56 HERZOG. 



Necropsy (No. 1003). — Post-mortem examination made July 17, 1904, at 10 

 a. m., fifteen hours after death. Body of a well-developed young male native. 

 Post-mortem rigidity still quite well marked. Post mortem lividity very mod- 

 erate. The whole surface, particularly the mucous membranes, is very pale and 

 anaemic. The abdomen appears much distended, particularly the upper part. 

 There are no signs of external violence, and no wounds or abrasions. On opening 

 the abdomen very extensive blood coagula are found to fill every available space 

 below the diaphragm. Serum has collected in the dependent parts of the abdom- 

 inal cavity, and the mass of serum and coagula removed amounts to about 

 two to three liters. All the organs are found to be very anaemic. The heart is 

 soft and flabby, but otherwise normal. The lungs are rather collapsed and pale 

 pink in color. Both of them have formed some adhesions and the apex of the 

 right lung contains four caseous nodules, varying in size from a pea to a hazelnut. 

 Otherwise, the lungs, the trachea, the bronchi and the larynx are normal. The 

 spleen is very soft, flabby and friable, measuring 23 by 10 by 6i centimeters and 

 weighing 655 grams. The capsule is wrinkled, transparent and grayish-blue. 

 The veins entering the hilum are very much enlarged and have very thin walls. 

 On the posterior, lateral surface of the spleen — namely, that which was in contact 

 with the internal thoracic wall of the left side — there is found a rupture, which 

 extends from the outer lateral margin of the organ toward the hilum. The 

 rupture is about 6 centimeters long and is directed somewhat downwards. It 

 forms a triangular gap, the base of which is found at the hilum, being 2A centi- 

 meters long. The rupture has torn into some of the larger branches of the 

 splenic vein. The lesser omentum contains a small, round body of the size 

 of a hazelnut, which is either an accessory spleen or a haemolymph gland. On 

 inspecting the internal wall of the thoracic cavity, it is found that the 9th rib 

 of the left side is fractured. This fracture is situated 9.5 centimeters behind the 

 anterior end of the rib. It is an incomplete, green-stick fracture, and is situated 

 in the mid-axillary line. The anterior segment of the fracture is very sharply 

 pointed. It projects somewhat into the pleura eostalis. The region around this 

 fracture, for a radius of several centimeters, is hemorrhagic. It is clear that 

 this fracture must have been produced by a dull force, which, however, left no 

 sign on the integument; it was probably a force exerted very quickly, not 

 crushing the soft parts, but splitting the rib and driving the anterior fragment 

 into the exceedingly soft, friable, enlarged spleen and producing a rupture. 

 The kidneys are normal. The adrenals are normal. The capsule of the liver is 

 smooth and transparent, and in color pale pinkish-blue, the upper surface show- 

 ing a number of small, punctiform haemorrhages. On the cut surface the organ 

 appears brownish-pink. The gall-bladder is normal. The ducts are normal. The • 

 mucosa of the duodenum and stomach is pale. The small intestine, the large 

 intestine, the prostate, etc., are normal. The brain and cord are normal. 



Anatomical diagnosis.- — Splenomegaly (primary ?), fracture of the ninth rib 

 of the left side, rupture of the spleen, haemorrhage, general anaemia of all the 

 internal organs, tuberculosis of the apex of the right lung. No malarial para- 

 sites were found in smears prepared from the spleen. 



Case II. — M. V., 25 years old, was working on a new building on February 13, 

 1905. He was engaged in lifting, by means of a lever, certain heavy weights, 

 and just as he had brought the lever to the required elevation, he staggered and 

 fell to the ground. His friends applied "smelling salts," thinking that he had 

 fainted, but as he did not respond to this treatment, the Bureau of Health was 

 notified. The time between the injury and his death was probably about twenty 

 minutes. His wife stated that his health had not varied since she had known 

 him. The post-mortem examination (Necropsy No. 1108) was made two hours 



