CHEST 267 of the auricles are more dangerous than those of the ventricles. The right ventricle is more likely to be wounded, as it exposes its widest area on the front of the chest. On September 22, 1919, the body of a Hindu male, 26 years old, was brought to the King George's Medical College Mortuary, On examination an arrow was found sticking in the left side of the chest, causing a penetrating wound, 1" X |", obliquely across the fourth intercostal space 1" below and internal to the left nipple, and through the wound a small portion of the lung was protruding. On opening the chest the arrow was found to have lacerated the left lung and penetrated the right ventricle, having pierced through the pericardium and the left ventricle above the apex of the heart. At the post-mortem examination on the body of one Chitaoo, aged 45 to 50 years, on January 28, 1934, thirty-six hours after death, I found among other injuries an incised •wound, 1" X i", across the chest wall in the left second intercostal space and to the left of the middle line. On opening the chest the blunt end of an arrow head was seen projecting out of the wound, 1" X i", through the upper portion of the left lung behind the external wound. On further examination the sharp blade of the arrow head was found to have traversed through the pericardium, left pulmonary artery, and left auricle, and had penetrated into the substance of the left lung below its root. Contusion of the heart with or without any visible evidence of external injury or fracture of any "bone of the thorax, is sometimes caused by a severe blow from a blunt weapon on the chest or by compression of the thorax. Such an injury may cause sudden death from ventricular fibrillation or may cause severe pain lasting for some time, followed by dyspncea, persistent myocardial weakness, angina pectoris, auricular fibrillation or valvular rupture.21 Rupture of the heart is usually caused by a blunt weapon, by a carriage wheel running over the chest or by a fall over a hard projecting surface. In such cases the heart is usually ruptured on its right side and towards its base, and the ribs and the skin over them are damaged. But in rare instances rup- ture of the heart may occur without leaving any external mark of violence or causing fracture of the ribs. Surgeon Major Gibbons22 reports a case where a cooly, aged about 30 years, died in three hours and ten minutes from rupture of the heart over the apex caused by a blow; with a bamboo stick. The rupture was ix/ long and irregular in shape and com- municated with the right ventricle. Externally there was an elliptical abrasion, 2J" X f", over the left fourth and fifth ribs below and inside the left nipple but no fracture. Ingle 23 also describes the case of a motor car accident in which' a young motor car driver sustained two tears admitting the tip of the index finger over the posterior aspect of the right ventricle. There was a contusion, 3J" by 3", over the front of the chest, but there was no fracture of the ribs or vertebrae. The following cases are given from my notes : — 1. An old Hindu widow was run over by a cart on the 2nd July 1922, at Lucknow. Post-mortem examination showed an irregular rupture of the right ventricle of the heart without any fracture of the ribs, or external injury on the left side of the chest. The second, third and fourth ribs were, however, fractured on the right side. 2. A male child, li years old, was run over by a tonga on the 7th October 1922, and died immediately. Autopsy revealed a contusion of the pericardium and the right chamber of the heart and lacerations of both lungs, but no external injury on the chest or fracture of the ribs. 3. A Hindu male child, aged 8 years, was run over by a bicycle wheel on the 19th October 1927, and died immediately. On examination a bruise, 5" X i", was found obliquely across the right side of the chest, and a contusion, 1" X i", with a rupture, i" X i", was seen across the front of the right auricle of the heart. The heart may also rupture spontaneously from sudden exertion if it has already been diseased. Patients are, as a rule, elderly, and the rupture in such cases occurs mostly in the left ventricle at its apex, though it may occur in the right ventricle or in the auricles. According to Nuzum and 21. Hugh Barber, Brit. Med. Jour., Oct. 19, 1940, Vol. JO", p. 520 ; see also Gerald Paaatefcs Smith and Denis Williams, Brit. Med. Jour., Jan. 1, 1949, p. 10. 22. Ind. Med. Gaz., Dec. 1897, p. 443. 23. Ind. Med. Gazette, Aug. 1934, p. 450. 24. Amer. Jour, of Med. Sciences, Philadelphia, Feb. 1926, p. 185.