Chest trauma of Alexander the Great, a pneumology approach.

Delgado-García, et al. presentan una disertación amplia, con revisión histórica profunda, de la lesión torácica que sufrió Alejandro Magno por el disparo de una saeta de dos codos de largo (88 cm) en la batalla contra los malios, donde a través de diversas narraciones se ha considerado que sufrió un neumotórax y que debido a la gravedad de la lesión sus médicos decidieron retirar el objeto punzocortante, obteniéndose aire y sangre posextracción; el emperador perdió el estado de alerta, recuperándose posteriormente la herida y permitiéndole montar a caballo a los pocos días. Los autores finalizan con la frase «Lo sucedido después del flechazo torna inverosímil la posibilidad de un neumotórax¼.

What the ancients knew of the fatal anatomic consequences of wounding of the lower thorax.

One of the most important lessons concerning the relevance of human anatomy to surgical diagnosis to be taught to medical students and first-year surgical residents concerns their sometimes poorly understood relationship of the structure of the lower thoracic cavity to the organs within the upper abdominal cavity. To make this indelibly clear, in surgical anatomic and clinical lectures given during the past 20 years, I have chosen to present the earliest Biblical examples of the ancient's knowledge of this critical relationship as regards wounds of the thorax specifically given to injure the liver and thus to produce a rapid and certain death. The first two concern the technique of assassination used by the warring factions of the House of King Saul and the followers of the House of David, which resulted in his succeeding to the kingship of Israel after the death of King Saul in the 10th century BC. The second example is the coup de grâce administered in 30 AD to the crucified Jesus by a Roman centurion to hasten His death. In all three cases, the evidence, in the first two cases explicit and in the third strongly implied, is that the executioners knew that a stab wound of the lower thorax on the right would lead to a rapid death by exsanguination because "the liver was suspended there." The importance of this understanding, made indelible by these examples discussed herein, is to insure the recognition by any medical student or surgical resident that any penetrating wound of the lower thorax may imply a much more serious injury to an intra-abdominal organ, and this must be rapidly and fully investigated.

An English admiral and an American aviator: advanced trauma life support and two historical military casualties.

This article considers two historical military casualties in the context of present day Advanced Trauma Life Support (ATLS) teaching. The death of Admiral Lord Nelson, Royal Navy, at the Battle of Trafalgar in 1805 has been well documented while that of Lieutenant Luke, an American aviator, U.S. Army Air Service, in France in 1918 has been almost disregarded. Both suffered a gunshot wound to the chest with the responsible weapon similarly sited. Nelson's dying was witnessed and recorded in detail by his surgeon. Luke's death was unwitnessed and has been the subject of considerable speculation. A recent monograph removes much of this speculation but cannot describe his last few minutes of life. This article describes both events and considers the mechanism of injury. It presents speculative radiological reconstructions and an outline of emergency management according to ATLS for both and further clinical speculation on Luke's demise.

The reported thoracic injuries in Homer's Iliad.

Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%), the stones (7.4%), the arrow (5.5%) and the sword (5.5%). We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim), medium (those which cause the victim to abandon the battlefield), and severe (those which cause death of the victim). According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95%) and the remaining 8 an Achaean (21.05%). The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield.

Fatal chest injury with lung evisceration during athletic games in ancient Greece.

The "Olympic idealism" that dominates modern athletic culture is a myth. The true aims of the athletes in ancient Greece were rewards and life-long appointments to various positions in the military or the city administration. Competitions in the athletic games included, among others, wrestling, boxing, and pangration (a combination of wrestling and boxing). Occasionally, these games resulted in severe trauma or death. Two cases of extreme violence resulting in fatal chest trauma are presented and commented on from both surgical and social points of view.

Evolution of our knowledge of sudden death due to commotio cordis.

Commotio cordis refers to circulatory arrest due to a nonpenetrating blow to the chest. First discovered in 1932 in a study using large rabbits, it came to the attention of clinicians who encountered children dying suddenly from a chest blow while engaging in sports activities. This review traces the history of commotio cordis, establishes the conditions necessary for sudden death from a nonpenetrating chest blow, and presents the first ECG record showing that a chest blow landing in the ventricular vulnerable period can produce ventricular fibrillation. The conditions necessary for sustaining ventricular fibrillation and numerous examples of sudden death by commotio cordis are presented.

Trauma to the lung.

Injuries to the lung parenchyma occur following both blunt and penetrating trauma and usually are associated with injury to adjacent structures. In most cases, patients with lung injury require little more than chest-tube insertion and supportive care. A thoracotomy is required, however, in approximately 10% of these patients, half of whom will need pulmonary repair or resection. Because serious morbidity and mortality can follow lung injuries, surgeons must have a broad understanding of the causes, types, and pathophysiologies of lung injuries and be able to promptly diagnose and appropriately treat them.

The shooting of President Reagan: a radiologic chronology of his medical care.

Radiography of the chest played a central role in the care of President Ronald Reagan who, in 1981, became the only president of the United States to survive being struck by a would-be assassin's bullet. These radiographs not only illustrate the medical events that followed the gunshot wound to the president's chest, but also provide graphic documentation of the president's medical care, suspected complications, and recovery following this near-fatal wound. This report constitutes the only complete pictorial record of the care of President Reagan during that historic episode.

The attempted assassination of President Reagan. Medical implications and historical perspective.

In 1981, President Ronald Reagan became the first incumbent president of the United States to survive being struck by a would-be assassin's bullet. Had President Reagan not survived, the history of this country and the world most certainly would have been changed. This report is the only first-hand account of the details of his medical care and complications following the assassination attempt, an event that emphasizes the vulnerability of presidents to would-be assassins and the importance of readily available expert medical care and facilities to their survival.