A Case for Diagnosis

was hard and enlarged to five finger breadths below the costal margin. The liver was enlarged to three finger breadths below the costal margin. He was put on to calcium chloride at once but on the 4th April, 1923, at 5 a.m., epistaxis started vigorously and continued slowly throughout the day. In the evening the temperature was 99.4?F. The bleeding did not stop until the evening of the 5th. On the morning of the 6th he complained of nausea and shortness of breath, there was some flatulence, the temperature was normal, the pulse quick and feeble, with gasping breathing at times and some restlessness,?all of which indicated internal haemorrhage in the abdomen. He sank gradually and died at 3 p.m. Major C. H. Reinhold, the Civil Surgeon, carried out a post-mortem examination at 5 p.m. and found the following conditions present:? General Condition.?Anaemic and fairly well nourished. Rigor mortis present in the whole body. Heart transposed to the right side of the chest and pale. The pericardium contained clear fluid. Petechial haemorrhages over the whole surface of the heart which was