WOUNDS TO THE HEART
Because exsanguination is the leading and most frequent cause of death in stabbing and incising wounds, it is not unreasonable to direct our attention initially to wounds to the cardiovascular system and further, to consider the evidence provided by the medical records and coroners reports of the current era. Let us first begin with a brief review of human anatomy. In an adult, the heart is approximately twelve centimeters long, eight to nine centimeters wide at its widest point, and some six centimeters thick. It is encased in a membranous sack, the pericardium, and rests on the upper surface of the diaphragm, between the lower portions of the lungs and behind the sternum. The organ is divided into four chambers: the left and right atria and the left and right ventricles. It is comprised almost entirely of muscle, and serves a vital function as a pumping mechanism to distribute blood throughout the body. It is unattached to the adjacent organs, but is held in place in the chest cavity, suspended by the pericardium and by continuity with the major blood vessels. The muscular walls of the heart are supplied with blood by the the right and the left coronary arteries, each of which bifurcates into a series of subdivisions.
Because the heart is a vital organ, it is generally thought that a serious injury to the heart will result in instant death. Consequently, it is not unreasonable to suppose that the duelist expected a thrust to his adversary's heart to disable him immediately. While swordplay done in earnest is now a thing of the past, a wealth of information regarding stab wounds to the heart has been accumulated in recent times by the practitioners of modern forensic medicine. Many of these wounds have been inflicted with instruments very much like the blades of rapiers, sabres, and smallswords and the means by which such wounds have been treated, combined with assessments of the injuries through the sophisticated discipline of forensic medicine, reveal some surprising truths with which many duelists most certainly had to deal.
While a stab wound to the heart is a grave matter, numerous instances of penetrating wounds to this organ have been documented in which victims have demonstrated a surprising ability to remain physically active. In 1896 a case was reported in which a twenty-four year old man was stabbed in the heart. Despite a wound to the left ventricle which severed a coronary artery, the victim not only remained conscious, but was also able to walk home. Much later, in 1936, a paper was presented to the American Association of Thoracic Surgery in which thirteen cases of stab wounds to the heart were cited. Of these, four victims were said to have collapsed immediately. Four others, although incapacitated, remained conscious and alert for from thirty minutes to several hours. The remaining five victims, thirty-eight per cent of the total, remained active: one walking approximately twenty-three meters and another running three blocks. Yet another victim remained active for approximately ten minutes after having been stabbed in the heart with an ice pick, and two managed to walk to a medical facility for help. In another instance a report cites an impressive case of a man stabbed in the left ventricle. Despite a wound 1.3 centimeters in length, the victim was able to continue routine activity for some time and lived a total of four days before expiring. In 1961, a survey conducted by Spitz, Petty and Russell included seven victims stabbed in various regions of the heart. While none of these people expired immediately, some were quickly incapacitated. Five were not, however, and one victim, despite a 2 centimeter slit-like "laceration" located in the left ventricle, managed to walk a full city block. After arming himself with a broken beer bottle, the victim finally collapsed while in the act of attempting to re-engage the individual who stabbed him.
The amount of time elapsing between a stab wound to the heart and total incapacitation of the victim is dependent upon the nature of the wound and which structures of the heart are compromised. In the light of the cases cited in the preceding paragraphs, one may expect that a penetrating wound to the left ventricle, such as that which would be inflicted by a smallsword, may not necessarily bring a combat to a sudden conclusion. Blood in this chamber of the heart, at the end of ventricular contraction (end-systole), may reach pressures as high as one hundred twenty millimeters of mercury or more, especially during combat, and one might reasonably expect blood under such pressure to escape readily through a breach in the ventricular wall. The walls of this chamber are comprised almost entirely of muscle tissue, however, and are exceptionally thick. As a consequence, the left ventricular wall has the potential to seal itself partially through the contraction of the muscle tissue immediately surrounding the site of the wound. While the end-systolic pressure in the right ventricle normally amounts to only eighteen percent that of the left, wounds to the right ventricle are far more likely to be quickly fatal because the thickness of this ventricular wall is only a third that of the left ventricle and is, consequently, less able to close a wound.
With respect to penetrating (stabbing) wounds to the heart the location, depth of penetration, blade width, and the presence or absence of cutting edges are important factors influencing a wounded duelist's ability to continue a combat. Large cuts that transect the heart may be expected to result in swift incapacitation due to rapid exsanguination, and immediate loss of pressure, but stab wounds, similar to those that might be inflicted by a thrust with a sword with a narrow, pointed blade may leave a mortally wounded victim capable of surprisingly athletic endeavors. Knight cites a case of one individual who, stabbed "through" the heart, was still able to run over 400 meters before he collapsed. Yet two more striking cases are also reported of victims who survived wounds to the heart, one of which is described as, "a through-and-through stab wound of the left ventricle that transfixed the heart from front to back."
WOUNDS TO THE MAJOR THORACIC BLOOD VESSELS
The vital area located in the center of the chest is not occupied by the heart alone. The large thoracic blood vessels converge with the heart in such a way as to present an area nearly equal in size to that presented by the heart. Consequently, a sword-thrust that penetrates the chest but fails to find the heart may nevertheless pierce or incise one or more of these large vessels.
Normally, blood pressure in the major arteries located in the chest (thorax) averages approximately one hundred millimeters of mercury, with a maximum pressure of some one hundred twenty millimeters at end-systole. Subdivisions of the aorta greater than three millimeters in diameter offer little vascular resistance. Consequently, the average blood pressure in these vessels is nearly the same. Since the thoracic arteries confine blood under considerable pressure, and because the walls of these vessels are relatively thin, compared to the walls of the ventricles, punctures or cuts in these vessels may allow blood to escape quite rapidly, depending on the size of the opening. The major thoracic arteries then, are more vulnerable to stabbing wounds than are the ventricles of the heart. While a good deal smaller in diameter, a puncture or severing of the coronary arteries, because they supply blood to the walls of the heart's ventricles, may also result in rapid incapacitation of a duelist. Forensic pathologists Dominick and Vincent Di Maio point out that especially vulnerable is the left anterior descending coronary artery which supplies the anterior wall of the left ventricle. Stabbing wounds which transect this small vessel may be expected to result in sudden death.
Nevertheless, cases have been reported in which stabbing victims, whose thoracic arteries were penetrated, remained physically active for a surprisingly long period of time. An example may be found in the case of a twenty-three year old man who was stabbed in the chest with a kitchen knife. At autopsy a wound tract was disclosed that penetrated both the aorta and the left ventricle. Blood issuing from these wounds into the chest cavity amounted to a volume of two liters. Despite the serious nature of his wounds, the victim nevertheless managed to walk more than 100 meters before collapsing and remained alive until shortly after he had been taken to the hospital. Another example is that of a twenty-five year old man whose subclavian artery and vein were severed by a thrust delivered by a kitchen knife. Losing a total of three liters of blood, he was able to run a distance of four city blocks before finally collapsing.
next time, more wounds!