= Solution
\b[A suitable published comparison is <J. B. Junor>'s 1858 report of <cardiac rupture> with a soft, fatty ventricular wall and <blood> in the <pericardium>.] The comparison comes from the published clinical record.
The patient was a woman of about seventy with repeated <vomiting> and an initially weak <pulse>. She deteriorated after a severe episode of <vomiting>, her radial <pulse> becoming almost imperceptible, and died a few hours later. At examination after death, a large <gallstone> was found impacted in the <ileum>. The <pericardium> contained much <blood>. The small, atrophied <heart> had an extremely soft and fatty right <cardiac ventricle>; when it was raised, <blood> emerged through several small fissures, and its tissue broke under very gentle handling. <Gallstone ileus with rupture of the heart by J. B. Junor>[Edinburgh Medical Journal, May 1858, pp. 1004–1005, clinical course and post-mortem findings]{ref}
The comparison is anatomical and pathological: a fragile ventricular wall, escape of <blood> and death. There are also important differences. <Morgagni>'s tear is in the left <cardiac ventricle>; <J. B. Junor>'s reported fissures concern the right <cardiac ventricle> and were described during handling of a very friable <heart>. The latter account includes intestinal obstruction and does not reproduce <Morgagni>'s sternal and arm <pain>. It supports the possibility of severe muscular degeneration in a ruptured <heart>, without establishing that the two patients had identical disease or that every observed fissure opened before death.
\b[Probable muscular condition in an 1864 answer.] The fibres around the tear were probably structurally weakened and softened; <fatty degeneration of the heart> is a strong historical pathological suggestion. This means alteration within damaged muscular fibres, rather than merely an abundance of <adipose tissue> outside them. In <Richard Quain>'s account, reproduced before the examination, microscopic fatty change involved loss of the normal transverse markings and refractile fatty particles within the fibre sheath. Extensive change could accompany a pale, mottled, flabby <myocardium>. Those are findings one would look for, not observations supplied by the Oxford passage. <On Fatty Diseases of the Heart by Richard Quain>[1850 account reproduced in 1852, pp. 120–123, distinction between fatty growth and degeneration within muscular fibres]{ref}
An appropriate investigation would compare thin preparations from the tear's margin with apparently unaffected <myocardium> under a <microscope>, looking at the cross-striation, continuity of the muscular structure and position of the fatty particles. Fat lying between bundles is different from particles lying within damaged fibres. The gross appearance, the microscopic preparation and the sampling site must be reported separately. The word “erosion” does not by itself supply these microscopic findings. <On Fatty Diseases of the Heart by Richard Quain>[1852 reproduction, pp. 123–126, microscopic appearances, friability and examination of fresh samples from different regions]{ref}
\b[Modern interpretation and its limit.] Rupture of a left ventricular free wall can follow <myocardial infarction>, where a zone of damaged <myocardium> becomes friable. That is a plausible modern differential for the combination of chest and arm <pain>, weak <pulse> and a tear, but the historical record does not supply coronary anatomy or <histology> sufficient to prove it. A sudden collection of <blood> in the <pericardium>, or <haemopericardium>, can impair cardiac filling and cause <cardiac tamponade>. This provides a mechanism compatible with the abrupt pallor and collapse; pericardial pressure was not measured in the reported case. Present-day assessment could use urgent <echocardiography>; that technology belongs to the later comparison. <Mechanical Complications of Acute Myocardial Infarction by the American Heart Association>[Free wall rupture: friable infarct zone, collapse, tamponade and bedside echocardiography]{ref}
The defensible conclusion is \b[a ruptured, locally weakened <myocardium>, with <fatty degeneration of the heart> a probable nineteenth-century interpretation and infarct-related damage a modern possibility requiring additional evidence].
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