60 HERZOG. 



in the form of a bandage is tied around the upper part of the abdomen, above 

 the umbilicus. This bandage has been drawn so tightly that it has left a deep, 

 annular impression running around the abdomen and back. Post-mortem rigidity 

 has almost disappeared. The post-mortem lividity is well advanced. On cutting 

 through the skin, the tissues are found to be very anaemic and on cutting through 

 the peritoneum the upper part of the abdominal cavity is found to be full of 

 clotted and fluid blood. An examination shows that this haemorrhage has come 

 from a ruptured liver. Further examination of the internal organs shows the 

 following: The heart is exceedingly soft and flabby, grayish-yellow' in color. 

 The spleen is small, soft and friable, otherwise normal. Both kidneys show 

 signs of fatty and parenchymatous degeneration. The liver is large, somewhat 

 swollen, weighs 2,280 grams, is pale-yellow in color, exceedingly soft and flabby 

 and so friable that on handling it a rupture is produced on the upper surface 

 of the left lobe. The upper surface of the right lobe presents two deep, lacerated 

 perforations and the tissues here are suggilated with extravasated blood. It 

 was at this place that clots of blood were found; on opening the abdomen, they 

 needed to be removed in order to show the condition of the liver. Examination 

 of the region of the liver and of the right thorax shows the ruptures in the liver 

 to have been produced by the eleventh rib of the right side. It is possible that 

 the outer one of the two perforations has been caused by the twelfth rib. The 

 pleura over the external end of the eleventh rib shows a small area of blood 

 extravasation. It is evident that when this rib was pressed against the liver, 

 perforating the latter, there was enough force used to cause a slight haemorrhage 

 of the pleura over the end of this rib. The uterus contains a female child nine 

 months old or, at least, near full term in breech presentation. The cervix is 

 soft, somewhat haeniorrhagie and admits two fingers. Evidently, the first stage 

 of labor had begun, but the membranes had not yet ruptured nor had detachment 

 of the placenta taken place. The placenta itself is perfectly normal. All of the 

 other organs including the brain are normal, but they are all profoundly anaemic. 

 The eleventh and twelfth rib were removed and cleaned. The former, the outer 

 end of which presented a sharp point, measured 135 centimeters in length, the 

 latter 9 centimeters. 



Microscopic examination of the various organs, pieces of which had been 

 fixed in Zenker's solution and in osmic acid, shows the following: Liver: The 

 protoplasm of the parenchyma cells is granular and finely vacuolated, the osmic 

 acid preparations show numerous, small, disk-like, black granules and round, 

 black granules, varying in size from a small coccus to about half the diameter 

 of the cell nuclei. There are also seen black masses of the size of a liver or 

 parenchyma cell and even larger, roundish bodies of this color; these are, of course* 

 all the result of the profound fatty degeneration. The nuclei of the parenchyma 

 cells are generally fairly well stained and many cells show two nuclei. The 

 periportal, interlobular connective tissue shows a slight, but manifest, increase. 

 The renal epithelium shows advanced cloudy swelling and fatty degeneration. 

 In the spleen, marked changes are not present, and malarial parasites are not 

 found. The myocardial fibers are very indistinctly striated, vacuolated and full 

 of fat granules. The fibroma of the vulva is composed of loose, cedematous, 

 fibrous connective tissue; it contains numerous, large vessels; this vascularity 

 had probably developed during the period of gestation. 



Anatomical diagnosis. — Fatty degeneration of the heart and of the kidneys 

 and profound fatty degeneration of the liver ; perforation of the latter by the 

 eleventh rib, copious haemorrhage, uterus gravis menses X. 



