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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.