TRAUMATISM OF INTERNAL ORGANS. 57 



after death. The findings were: Beginning cirrhosis of the liver, splenomegaly 

 ( very large spleen ) , rupture of the spleen, copious haemorrhage into the abdom- 

 inal cavity. No external injuries, no ribs fractured. Smears from the spleen 

 showed neither malarial parasites nor the Donovan-Leishmann bodies. 



PERFORATION OF THE HEART. 



The two following descriptions refer to cases of perforation of the 

 heart. In one of them the myocardium was ruptured by a fractured 

 rib, out not the pericardium and the victim did not die from the effects 

 of losing a large amount of blood, but from compression of the heart 

 and cessation of its action. In the second case a floating rib perforated 

 a heart which was in an advanced condition of fatty degeneration. 



Case III. — Necropsy No. 1004. Sra. M. R,., Filipina, age, 25, died July 17, 

 1904. The post-mortem examination was made July 18, twelve hourse after death. 

 Immediate cause of death not known. It was stated that she had been struck 

 by a carromata shortly before she died. Body of a well-developed, young, native 

 woman, 25 to 30 years of age. Post-mortem rigidity strongly marked. Post- 

 mortem lividity quite noticeable. Abdomen somewhat distended. A repeated 

 careful inspection fails to show any signs of external violence. No wounds, con- 

 tusions or abrasions of any kind to be seen. On opening the thoracic cavity, 

 the pericardium is found to be much distended, and shining through it there 

 appears to be a firm, dark, blood coagulum. On opening the pericardium it is 

 found to contain a large amount of dark, coagulated, gelatinous blood and 

 blood-tinged serum, distending the pericardium ad maximum and compressing 

 the heart. A careful examination fails to show any perforation in the pericar- 

 dium. The heart, which weighs about 226 grams, presents a perforation, which 

 begins 2 centimeters to the left of the anterior border of the interventricular 

 septum. The perforation extends almost horizontally toward the left, being a 

 little downwardly inclined. It forms a slit 2.2 centimeters long, running 5 

 centimeters above the apex and 5.5 centimeters below the sulcus of the heart. The 

 edges of the perforation are almost clean-cut where they enter the myocardium, as 

 if they had been produced by a dull, somewhat serrated knife. The cut takes a 

 somewhat downward and inward course, traveling through the whole thickness 

 of the myocardium. Where the cut enters the cavity of the heart, the margins 

 are not very smooth, but rather irregular and ragged. The eonsistensy of the 

 myocardium is good. Its color is pinkish-brown and all the serous surfaces are 

 smooth. There are no atheromatous changes. The heart is covered with a very 

 moderate amount of epicardial fat. In short, the whole organ is absolutely 

 normal. After the removal of the lungs (the apex of the right one showing a 

 very few tubercles and a little caseous nodule not larger than a lentil) it is 

 seen that the second, fourth and fifth ribs are fractured. The fracture of the 

 second rib is found to be 7.5 centimeters posterior to the sternal articulation, 

 that of the fourth one 9 and that of the fifth one 9.5 centimeters. The anterior 

 fragments are directed inwards. The fragments of the fourth and fifth ribs are 

 very sharp and are surrounded by an area or subpleural blood extravasation. 

 However, these fragments have not perforated the pleura costalis. The extra- 

 vasated blood is strictly subpleural and no free blood is found on the surface 

 on the pleura. The uterus appears somewhat enlarged and the left ovary shows 

 a fresh, but already closed corpus lutem. On opening the uterine cavity, 

 a little haemorrhagic mass, about one-half centimeter in diameter, is found em- 

 bedded in the mucosa of the posterior wall, near the entrance of the left tube. 



