184 SURGICAL APPLIED ANATOMY. [Chap. x. 



appear in a great number of cases to be due to an 

 impression upon the nervous centres rather than upon 

 actual haemorrhage. Many instances have been 

 recorded to show that the heart may be very tolerant 

 of foreign bodies in its substance. Thus a man lived 

 for twenty days with a skewer traversing the heart 

 from side to side (Ferrus). In another case a lunatic 

 pushed an iron rod, over six inches in length, into his 

 chest, until it disappeared from view, although it 

 could be felt beneath the skin receiving pulsation 

 from the heart. He died a year following, and the 

 metal was found to have pierced not only the lungs, 

 but also the ventricular cavities (Tillaux). A propos 

 of chest wounds, Velpeau cites the case of a man in 

 whose thorax was found a part of a foil that entirely 

 transfixed the chest from ribs to spine, and that had 

 been introduced fifteen years before death. In the 

 museum of the Royal College of Surgeons is the 

 shaft of a cart that had been forced through the ribs 

 on the left side, had passed entirely through the chest, 

 and had come out through the ribs on the right side. 

 The patient had lived ten years. 



Paracentesis of the pericardium has been 

 performed through the fourth or fifth spaces on the 

 left side close to the sternum, care being taken to 

 avoid the internal mammary artery. The operation 

 has also been performed through a trephine hole 

 made in the middle line of the sternum. 



The mediastina. Abscess in the anterior 

 mediastinum may have developed in situ, or may 

 have spread down from the neck. In like manner 

 posterior mediastinal abscesses may arise from diseases 

 of the adjacent spine, or lymphatic glands, or may be 

 due to the spreading downwards of a retro-pharyngeal 

 or retro-oesophageal collection of matter. 



The azygos veins, commencing as they do below 

 in the lumbar veins, and having more or less direct 



