TRAUMATISM OF INTERNAL ORGANS. 59 



of the aorta is atheromatous and the intima covered with calcareous patches; 

 the eoronaries are likewise atheromatous. The lungs are normal. The osseous 

 framework of the thorax is normal, none of the ribs are broken, but both of the 

 tenth ribs are unusually long and their free, floating ends reach very much for- 

 ward. The tissues over the. free end of the tenth rib of the right side are 

 decidedly hypersemie, however, there is no break of continuity in this region. 

 The spleen is very small, soft and mushy. The kidneys are small, slightly uneven, 

 the capsules peel off with some difficulty. Other abdominal organs, normal; 

 putrefactive changes well advanced. The brain is of medium size (weight, 1,210 

 grams), all the arteries at the base are in an advanced stage of atheromatosis. 



Anatomical diagnosis. — Hypertrophy with concentric atrophy, fatty degenera- 

 tion, and dilatation of the myocardium. Perforation of the myocardium and of 

 the atrophic anterior wall of the right ventricle; haemorrhage into the pericardium 

 and into the left pleural cavity. Extensive atheromatosis of the aorta, of the 

 coronary arteries and of all the vessels at the base of the brain. Atrophic inter- 

 stitial nephritis of moderate degree. Abnormal lenght of both of the tenth ribs. 



Epicrisis. — It is evident that in consequence of the fall, the free end of an 

 unusually long tenth rib which reached far forward perforated the pericardium 

 and the atrophic, degenerated myocardium, and this led to the haemorrhage which 

 became fatal inside of a short time after the accident had happened. 



RUPTURE OF THE LIVER DUE TO AN" OBSTETRICAL PRACTICE IN THE 

 PHILIPPINE ISLANDS. 



It is a well-known fact that certain races have adopted peculiar practices 

 to assist a parturient woman during labor, in order to facilitate and hasten 

 the expulsion of the child from the uterus. The North-American 

 Indians, for instance, place a woman in labor with her back against a 

 tree, an old woman then stands behind the tree, reaches around the latter 

 as well as the woman propped up against it, and makes violent compres- 

 sion over her abdominal region. The native Filipinos have a method 

 which, while different in arrangement, is based upon the same principle. 

 They place a folded piece of cloth, a long towel, or some similar thing- 

 above the bony pelvis and around the loins of the woman in labor, and 

 then one or two persons with all their might make traction on the encir- 

 cling bandage. That this method may, under special circumstances, lead 

 to much harm, in fact to a fatal issue, is shown by the following case. 

 Nothing is known concerning its clinical history, except that one of the 

 medical inspectors of the Bureau of Health was called in February, 1906, 

 to view the remains of a woman who had died quite suddenly during labor. 

 The body was sent to the morgue, where a post-mortem examination was 

 made. The following were the findings : 



Case V. — Necropsy No. 1061, about twenty hours after death. C, age un- 

 known, a female Filipina, died February 16, 1906, at 1.15 p. m. Cause of death, 

 unknown. Body of a woman, about 35 years old, of medium size and fair 

 nutrition. The woman appears to be pregnant, at or near full term. She ap- 

 pears to be a primipara because the abdominal wall does not present any striae. 

 There are no external anomalies, but the labium ma jorum of the left side shows 

 a pediculated fibroma of the size and shape of a large pear. A piece of cloth 



