death was apoplexy, produced by the weakening and thinning of the
heart's walls, the effect of the wound. Tillaux reports the case of a
man of sixty-five, the victim of general paralysis, who passed into his
chest a blade 16 cm. long and 2 mm. broad. The wound of puncture was 5
cm. below the nipple and 2 cm. to the outside. The left side of the
chest was emphysematous and ecchymosed. The heart-sounds were regular,
and the elevation of the skin by the blade coincided with the
ventricular systole. The blade was removed on the following day, and
the patient gradually improved. Some thirteen months after he had
expectoration of blood and pus and soon died. At the necropsy it was
seen that the wound had involved both lungs; the posterior wall of the
ventricle and the inferior lobe of the right lung were traversed from
before backward, and from left to right, but the ventricular cavity was
not penetrated. Strange to say, the blade had passed between the
vertebral column and the esophagus, and to the right of the aorta, but
had wounded neither of these organs.

O'Connor mentions a graduate of a British University who, with suicidal
intent, transfixed his heart with a darning-needle. It was extracted by
a pair of watchmaker's pliers. In five days the symptoms had all
abated, and the would-be suicide was well enough to start for the
Continent. Muhlig was consulted by a mason who, ten years before, had
received a blow from a stiletto near the left side of the sternum. The
cicatrix was plainly visible, but the man said he had been able to
perform his daily labors, although at the present time suffering from
intense dyspnea and anasarca. A loud bellows-sound could be heard,
which the man said had been audible since the time of reception of the
injury. This was a double bruit accompanying systole, and entirely
obscuring the physical signs. From this time the man speedily failed,
and after his death there were cicatricial signs found, particularly on
the wall of the left ventricle, together with patency of the
interventricular septum, with signs of cicatrization about this rent.
At the side of the left ventricle the rent was twice as large and lined
with cicutricial tissue.

Stelzner mentions a young student who attempted suicide by thrusting a
darning-needle into his heart. He complained of pain and dyspnea; in
twenty-four hours his symptoms increased to such an extent that
operation was deemed advisable on account of collapse. The