426 



THE CIRCULATORY SYSTEM. 



downward. Emphysema, pleurisy with effusion, or pneumothorax of one side pushes 

 the heart to the other side. Pleurisy or chronic pneumonia, producing retraction of one 

 side of the thorax, draws the heart to that side. New growths, aneurisms, and curva- 

 tures of the spine displace the heart in various directions. 



3. Changes in the abdomen. Accumulations of fluid and new growths in the ab- 

 domen, and tympanites, may push the heart upward. 



FIG. 224. ABNORMAL CHORDAE TEXDINKJS. 

 These unite to form a slender band stretching across the cavity of the ventricle. 



WOUNDS AND RUPTURES. 



Wounds of the heart are most frequently made by penetrating instru- 

 ments, by bullets, and by fragments of bone. The right ventricle is the 

 more frequently wounded (Fig. 225) ; next the left ; rarely the auricles. 

 The wound may penetrate into the cavities of the heart or pass only partly 

 through its wall, or a bullet or the broken end of a weapon may be em- 

 bedded in the wall. If the wound penetrate a cavity and be gaping, 

 death may follow instantly and the pericardium be found filled with 

 blood. If the wound be small and oblique, the blood may escape grad- 

 ually and death may not ensue for several days. In rare cases adhesions 

 are formed with the pericardium and the wound cicatrizes. Wounds 



