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.