Arch Surg. 1923;6(1_PART_I):101-117. doi:10.1001/archsurg.1923.01110160111006.
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Diagnosis may be established in obscure conditions occasionally, and permanent relief given to the patient, with only a negligible risk, by a digital exploration of the heart sac.

Philadelphia has been interested in the surgery of the heart and pericardium for years. In 1876 an intern of the Pennsylvania Hospital made a search in its library for literature on pericardial tapping. Some results of this study were incorporated in journal articles1 and later in Pepper's System of Medicine, 1885, in which an improved form of pericardial aspirating trocar was illustrated. This instrument has proved a useful device. It was described in 1877 and 1881. In October of the latter year, an article, read in Brooklyn, suggested the employment of pericardiotomy to permit the suturing of cardiac wounds.2

A suggestive article on cardiac suture by Block3 appeared in 1882, which I mentioned before the College of Physicians of


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