370 Maximilian Herzog. 



anterior sharjD fragment of the fourth or of the fifth rib was evi- 

 dently driven into the wall of the left ventricle, producing a com- 

 plete perforation. A highly interesting point is that the sharp frag- 

 ments neither perforated the pleura costalis nor the parietal layer 

 of the pericardium. Only when the resistance of the firm wall of 

 the ventricle was encountered did a rupture or perforation occur. 

 A hemorrhage took place, and when the pericardium was completely 

 filled, and the myocardium much compressed, the heart's action came 

 to a sudden standstill. Death occurred from syncope at once. 



Anatomical Diagnosis. 



Fracture of the second, fourth, and fifth ribs of the left side. 

 Complete perforation of the wall of the left ventricle. Hemorrhage 

 into the pericardium. Compression of the myocardium. Begin- 

 ning tuberculosis of the apex of the right lung. 



Microscopic examination of the myocardium showed it to be 

 perfectly normal. 



To this history may be added the statement that it was later 

 learned through the police reports that the woman had indeed been 

 struck by the swiftly-moving shaft of a small carriage ; that she fell 

 forward, got up, staggered, fell again, and was dead within a very 

 short time.^ 



The small piece of tissue removed from the uterus was placed 

 in Zenker's solution, later washed in running water, and was then 

 embedded in paraffin. Since our facilities for cutting serial sections 

 were not the very best at this time (July, 1904) in Manila, and 

 since the writer was then engaged in the study of Bubonic plague, 

 a few sections only were prepared, and the bulk of the block was 

 preserved for future work. From the few sections examined, the 

 firm impression was gained that the uterine mucosa presented the 

 picture of a very early decidua, with cystic hemorrhagic gland spaces 



'The history of this case has previously been published by the author in 

 a paper: "Peculiar Cases of Traumatism of Internal Organs, Some Due to 

 Tropical Conditions and Tractices." Surgery, Gynecolocy and Obstetrics, 

 Vol. IV, No. 6, p. 741, Chicago, 1907; and Philippine Journal of Science, 

 Vol. 2, 1907. 



