58 HERZOG. 



All the organs of the body, with the exception of the apex of the right lung are 

 found to be absolutely normal. They are all more or less congested with dark, 

 fluid blood. It appears clear that the woman must have been struck at the side 

 of her body or in the back by a swiftly moving force. This force, however, did 

 not produce any signs of external violence, particularly no contusions, abrasions 

 or wounds. The force traveled through the soft parts, and meeting the resistance 

 of the ribs, fractured them. The anterior, sharp fragment of the fourth or of 

 the fifth rib was evidently driven into the wall of the left ventricle, producing 

 a complete perforation. A highly interesting point is that the sharp fragments 

 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 haemorrhage taking 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. 



Anatomical diagnosis. — Fracture of the second, fourth and fifth ribs of the 

 left side. Complete 'perforation of the wall of the left ventricle. Haemorrhage 

 into the pericardium. Compression of the myocardium. Beginning tuberculosis 

 of the apex of the right lung. 



Microscopic examination of the myocardium showed it to be perfectly normal. 



Case IV.— Necropsy No. 1185, May 15, 1905. A. P., 70 years old, female Fili- 

 pina, died May 13, 1905, at 3 p. m. Post-mortem examination forty-two hours 

 after death. This woman fell downstairs. She immediately went into collapse 

 and died within fifteen minutes after the accident. 



Body of a medium-sized, quite fat woman, probably younger than 70 years old, 

 perhaps 60. Post-mortem rigidity has disappeared, post-mortem lividity well 

 marked and extensive over the dependent parts of the body. Putrefactive changes 

 well advanced. A close inspection fails to show any signs of external violence; 

 there are no signs of a contusion, the skin shows no areas of suggilation. On 

 opening the body, the abdominal cavity presents nothing abnormal. However, in 

 the thoracic cavity, the pericardium is found distended and it contains a soft blood 

 coagulum and hasmorrhagic, dirty-brown fluid. A blood coagulum of the size of 

 two fists is also found in the right pleural cavity. The anterior surface of the 

 pericardium presents a slit 18 millimeters long. Its direction is from above down- 

 ward, its margins are sharp cut, linear on the whole, but here and there irregular 

 and wavy, however, not serrated or fringed. Corresponding to this slit in the 

 pericardium there is a perforation in the anterior wall of the right ventricle. It 

 is almost immediately to the right of the interventricular septum and 8.5 cen- 

 timeters above the apex of the heart. It is 7 millimeters long but not clean cut, 

 rather irregular and with ragged margins. Its direction is oblique, being from 

 above and to the left, to below and to the right. The perforation traverses the 

 whole of the myocardium which is here less than 2 millimeters thick. The exit 

 of the perforation into the endocardium is about one-half the size of its entrance 

 at the outer surface of the myocardium. The heart as a whole is somewhat 

 enlarged in its diameters; it measures from base to apex 13.5 centimeters; 9 

 centimeters across the broadest point, and it is 7 centimeters thick. It weighs, 

 including the arch of the aorta, 380 grams. The walls of the left ventricle are 

 thickened, but the myocardium here, as elsewhere, is very friable, flabby and soft 

 and of a grayish-yellowish, dirty-pink color; it is porous and honeycombed, but 

 this condition is evidently due to the action of gas forming bacilli and must be 

 looked upon as a post-mortem change. The right ventricle is dilated; its wall, 

 particularly the anterior part, is very thin, measuring on an average only 2 to 

 3 millimeters in thickness. The endocardium is smooth, the valves show no 

 change, but the right auriculo-ventricular opening is enlarged. The whole arch 



