Wounds of the heart are not by any means necessarily fatal, although, of course, commonly so. In most cases of penetrating wound of the heart there will be fatal haemorrhage, but such wounds, especially if they do not divide the muscular fibres transversely, may heal, and be finally closed by •connective tissue. There are even cases in which the point of a knife or a rifle ball has lodged in the heart and become surrounded by a connective tissue capsule.

Calcareous infiltration of the muscular tissue of the heart.

Fig. 213. - Calcareous infiltration of the muscular tissue of the heart. The branching muscular cylinders are shown in a petrified condition with transverse fractures. From a case of pyaemia, x 350.

Calcareous infiltration of the muscular fibre of the heart.

Fig. 214. - Calcareous infiltration of the muscular fibre of the heart. Fine granules occupy the muscular fibres, x 300.

Spontaneous rupture of the heart rarely occurs except in consequence of softening from obstruction of a coronary artery, as has been already described. It sometimes occurs in pyaemia from the formation of an abscess in the wall of the heart. It may also result from the bursting of an aneurysm of the heart, but this also is the more remote result of disease of the coronary arteries. Rupture of the heart is sometimes ascribed to fatty degeneration of the muscular fibre, but there seems no evidence that this alone can cause it. The rupture mostly occurs in the left ventricle, and near the apex or towards the aortic orifice. There is usually a large escape of blood into the sac of the pericardium, and the patient dies rapidly. Beadles has drawn special attention to the occurrence of spontaneous rupture of the heart in the insane.

Literature

Atrophy and fatty changes - Alb'ers, Atropine des Herzens; in Casper's Wochenschr., 1836, 50; Church (small heart weighing 3 oz. 1 dr.), Path, trans., xix., 1868, p. 147; R. Quain, Fatty dis. of heart, 1851; Barlow, Fatty degen., 1858; Perl (Fatty heart in ansemia), Virch. Arch., lix. 39; also Ponfick, Berl. med. Wochenschr., 1872. Calcification - Coats, Glas. Med. Jour., Aug. 1872; also Heschl, Zeitschr. f. pract. Heilk., 1860, and Both, Correspbl. f. schweizer Aerzte, 1884; Bobin et Juhel-Benoy, Arch. gen. de med., 1885; Allan Burns (exaggerated case of calcification of pericardium and heart), Dis. of heart, etc., 1809. Amyloid degeneration - Heschl, Wien. med. Wochenschr., 1870; Kyber, Virch. Arch., lxxxi.; Wild, Amyl. und hyalin degen. des Bindegewebes, 1885. Rupture - see Schrotter, in Ziemssen's Encycl., vol. vi. Various cases in Path, trans., etc.; Haddon (Rupture in pyemia), Path, trans., xxxv., 121; Robin, Gaz. hebd., 1885, No. 51; Beadles (Rupture in the insane), Path, trans., xlvi., p. 36.