An Account of a Blow upon the Heart, and of Its, Effects: By Mark Akenside, M. D. F. R. S. and Physician to Her Majesty

L. An Account of a Blow upon the Heart, and of its Effects: By Mark Akenside, M.D. F.R.S. and Physician to Her Majesty. Read Dec. 22, 1763. On the 11th of September, 1762, Richard Bennet, a lad about fourteen years of age, was brought to a consultation of the physicians and surgeons of St. Thomas's Hospital. His disorder was a palpitation of the heart; so very violent to the touch, that we all concluded it to be an aneurysm, and without remedy. He had a frequent cough. His pulse was quick, weak, and uneven; but not properly intermitting. It was apparent that nothing could be done, farther than by letting blood in small quantities, and by the use of emollient pectoral medicines, to lessen now and then, however inconsiderably, the extreme danger to which he was continually subject. He was taken into the hospital that same day, being Saturday; and treated according to what had been agreed upon. But on the Tuesday morning following, he died, without any previous alarm or alteration. The origin of his complaint was a blow, which he had received six months before, from the master whom he served, as waiter in a public house. The master had owned that he had pushed him slightly on the left side with his hand. The boy informed us that he himself was then carrying a plate under his arm; and that the blow or push, from his master, ter, drove the edge of the plate forcibly between two of his ribs. He was immediately very ill from the hurt; sick, and in great pain. His mother also informed us, that she thought the palpitation was more violent about a fortnight after the accident, than when we examined him. The day after the blow, they took eight ounces of blood from his arm: about three weeks after that, they again opened a vein, but got not much from it: and three weeks from thence, they let him blood the last time, to the amount of eight ounces. He began to have a cough soon after the hurt, with frequent spittings of blood in very large quantities; and had nocturnal sweats almost the whole six months, during which he survived the blow. About four months after it, there came, over the umbilical region of the abdomen, a livid appearance like a mortification: but it went off gradually, and at length vanished. He had nothing particular in his habit of body or state of health; save that, about a year before this accident, he had been crippled with the rheumatism. He was, when we saw him, a good deal reduced; but had not a hectic nor consumptive look. On the day of his death, Mr. Cowell opened him; when, to our great surprize, we found no aneurysm, nor the least extravasation of blood either from the cavities of the heart or the large vessels. But on the left ventricle of the heart, near its apex, there was a livid spot, almost as large as a half-crown piece, bruised and jelly like; the part underneath being mortified quite to the cavity of the ventricle. From thence upward, toward the auricle, auricle, there went several livid specks and traces of inflammation, tending in like manner to gangrene. The heart did also, throughout its whole surface, adhere very closely to the pericardium; and the whole outer surface of the pericardium, as closely, to the lungs. The other viscera were quite sound. So that the mischief here was properly a contusion of the heart; the edge of the plate having struck it, probably at the instant of its greatest diastole. This produced an inflammation on its surface, followed by a gangrene, and terminating in that double adhesion: by which the whole heart was fast tied up; till on this account, as well as by reason of the mortification, it was no longer able to circulate the blood.