v/ound through which the t be drawn in. and thrown out, diirinir the action of the heart. After death, it was found that this aperture led into the pericardium, which much thickened, and adherent to the heart, tor a of two inches by one, at the anterior and middle part <>f that nnran.
The opening mentioned l-d into a by the pericardium round the roots of and which pouch communicated freely with the sac of the base of the heart below the adhesion. Pus was fivcly the pericardium, and the mbrane, as well as that of the heart, was of a drab colour, and thickly coated with lymph of a low type of or. e heart itself was healthy. were somewhat ted, and their anterior; t> the parietes. The coats of the unhealthy, but beyond this nothing was.iirainst death this JMM.T jury, the oj-enini: of the cardium, and the scaling of both sides of tin 1 thorax by the pleura adhesions, were all points of much interest and no little The two following cases show how small a difference in the place of transit of the ball may determine the question of life or death: A Zouave was struck at the Alma by a round ball, which entered the parietes close to the right nipple, and escaped at a corresponding point on the left side.
The ball passed in front of the sternum, which it fractured. Curiously enough, no inflammation whatever of the contents of the thorax followed, and he was in a short time discharged well. The points of entrance and exit differed little in this and in the case of Fleming: but the projection of the sternum being less in this patient, the result was very different. A Russian soldier lay close to the Zouave just referred to, who, in the same battle, had been struck by a ball about a quarter of an inch to the outside of the right nipple. The ball had then passed behind the sternum, fracturing it badly in its course, and escaped close to the left nipple.
Double pneumonia and pericarditis followed, and he died. The whole contents of the thorax were found implicated in one vast inflammation. Not being present at the post-mortem examination, I did not learn * John Bell (2nd Discourse on Wounds, p. 302) refers to a case related by Galen, in which part of the sternum was removed, the pericardium opened, and the man cured, He thus comments upon it " Here, then, we have, upon that authority which has been always respected, a case exceeding in the inirarulous fill that has ever been recorded by the patient Vandcr Wiel, or gathered by Sclienkius, or any German commentator among them?. man with a slow suppuration, confined matter, a carious sternum, and the heart absolutely exposed and bare." In Fleming's case we had all the unfavourable symptoms, but unfortunately not the recovery.