is not traumatic, in which the rupture
occurs spontaneously, the predisposing cause being fatty degeneration,
dilatation, or some other pathologic process in the cardiac substance.
It is quite possible that the older instances of what was known as
"broken-heart," which is still a by-word, were really cases in which
violent emotion had produced rupture of a degenerated cardiac wall.
Wright gives a case of spontaneous rupture of the heart in which death
did not occur for forty-eight hours. Barth has collected 24 cases of
spontaneous rupture of the heart, and in every instance the seat of
lesion was in the left ventricle. It was noticed that in some of these
cases the rupture did not take place all at once, but by repeated minor
lacerations, death not ensuing in some instances for from two to eleven
days after the first manifestation of serious symptoms. A more recent
analysis is given by Meyer of cases reported since 1870: Meyer collects
25 cases of rupture of the left ventricle seven of the right ventricle,
and four of the right auricle. Within the last year Collings has
reported a case of idiopathic rupture of the heart in a man of
fifty-three, who had always lived a temperate life, and whose only
trouble had been dyspepsia and a weak heart. There was no history of
rheumatism or rheumatic fever. The man's father had died suddenly of
heart disease. After feeling out of sorts for a time, the man
experienced severe pain in the precordium and felt too ill to leave his
bed. He gradually became worse and sick after taking food. Speech
became thick, the mouth was drawn to the right, and the right eye was
partially closed. The left arm became paralyzed, then the right leg.
The tongue deviated to the right on protrusion. The sphincters were
unaffected. The heart sounds were faint and without added sounds. The
man was moved to a water-bed, his body and head being kept horizontal,
and great care being taken to avoid sudden movement. Later, when his
pelvis was raised to allow the introduction of a bed-pan, almost
instantaneous death ensued. Upon postmortem examination prolonged and
careful search failed to reveal any microscopic change in the brain,
its vessels, or the meninges. On opening the pericardium it was found
to be filled with blood-clot, and on washing this away a laceration
about 1 1/2 inches in length was found in the left ventricle; the
aperture was closed by a recent clot. The cavities of the heart were
dilated, the wa