268 MEDICAL JURISPRUDENCE spontaneous rupture of the heart frequently follows obstruction of a coronary artery. Coronary thrombosis invariably results in an infarction of that portion of the heart wall supplied by the obstructed vessel. Pulvertaft25 reports the following cases where rupture occurred in the right ventricle in a young female of 19 years of age, in whom there was no evidence of cardiac or vascular disease : — The female had committed suicide in a fit of temper by putting her head in a gas oven The usual signs of poisoning by carbon monoxide were present; in particular Tard'ieu's spots were prominent on the diaphragm and the visceral layer of the peri- cardium. On opening the pericardium, about 12 ounces of uncoagulated blood were found A tear, 3" long, was found on the anterior aspect of the right ventricle, about V from the apex and -]" lateral to the interventricular septum. The coronary arteries were normal. There was no chronic endocarditis or myocarditis. I quote below three cases of spontaneous rupture of the heart from my case book : — 1. In Agra a Hindu hawker of about 70 years went to a prostitute's house to purchase empty bottles, and after ascending a staircase sat down on a charpoy and asked for a glass of water, but he expired before it was brought to him. At the autopsy I found that death was due to rupture of the left ventricle owing to thinning of the heart muscle as a result of chronic ulceration. 2. A Hindu woman, aged 65, died all of a sudden. Upon examination the left ventricle was found ruptured, the muscle being thin with a deposit of fat. There were calcarious ulceration in the aorta. 3. A Hindu male, 60 to 65 years old, was found dead in a third class compartment of a railway carriage on the thirteenth December 1933, and his body was removed to the Medical College Mortuary, Lucknow. Post-mortem examination showed that there was no external mark of violence on any part of the body. The pericardium contained liquid and clotted blood. The heart was found contracted and empty. The right auricle was lacerated, the tear being 1" X J" along its posterior surface towards the lower part. The opening caused by the tear was covered with a blood clot. The wall of the right auricle was quite thin. The valves of the left chamber were thickened and the aorta was dilated and had atheromatous ulcers. The lungs were bulky and congested. They exuded frothy serum from cut surfaces. The bronchial tubes were dilated. In all the cases of rupture of the heart that came under my observation death occurred immediately except in the case of a Hindu* female, about 50 years old, who died within two to three hours after she was run over by a motor car on the 4th October 1928. At the post-mortem examination I found -that all the ribs except the twelfth were fractured, and the right ventricle of the heart was lacerated in front, the laceration being 1" X 1/6". Both lungs were also lacerated. Leslie Pearce Gould20 describes the case of a chief boatswain, aged 47, who fell a distance of twenty feet and sustained an injury to the heart. He died within about six hours. During the interval he was quite conscious and rational, and answered questions intelligently. Examination showed fracture of the first segment of the gladiolus of ths sternum which was running obliquely downwards from right to left. A very small tear was found in the anterior wall of the right ventricle, close to the semilunar valves, large enough to admit a lead pencil into the cavity of the ventricle. Corin 27 records a similar case which survived six days. O'Neill28 records the case of a boy who died after five days. He had a slit, 3 mm. long at the auriculo-ventricular valve. Howat29 mentions a case of delayed traumatic rupture of the heart, described to him by his colleague, Dr. J. Donaldson, as occurring in his practice. A bricklayer, aged 68, unusually deep chested, was working beside a large iron pipe close to which were the rails on which bogey trucks ran. On the approach of a truck he stood with his back pressed close against the pipe in order that the truck might clear 25. Lancet, Aug. 6f 1932, p. 289. 26. Lancet, Oct. 13, 1917, p. 567. 27. Bulletin de FAcad, Jto^t/dLe Belgique ; 4 Med. Series, 1911, p. 562. 28. Jour. Amer. Med. Assac., 1914, Vol. LXH, p. 697. 29. Lancet, June 19, 1920, p. 1313.